The tip of the iceberg

In 1841, Registrar General William Farr, a distinguished mathematician and physician who famously said to Florence Nightingale, ‘Statistics should be as dry as dust’ produced the first report which identified a seasonal excess of deaths in the British winter. Some 170 years later, we are still recording a yearly excess of between 20 and 40,000 winter deaths. And by far the greatest numbers of those dying in the winter are those over 65, for many of whom both physiology and social conditions create a special vulnerability.

It has taken generations of scientists to unravel the causes of winter mortality. The evidence is now clear on cause – it is the cold that is the killer. All other factors, except in conditions of epidemic influenza, pale into insignificance. So precise is this relationship that it has been calculated at 8,027 extra deaths for every 1°C the winter is colder than the average. Paradoxically, this algorhythm applies only to the United Kingdom. The irony is that the colder countries of the world – such as the Nordic lands, Russia, Canada and so on – have much lower winter mortality than the ‘warm’ UK. It is an amazing truth that Yakutsk, the coldest city on earth with average winter temperatures of - 30°C, has virtually no seasonal fluctuation in mortality. How can this be?

The answers are peculiarly British. Our heritage of an old and poorly insulated housing stock has meant that for years many have been consigned to winters spent in indoor cold, unable to afford their heating bills. Add to that the exceptionally cold winters of recent years, rising energy prices and declining winter fuel benefits, we have a lethal cocktail of risk. Fuel poverty is a real and vital issue for increasing numbers of older people.

But the evidence shows that indoor cold is only half of the story. Deaths in the winter are largely due to respiratory illness and disease caused by blood clotting, the so-called ‘thrombotic illnesses’ of heart attack and stroke. Over the last few decades we have seen a reduction in deaths from respiratory illness in the winter, brought about it is thought by improving indoor warmth. What has not declined is the mortality through heart attack and stroke. These conditions are more dependent on going out into the cold, insufficiently protected by our winter clothes. If you doubt this, look at the typical British wardrobe: how many of us have a separate winter edition? And how many of us frequently take trips outside without hat, scarf, gloves and coat? And so we are ambushed by winter cold.

Even a conservative estimate shows that the British winter, since Farr’s first report, will have been responsible for over 3 million deaths, deaths which we now know are entirely avoidable. No wonder research tells us that older people in Britain fear the winter more than any of their European neighbours. The question is, then, how may these deaths be avoided? Physiologists will tell you that ‘man is a tropical animal’: we must stay warm in order to stay well. That is why Age UK, working with the Met Office, has taken the best scientific advice to launch its campaign ‘Spread the Warmth’. On the basis of new and compelling evidence, we are advising older people of the risks of both indoor and outdoor cold in an effort to stem the ‘British disease’. And with DH, we are joining the Met Office as it seeks to alert the public of impending severe cold.

Some estimates have said that 2,700 people every winter die because of fuel poverty. This is only the tip of a huge iceberg of winter deaths brought about by cold. By translating the best research evidence into practice and by working with others, we are attempting win the war against the British winter.