Not simply by way of air con

The story of the deadly heatwave in Chicago in 1995 was one of many told by the late Jane Jacobs in her 2004 book Dark Age Ahead. Best known for her death and the life of great American cities in 1961, Jacobs had long viewed social science experts with suspicion. She had had trouble questioning authority since high school, and although she never graduated from college, she made her career with PhD students in urban planning, sociology, and economics. Her doubts about Adam Smith’s “Man of the System” were as deep as her high esteem for the ability of various communities to organize and sustain themselves, a respect built over decades to keep an eye on their neighborhoods, streets and sidewalks .

I was in medical school at the University of Chicago when the heatwave hit. During the five days beginning July 12, temperatures peaked at 106 degrees Fahrenheit, and even during the night the mercury was floating in the 80s. The culprit was a large high pressure system strolling through the Midwest, compounded by a lack of wind and soaked humidity. Power outages made many air conditioning systems unusable. While exact numbers are difficult to get, it is estimated that the city suffered around 750 deaths during the heat wave. The health system was so overwhelmed that a local meat packer offered to relieve the medical examiner’s office by storing bodies in his refrigerated truck.

My colleagues and I saw everything from the university’s southern hospital. Patient by patient was taken to the emergency room, where he suffered from dehydration, kidney failure and heat stroke, quickly ending up some victims in the intensive care unit. For every person who died there were many more who got sick, and while we did our best to stabilize them, much sustained long-term damage. In the heat of the moment, we gave little thought to the source of this widespread need and simply cursed the historic dog days. We trusted that experts would come by later and get to the bottom of things.

In fact, the U.S. Centers for Disease Control soon dispatched a team of 80 researchers to study and develop more effective countermeasures. They paired each victim with a randomly selected survivor and concluded that deaths were largely due to deficiencies in hydration and air conditioning. In short, the survivors had managed to stay cool and hydrated, while the victims, who usually suffered from underlying diseases, did not take appropriate steps to ensure their own survival. The results were published in the New England Journal of Medicine, concluding that “People with medical conditions who were socially isolated and had no access to air conditioning were at greatest risk of dying from the heatwave.” Hardly surprising or illuminating.

Then came Eric Klinenberg, a Chicago graduate student, who noticed that death rates varied widely in different parts of the city. He compared different parts of the city in which older people lived alone with similar frequency. He found that the death rate in North Lawndale was ten times that of adjacent South Lawndale. As a rule, North Lawndale residents did not have a habit of walking as they had few shops or gathered places to walk to. As a result, they were socially isolated, had no one to turn to, and eyed strangers’ efforts to check them out with suspicion. In contrast, the residents of South Lawndale got off and went to their parish, familiar with air-conditioned buildings to take refuge in and trusted those who looked after them.

Klinenberg looked even deeper. In North Lawndale, the population had been thinned by the escape to the suburbs. It was full of empty buildings and lots. In contrast, South Lawndale had remained relatively densely populated so people could stay connected. Another factor was gender. Most assumed that there would be more deaths in women because more older women than men live alone. But men were twice as likely to die as women, largely because older women were more likely to have a network of relationships with neighbors. After all, Latinos died much less often than whites or blacks, due to the much higher population density of the Latino communities.

As Jacobs saw, people are brighter and more able to take care of themselves than we usually assume. They can often respond more understandingly, precisely and effectively than any external organization, regardless of their budget.

It turns out that the key to combating heat waves is not just installing more air conditioning and robust power grids, but also reducing poverty, isolation and fear. Investigators seeking to uncover the complex causes of such disasters need to recognize that health is both a social and an individual attribute. It is not enough to just examine a person’s blood sugar levels, waistline, or alcohol consumption. It is also necessary to look at the communal patterns of life. CDC investigators spent considerable time, resources, and money finding that “air conditioning and water are good at combating heat.” Building a frame of reference around individuals rather than communities reflected and continued a misleading analytical perspective.

In Dark Age Ahead, published by Jacobs at the age of 87, she draws the lessons of the great Chicago heat wave and expresses feelings that are both “grim and hopeful” about the future of North America. While she saw the conditions ripe for reaching a cultural impasse, such a fate could be avoided by “preserving and developing our living, functioning culture, which contains so much value and is so hard won by our ancestors” . One of the most worrying symptoms was the widespread belief that such social decline could never take place here. Perhaps every culture that followed the path of the dinosaurs has similarly forgotten about its own fragility.

Jacobs focused on five pillars and the menacing signs of decay in every work. This included community and family, higher education, science and technology, taxation and self-control through the professions learned. She expressed an awareness that these pillars will surprise and disappoint many who expected her to criticize racism, environmental degradation, crime, low political participation, voter distrust and growing inequality. But this second set of factors, she believed, are products of mishaps in the first. In addition, she argued that the five pillars on which she focused are widely underestimated and desperately in need of attention.

As the ties between family and community deteriorate, people become more isolated and vulnerable. To serve them we need to understand what they are, not only in terms of demographic and public health statistics, but also through close observation of daily life. Higher education needs to do more than fill your head with facts and figures. It needs to educate the eye, discipline the ear, and open the heart so that learners can look deeper into what is really happening. Science should be viewed as one of several windows that clarifies some aspects of the truth but obscures others. The necessary evil of taxation should affect as little as possible the expression of personal and social excellence. And professions must take seriously their responsibility to protect those they serve.

In describing the third of its five pillars, science and scientific technology, Jacobs addressed a particularly venerable, Socratic concern – the need to ask good questions. The Socratic modus operandi, which answers a question with a question, reminds us that the wise men are often distinguished not by their answers but by the quality of their questions. The question asked first is not always the one that needs to be addressed the most. In the 1995 Chicago heatwave, knowing that the incidence of heat stroke was increasing or that even many deaths could have been prevented by air conditioning was insufficient. The most important questions had to be asked at the neighborhood level in order to highlight the interplay between social solidarity and resilience in the face of disasters.

As Jacobs saw, people are brighter and more able to take care of themselves than we usually assume. On this occasion, they can often react in a more understanding, precise and effective manner than any external organization, regardless of how much budget and staff they need. Experts play a role, but in most cases their top priority should be to listen and work with those they serve. They must learn at least as much as they teach, and until this is understood they should proceed with respect and caution.

Jacobs’ intense curiosity often brought her into conflict with experts who wanted to fire her as a housewife and mother, college dropout and dilettante. But Jacobs dug deeper and refused to accept superficial answers. She deliberately warned that North Americans are preoccupied with answering second- and third-class questions, while first-order questions remain largely unanswered and that culture is “drifting towards darkness.”

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