Correspondence

Review of Heat Wave: Social Autopsy of Disaster in Chicago

N Engl J Med 2003; 348:666-667February 13, 2003

Article

To the Editor:

As commissioner of the Chicago Department of Public Health and an important figure in my book, Heat Wave, John Wilhelm has a distinctive view of whether he and the administration for which he works responded adequately to the 1995 disaster, which killed more than 700 people. In his review (Sept. 26 issue),1 Wilhelm claims that the people I interviewed for the two chapters assessing Chicago's social protection programs and emergency responses “were not there.” This is not true. Wilhelm, who was a leader in the city's effort to manage the crisis, was himself a source for the book. I conducted a face-to-face interview with him in July 1996, and I interviewed many other top city officials and employees who were on the front lines of the response to the heat wave. They are quoted and listed in the index of the book.

Wilhelm also takes issue with my analysis in Heat Wave of the racial disparities in mortality. In Heat Wave, I cite disaster mortality rates from a study that used standard age-adjustment techniques to show that blacks were more vulnerable than whites.2 Wilhelm challenges this approach — and thereby the scientific validity of basic population health statistical methods — suggesting that “raw death totals” are preferable for epidemiology. He contends that “many do not see race as the risk factor that [Klinenberg] claims it is.” But that is precisely because the city of Chicago has repeatedly contested serious health science with its own crude numbers — just as it tried, unsuccessfully, to refute the medical autopsy findings during the 1995 heat wave.

My social autopsy shows that an emerging population of poor, old, and isolated urban residents makes extreme summer weather especially dangerous. Wilhelm agrees. His response is to call for more social and familial ties. However, as Heat Wave makes clear, there are sociologic reasons why the most reclusive people and fractured families are disconnected from the communities around them and why moral suasion is an inadequate response. Vulnerable, isolated people tend to live in places that foster social withdrawal and insecurity: neighborhoods that have been devastated by commercial and industrial abandonment, population loss, concentrated poverty, and violent crime. Until governments, health agencies, and scholars address these conditions and the health hazards they pose, we can expect to see their symptoms in emergency departments and medical examiners' offices in cities everywhere, and not only during heat waves.

Eric Klinenberg, Ph.D.
New York University, New York, NY 10003
eric.klinenberg@nyu.edu

2 References

1. 1

   Wilhelm J. Review of: Heat Wave: A Social Autopsy of Disaster in Chicago. N Engl J Med 2002;347:1046-1046
   Full Text

2. 2

   Whitman S, Good G, Donoghue ER, Benbow N, Shou W, Mou S. Mortality in Chicago attributed to the July 1995 heat wave. Am J Public Health 1997;87:1515-1518
   CrossRef | Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Colleen Reid, Marie O'Neill, Carina Gronlund, Shannon Brines, Dan Brown, Ana Diez-Roux, Joel Schwartz. (2009) Mapping Community Determinants of Heat Vulnerability. Environmental Health Perspectives
   CrossRef

2. 2

   Xavier Thirion, David Debensason, Jean Christophe Delaroziere, Jean Louis San Marco. (2005) August 2003: Reflections on a French Summer Disaster. Why were its medical consequences so serious? Are we sure to do better next time?. Journal of Contingencies and Crisis Management 13:4, 153-158
   CrossRef