There are lots of ways to minimize the significance of the Chicago heat wave of July 14-20, 1995, and none of them work.We'd like to believe that the death toll wasn't really in the hundreds, but it was. Depending on how you count, between 485 and 739 people died of the heat, making it the second deadliest week in city history.
We'd like to believe the weather was so extreme that nothing could have made a difference. But people with friends and working air conditioners were more likely to survive than those without.
We'd like to believe that the victims--three-quarters of whom were over 65--were about to die anyhow. But that can't be true. If they'd been on their last legs and the heat wave had just killed them a few days early, then the death rate in the following weeks would have dropped below normal, since many of the people who would have died during that time would already have been gone. Yet in those weeks the death rate was normal.
It was an honest-to-goodness disaster, and for students of society every disaster is an opportunity. A disaster shakes us out of the routines and assumptions we take for granted, revealing how the city works, or doesn't work, in normal times. And of course it lends an air of urgency to accounts that might otherwise draw only a yawn. In her 1995 book Smoldering City: Chicagoans and the Great Fire, 1871-1874, historian Karen Sawislak used the disruption caused by the Chicago Fire (which killed only 300 people) to probe the social order of the Victorian city. Now Northwestern University assistant professor of sociology Eric Klinenberg has used the 1995 heat wave to look closely at today's city. He doesn't like what it shows. "When hundreds of people die slowly, alone and at home, unprotected by friends and family and unassisted by the state, it is a sign of social breakdown."
That's a one-sentence summary of his slim, fact-packed book Heat Wave: A Social Autopsy of Disaster in Chicago. Klinenberg isn't saying that Chicago is in a state of social breakdown, which would be silly. But he is saying that the heat-wave deaths are a sign that bad things have been happening under the surface, things that signify worse to come if we don't fix them. Despite its title, his book isn't really about the heat wave. It's about what the heat wave tells us about long-standing conditions in the city.
In effect, Klinenberg is arguing against a shadow book, a book that--if it existed--would be much more to the liking of the Daley administration. The key sentence of this shadow book would be "When hundreds of people die in unexpected and unprecedented heat, it's partly an extreme event that no one could plan for and partly a sign that the city didn't plan very well."
To make his case against this shadow book, Klinenberg has to do three things. First, he has to show that the victims didn't simply die of extreme weather conditions. Second, he has to tell us what other factors contributed to their deaths. And third, he has to give some idea of what we might have done and still should do about those other conditions--of what the alternatives are. What do we need to do, either as individuals or as a city? Fire a few department heads? Beef up emergency planning? Hire lots more social workers? Mount a full-scale war on inequality? Repudiate capitalism? Klinenberg clearly doesn't want to say how far he thinks the social breakdown has gone, but he has to grapple with the third point, because his critique implies that if only such and such had been done things might have been better.
Heat Wave accomplishes the first two jobs and pretty much whiffs the third. But even when Klinenberg doesn't succeed, his attempt is honorable. Unlike better-known social critics such as Jane Holtz Kay and Robert McChesney, Klinenberg actively seeks out information. And he doesn't twist or ignore the inconvenient bits.
When public health experts correlate the heat index and the number of deaths during various heat waves, July 1995 in Chicago stands out. More people died here than would be expected given how hot it was. Something more was clearly going on.
Part of the "something more" is great social inequality--in direct contradiction of the conventional wisdom expressed in the Tribune's front-page headline on July 18, 1995, which falsely claimed that the heat victims were "just like us." The heat wave was no leveler. Comparing people of the same age, 11 per 100,000 whites died in it, compared to 17 per 100,000 blacks. (Public health researchers calculate death rates as "age-adjusted" deaths per 100,000 people, so that they can compare groups of different sizes and with different age distributions.) Five of the six most lethal neighborhoods during the heat wave were largely black. The match isn't perfect, but most of the places with high heat-death rates were also among the city's poorest and most violent.
Klinenberg uses the heat wave to argue that vulnerable Chicagoans need more help than they're getting. Early in the book he rings the left-liberal fire bell: "We have collectively created the conditions that made it possible for so many Chicago residents to die in the summer of 1995."
But the fire bell has a crack in it. Not all of the vulnerable people are the usual suspects, and not all of the usual suspects are vulnerable. Yes, blacks died half again as often as whites. But Latinos--comparably poor and downtrodden--died much less often than either: while making up almost a quarter of the city's population, they accounted for only 2 percent of the heat-wave deaths. Most surprisingly, men died at almost three times the rate of women--19 men per 100,000, compared to just 7 women per 100,000. This is a dramatically greater difference than that between racial and ethnic groups. Klinenberg reports that 44 of the 56 unclaimed bodies buried at public expense after the heat wave were men.
According to the usual left-liberal analysis, the victims of incipient social breakdown are supposed to be women and people of color, not just men and blacks. The heat wave does indeed reveal some social fault lines, but not quite the ones you might expect.
The first outside experts to study the disaster carefully, Klinenberg explains, were the members of Jan Semenza's team from the Centers for Disease Control. Even as bodies were still being hauled out of cluttered, stuffy apartments, they began the process of interviewing survivors about the dead. They also knocked on doors in the immediate area to find people of about the same age who'd survived. In the end they came up with 339 "matched pairs"--678 people of similar age who lived close by, one of whom lived through the disaster, one of whom didn't. Their classic "case-control" study appeared in the July 11, 1996, issue of the New England Journal of Medicine (and can be found on-line at www.nejm.org).
People who lived alone, the researchers found, were more than twice as likely to die in the heat wave as those who lived with others. Klinenberg doesn't spend much time trying to explain why one in three Chicagoans over 65 live by themselves today, compared to just one in ten in 1950. This is a pretty dramatic change, and a significant one; at the very least, one would expect that an old person living with a child or grandchild would be less likely to end up in a locked room where temperatures soar to over 100. An author of a more conservative bent might well have paused to consider what a key crack in society's foundation this is and how it might be patched up. But, like the idea that men as a group might be victims of society, this apparently isn't something we know how to think about. Klinenberg contents himself with calling it a "demographic shift."
Merely living alone wasn't the worst danger. Social isolation was. People who lived alone and didn't get out every day were almost seven times more likely to die. "Anything that facilitated social contact," the CDC study concluded, "even membership in a social club or owning a pet, was associated with a decreased risk of death."
Isolation of course doesn't directly cause heatstroke, dehydration, heat exhaustion, or renal failure. It works indirectly. Isolated people are likely to be unaware of how to stay alive in the heat, resistant to help when it's offered, and reluctant to follow advice that involves going outside--to a cooling center, for instance. Building on Semenza's article, Klinenberg goes on to ask what social factors cause merely living alone to turn into genuine social isolation. These factors include being black, being male, being afraid of violent attack, and living in neighborhoods where such a fear is realistic.
Childless people--or those not in contact with their children--are more likely to become isolated, which right away puts both men and African-Americans at greater risk. "Surveys consistently show," writes Klinenberg, "that a higher proportion of black elderly than white elderly have dead or incarcerated children, and that a higher proportion of men than women are estranged from their children."
Fear of urban violence also tends to close people off. That fear is fed by sensationalistic local television "news"--a noxious commodity disproportionately consumed by the elderly (older Americans are big media consumers). But all too much of the fear is well-grounded. A conservative author would have soft-pedaled the crucially important fact that different racial or ethnic groups and economic classes respond differently to it.
Klinenberg describes a catastrophic decision made by the Chicago Housing Authority in the early 1990s. The agency opened its senior housing units to disabled individuals, often drug users, who then preyed on their elderly neighbors. Unlike their more affluent counterparts elsewhere, these old people had nowhere to go except into their barricaded (and rarely air-conditioned) rooms. This is not a problem that the well-off elderly, no matter how terrified, have to deal with.
Something similar happened in single-room-occupancy hotels beginning about 30 years ago, when an economizing state government began turning mental patients out into what was called the "community." The SROs, Klinenberg writes, gradually "became repositories of people shunned by other protective institutions: the mentally and physically ill, substance users and abusers, drug dealers looking for places to work temporarily, parolees and probationers who cannot find other housing--and the impoverished seniors who once constituted the core population of hotel residents." SROs are now more dangerous--and hence more isolating--than they were 50 years ago. Klinenberg quotes from a mid-80s census of SROs conducted by Charles Hoch and Robert Slayton: "The inability of the former patients to collaborate in the maintenance of the fragile social order of the hotel...threatened to overwhelm the balance of reciprocal exchanges that kept the hotel secure."
There's not much statistical evidence that can tell us whether heat-wave deaths in fact happened disproportionately in CHA and SRO housing, but the indirect and anecdotal evidence is pretty good. Isolation and staying inside all the time were major risk factors, and SRO and CHA conditions encouraged both.
Klinenberg sees a system at work that casual observers don't notice. The government saved money by emptying out mental hospitals and arranging to provide medications and services in other ways--privatizing before the word was on everyone's lips. But that move had a cost, paid mostly by those least able to manage it. Unable to move anywhere else, they stayed in their rooms and barred the doors and windows.
Neighborhood was another factor in turning mere aloneness into isolation. Citywide about 7 of every 100,000 people died of the heat--but few communities were average, and the range was enormous. The death rate was 47 per 100,000 in Grand Boulevard, 51 per 100,000 in Washington Park, 52 in Greater Grand Crossing, 54 in Archer Heights, 73 in Woodlawn, and 92 in Fuller Park. Four of these six neighborhoods rank in the city's top eight for violent crimes; four have lost more than half of their population since 1960; five are over 95 percent black. (The sixth neighborhood, Archer Heights, has almost no black people and a relatively low crime rate but an above-average concentration of the elderly.)
Zeroing in on a matched pair of communities, public health-style, Klinenberg describes in detail the contrast between the adjacent west-side neighborhoods of South Lawndale (aka Little Village), which is predominantly Latino, and North Lawndale, which is predominantly black. Both are poor, but otherwise they're two different worlds. "In North Lawndale, the dangerous ecology of abandoned buildings, open spaces, commercial depletion, violent crime, degraded infrastructure, low population density, and family dispersion undermines the viability of public life and the strength of local support systems," he writes. "In Little Village, though, the busy streets, heavy commercial activity, residential concentration, and relatively low crime promote social contact, collective life, and public engagement in general and provide particular benefits for the elderly, who are more likely to leave home when they are drawn out by nearby amenities."
The same weather was ten times more dangerous in North Lawndale than it was in Little Village. In Little Village 3 people died, for a death rate of 4 per 100,000. In North Lawndale 19 people died, for a death rate of 40 per 100,000.
Even allowing for the small absolute numbers, this is quite a disparity. And the same phenomenon has shown up often enough that social scientists have given it a name: the "Latino health paradox." Figuring out why the two neighborhoods have gone in such different directions could fill another book. Maybe it should have filled more of this one, because the example of Little Village tends to undermine Klinenberg's later critique of city government. (He faults the city for providing too few services, such as calling seniors regularly, but if we knew how to foster neighborhoods like Little Village perhaps fewer or different services would be needed.) We can say that "culture" must explain some of the paradox, but Klinenberg doesn't think it explains much. And he rejects the crude theory that the North Lawndale victims died because their neighbors didn't care. Instead, he writes, "there is good reason to believe that [they] died alone because they lived in social environments that discouraged departure from the safe houses where they had burrowed."
This is probably true, and it's what you'd expect a sociologist to say. But I'm not sure Klinenberg completely convinced himself. The book's epilogue, "Together in the End," dwells on the absence of family members from the August 25, 1995, burial of 41 unclaimed heat-wave victims in Homewood Memorial Cemetery. That sad scene deserves notice, but it implies a simpleminded view of the disaster that Klinenberg rejects. Most people did not die because "nobody cared."
OK, so a lot of elderly Chicagoans live isolated and vulnerable lives. It's not within even Mayor Daley's power to make extended families live together again or to transform abandoned and impoverished North Lawndale into bustling and impoverished Little Village, let alone Lincoln Park. But can't a well-organized government at least manage to keep a hot spell from becoming disastrously lethal?
In July 1995 the city of Chicago didn't. Its 56 ambulances and 600 paramedics were overwhelmed, yet the fire department didn't call on an additional 85 ambulances from the suburbs that might have been pressed into service. More than 20 of the city's emergency rooms were on "bypass" at various times during the week--they were working on as many heat victims as they could handle and had to turn incoming emergencies away. Ambulance drivers had no way of knowing which hospitals would accept heat victims. Robert Scates, then deputy chief paramedic in charge of south-side emergency services, wanted a heat emergency declared, which would have alerted the public and allowed for a better-coordinated response. But the city delayed. "Without a warning from the Fire Department, which is in charge of disaster management," writes Klinenberg, "the city government did not recognize the crisis and failed to organize a multiagency response before the death toll began to rise." Scates resigned in protest, saying the city was "committing murder by public policy" because it preferred to save money and get "maximum performance out of minimum manning, which is totally ridiculous in public safety."
These were mistakes made under difficult circumstances. But Klinenberg argues that so many people were already so isolated that even a good plan couldn't have saved them all. And, he argues, they'd become isolated in part because the helping hand of government had become invisible--withdrawing subtly in many ways, always under the bipartisan banner of greater efficiency. The heat-wave death toll, he writes, was partly the result of social services being cut, contracted out to private providers, or turned over to police and other fallback agencies. As a result, old, isolated people were required to somehow transform themselves into aggressive, knowledgeable consumers of government services. In short, many of the deaths were the result of government acting like a business. In their popular 1992 book, David Osborne and Ted Gaebler called this process "reinventing government." Klinenberg calls the result the "entrepreneurial state." As when mental hospitals were emptied out, the intentions were often good, but the results were something else.
Klinenberg uses numbers to tell part of the story. Between 1991 and 1998 the number of full-time police rose from 16,243 to 17,752. At the same time the number of full-time health department employees dropped from 2,160 to 1,684, human-services workers from 1,074 to 474, and housing workers from 345 to 195. Many of the jobs these workers had done were put out for bid, under Osborne's theory that government need not itself provide all of the services that it funds. In reinventing-government circles this is called "steering, not rowing," and it sounds reasonable. But in practice, Klinenberg found, bidders had to race toward the bottom. If a private agency wanted to win a city contract (say, for working with the elderly) it had to underestimate its costs and overestimate its capacities.
"As I spent time alongside social workers and home care providers for Chicago seniors," he writes, "it became clear that underservice of Chicago's poor elderly is a structural certainty and everyday norm....The agencies I observed had bargained themselves into responsibilities that they were strained to provide....Charged with the responsibility to visit their clients at least twice a year, most caseworkers I shadowed and got to know reported that they were managing to get to them once annually, at best."
This picture is compelling and based on firsthand observation. But it's not enough to prove Klinenberg's case. His argument persuades only if the reader thinks there must be a better alternative available, though Klinenberg refuses to say directly what that alternative might be. He drops hints--implying that social services were better before city workers were replaced by those on contract. But then he denies that history is relevant: "There is little reason to believe that Chicago's earlier modes of governance would have mobilized a more effective response to the crisis."
One unmentioned possibility would be to operate within the framework of the entrepreneurial state. When the city contracts out social services it could make its terms very specific, and then monitor contractors closely to make sure they actually did everything they were supposed to do. That way, underbidding and cutting corners wouldn't work. For this reform to make any difference, city leaders at all levels would have to be as seriously committed to providing services as they are to cutting costs. It might well be that if privatization were carried out this way costs would increase rather than decrease. The other obvious possibility is the one Klinenberg hints at--to abandon the entrepreneurial state, quit privatizing, and double or triple the number of social workers employed by the Department of Human Services. Klinenberg doesn't discuss these reforms. I don't know if either one is a good idea, but it seems a bit unfair for him to shape the discussion in a way that suggests an alternative without ever defending it.
With more federal money available for police work than for social work, Klinenberg writes, Chicago expanded its police force and developed a community policing program, under which "in addition to traditional law enforcement work [police] are expected to be neighborhood organizers, community leaders, liaisons to other city agencies, and, if necessary, service providers." It didn't work that way in July 1995. "None of the system leaders recognized the department's responsibility or capacity to protect vulnerable citizens." Rank-and-file police, especially in high-crime areas, lack either the inclination or the time to add "social worker" to their job descriptions.
As a result, people who need help have to be pushy, and they have to know where to push. But that's a catch-22, writes Klinenberg. "According to local social workers and case managers, Chicago residents with the lowest levels of education, the weakest ties to mainstream institutions such as government agencies and churches, and the least resources are also poorly prepared to claim the public benefits--from health care to prescription drugs to Social Security income--to which they are entitled." The right drugs or more income may or may not save you from the heat, but the point is that "those out of the loop in their daily life are more likely to remain so when there is a crisis." Once again, Klinenberg's reluctance to consider history works against him, because it's not at all obvious that this unfairness has anything to do with the entrepreneurial state. It seems like a common property of people who need help in any context--those who need it the most often have the least idea of where to look or what to ask for.
Even a smart shopper can't do much when there's no money to shop with. In their New England Journal of Medicine article, Semenza and his colleagues estimated that more than half of the heat-wave deaths could have been avoided if each home had had a working air conditioner. But that's not the end of the story, says Klinenberg: many elderly people wouldn't use air conditioners even if they had them, because of the cost of running them. "The most impoverished seniors I visited kept their lights off during the day, letting the television, their most consistent source of companionship, illuminate their rooms."
The federal Low Income Home Energy Assistance Program (LIHEAP) might have helped them, but it's out of favor in the entrepreneurial state because it simply gives people money rather than "empowers" them. In the years prior to the heat wave Congress cut the program in half, from $2.1 billion in 1985 to $1 billion in 1995. As a result Chicago Department on Aging workers told Klinenberg that "LIHEAP was the program that almost all of their seniors needed but could never get....Ironically, as the environmental historian Ted Steinberg shows [in his book Acts of God: The Unnatural History of Natural Disaster in America], during the same term that Congress trimmed its energy support for the poor it expanded the federal government's commitment to subsidize insurance companies and home owners who suffer property damage in disasters."
It's always good to be reminded that conservatives believe in small government and individual responsibility only when the people involved are poor. But conservative hypocrisy doesn't necessarily make liberals right. Specifically, it doesn't follow that everything will be OK if the feds put a billion or two back into LIHEAP. Once more Klinenberg implies that this should be done, but he never actually says so and thus avoids having to defend the program's effectiveness.
In theory, an entrepreneurial government could acknowledge its failings. In practice, even an unchallengeably dominant politician like Richard M. Daley hasn't found it possible to do so. Both his own policies and those pressed on him by federal and state governments have made it difficult to help Chicagoans who need it most. But rather than say so, in July 1995 the mayor found it convenient to attack the professionalism of Cook County chief medical examiner Edmund Donoghue, with whom he'd previously had good relations. During the heat wave Donoghue documented each case, using clear criteria to decide which deaths could be considered heat related. Daley had no such knowledge or expertise. As the number of deaths rose into the hundreds, he used the power of his office to manufacture doubt by simply denying the validity of Donoghue's findings.
This was no isolated fit of pique. In the deadly hot week and afterward, city government denied or minimized the crisis in as many ways as possible. Besides denying Donoghue's figures, the Daley administration sought to minimize its own responsibility. Human Services commissioner Daniel Alvarez defended city policies by demeaning the victims. "We are talking about people who die because they neglect themselves," he said. "We did everything possible. But some people didn't want to even open their doors to us." The City Council followed that lead: it held hearings on Com Ed's response to the heat wave, but canceled hearings on what city agencies did. The administration also made liberal use of euphemism. Later the mayor appointed what was called a "Commission on Extreme Weather Conditions," which in turn called the heat wave a "unique meteorological event"--making it sound innocuous.
Despite this classless performance, the city did learn from its experience and responded more aggressively to less severe heat waves in August 1995 and July and August 1999. After the 1999 event, researchers at the Midwestern Regional Climate Center complimented city government on its "pro-active" and "timely and vigorous" response. An article published in the American Journal of Preventive Medicine too recently to make it into Klinenberg's book finds that fewer of the victims in 1999 were elderly, and suggests that the city's increased outreach may have helped.
Is this a sign that the entrepreneurial state can correct its course and avoid the unintended consequences of privatization? Klinenberg doesn't think so. Some 110 people still died of the heat in 1999, and most of them were "discovered dead or dying in stifling hot apartments." Even a well-executed heat emergency plan, he says, can't fully counteract years of neglect in a few days.
The heat wave makes a good scalpel for Klinenberg's "social autopsy," and he wields it well as he dissects Chicago government's fascination with the market model. But in the end an autopsy isn't enough. Even if it generates outrage, outrage alone will only lead us back onto familiar paths--toward limiting privatization and bulking up the civil service again--because that's the course with concentrated political support. However, nothing in this book suggests that such a governmental about-face would help the isolated old people, poor people, black people, and men whose plight Klinenberg has dramatized. What will?
Heat Wave: A Social Autopsy of Disaster in Chicago by Eric Klinenberg, University of Chicago Press, $27.50.
Art accompanying story in printed newspaper (not available in this archive): illustration/Mark S. Fisher.