January 1986 issue of the Socialist Standard
Every winter thousands of old people face the agonising choice of heating their homes or buying food. Unable to accumulate sufficient savings for retirement from the meagre wages paid during their working lives and forced to subsist on inadequate pensions, they spend time each winter huddled in blankets in badly heated homes, trying to make their small stock of food last until the next payment of their pension allowances. The onset of each spell of cold weather leads to considerable numbers of the elderly being admitted to hospital suffering from accidental hypothermia and, if the weather is particularly severe, the death toll can be quite high.
Hypothermia is a medical condition in which the central (or deep) body temperature falls below 35 degrees centigrade (95 degrees Fahrenheit). If a further fall in temperature continues unchecked the victim passes through the various stages of shivering (though sometimes this does not occur in the elderly), confusion, memory loss, abnormalities of heart rhythm and muscle rigidity, semi-consciousness, more serious heart abnormalities, irreversible coma and death. The condition is called "accidental hypothermia" to distinguish it from the short-term, deliberately induced, hypothermia for therapeutic reasons.
Unfortunately, accidental hypothermia can be caused by an interplay of factors — exposure; impaired regulation of body temperature; decreased metabolism; drugs. It is. therefore, extremely difficult to determine how much accidental hypothermia is due to living in cold conditions, or to poor nutrition leading to decreased metabolism, or to a combination of several causes of which poverty is the final straw. Hypothermia may also occur in the summer months, or even in hospital as a result of medical conditions which lower the metabolic rate.
Nevertheless, even when other factors are taken into consideration, elderly workers are prone to suffer from hypothermia because they are poor. More than half the substandard housing or property lacking in basic amenities is occupied by the elderly. It is much more difficult adequately to heat and keep warm in damp, draughty properties with outside toilets, which are also less likely to have central heating. Open fires can present a problem for the frail elderly who, because of poor social services, may then have to rely on the goodwill of relatives or neighbours to ensure that a fire is lit for them.
Where the "head" of a household is elderly the average income is only 53 per cent of that of all households (Central Statistical Office. 1976). The cost of heating, therefore, stretches the limited resources of most pensioners even when their homes are of a reasonable standard. Malnutrition may play a part in causing hypothermia and in Britain it is the elderly who are most likely to be its victims. In 1972 the DHSS stated that 3 per cent of the elderly suffer from malnutrition, and the Consumers' Association pointed out the close relationship between hypothermia and poverty a couple of years later.
The importance of hypothermia in the elderly was first recognised during the excessively cold winter of 1963, when 148 people died from the condition compared with only seven recorded deaths in 1957, although the number of certified deaths from accidental hypothermia does not provide a true total as many deaths are certified as due to bronchopneumonia without the underlying cause being detected. Indeed, accidental hypothermia in the elderly is not mentioned in medical books written before the second world war, or in nursing books written before the 1960s, although accidental hypothermia was a well known hazard for shipwrecked sailors immersed in cold water for long periods, and there must have been a high death toll during the winter of 1947 when power failures added to the difficulties of the severe weather conditions.
The reason for the failure to recognise the widespread dangers of accidental hypothermia for such a long time lies in the social organisation of capitalism. Medical resources are directed towards the "productive" members of the working class, as their continuation at work provides profits for their employers. The elderly, having ceased productive work, are at a disadvantage in competing for a share of the resources available — a disadvantage enhanced still further during a recession, when it is less profitable for capital to spend money maintaining a healthy workforce.
The elderly frequently have to put up with redundant workhouses as hospital accommodation when they fall ill. Geriatricians have to manage far more hospital beds than their consultant colleagues in acute medical and surgical specialties. At a symposium on geriatric medicine Dr Nagley described how, when he was seconded to the Western Road Infirmary, Birmingham in 1936, there were two doctors for 1,350 elderly patients and Dr Parnell stated that the North Birmingham Group had one consultant geriatrician for 548 beds while 144 longer-stay beds had no consultant at all. compared with 20 consultants responsible for 316 "acute'' beds in 1971 (Symposia on Geriatric Medicine, Vol.l. 1972).
The sheer pressure of work made accurate diagnosis extremely difficult and the pioneering geriatricians of the 1930s and 1940s had to battle against government indifference to the plight of the elderly, squalid hospital accommodation, scarce resources and the professional prejudices of their colleagues. Training in nursing care of the elderly was not included in the syllabus for student nurses until 1973, reflecting capitalism's lack of concern for the well being of "non-producers". Medical and nursing textbooks, in common with all goods, are produced for a market and the profit that can be made from them. Knowledge of hypothermia, therefore, no matter how important it may have been to prevent or treat the condition and save large numbers of elderly people from serious illness, was omitted because of lack of demand.
Although accidental hypothermia has now been well researched and documented the death toll continues. The response of governments has varied from exhortations to the public to be charitable —the "Be A Good Neighbour" scheme, while making cuts in public spending — to patronising advice — the Health Education Council's booklet advised the elderly to "Ask visitors if it seems cold to them in your house and take their advice". While it is quite possible for some old people to have defective regulation of body temperature, asking the advice of visitors is a poor substitute for having sufficient means to heat their homes properly. Victim blaming has been a recent government trend, emphasising individual responsibility for maintaining health. This trend disguises the social causes of poverty and disease and hampers the attempts of workers to control environmental and occupational hazards.
Financial help is available to assist pensioners with heating costs but it is confined to the poorest group who are in receipt of Supplementary Benefit. Grants are also available to help with house insulation but are not always claimed as they tend to be poorly publicised and many pensioners are not aware of them or find the spirit of condescending charity with which they are given offensive. In a study of hypothermia it was estimated that 700.000 people were "at risk" as a result of physical disability, low income and poor housing (Wicks. M.. Old and Cold. Hypothermia and Social Policy. Heinemann. 1978). Other studies have confirmed that one in eight pensioners are cold both by day and night in the winter.
Undoubtedly, better education could help to prevent some of the problems associated with cold weather. Lack of knowledge of the dangers of cold means that it is not unusual for bedrooms to be kept cool and windows left open in the mistaken belief that it is healthy, even in winter. Alcohol may be consumed late at night or before going outside in the cold to "keep out the cold". In fact alcohol dilates the blood vessels and. after an initial feeling of warmth, the body loses heat. Comparatively little is done to educate older people to such dangers because their health commands a low priority under a profit-oriented society.
Capitalism, in the pursuit of profit, is an inhumane society in which coal mines are closed while old people die of cold; food is thrown away while a quarter of a million pensioners suffer from malnutrition, media coverage is devoted to the trivial jaunts and extravagant spending of the parasitical royal family while pensioners remain ignorant of the risks of hypothermia.
Hypothermia is, on the whole, a disease of poverty: eighty-year-old millionaires are not taken to hospital suffering from the cold. It is the poor whose lives are placed in jeopardy and often, on discharge from hospital, returned to the same deprived circumstances which made them ill in the first place. Accidental hypothermia may be correct medical terminology but there is nothing accidental about a vicious social system which condemns its pensioners to an ice cold death while a minority of capitalists can live in luxury.