Social isolation could be a factor in why more older men are dying from extreme heat

This article was originally published by The 19th.

More than 2,000 older Swiss women won a historic lawsuit against their government this spring. The plaintiffs argued that worsening heat waves were putting their health at risk due to their gender and age. The European Court of Human Rights ruled that the government failed to protect its residents from the effects of the climate crisis.

The lawsuit brought political and media attention to a sobering reality of the climate crisis: It takes a disproportionate toll on women and girls.

In heat waves that swept across Europe in 2022, women represented 35,667 of the over 61,000 people who died, with the greatest toll among older women. During a heat wave in France in 2003, the number of women over 55 who died from a heat-related death was 15 percent higher than men when adjusted for age. Though study results focused on the Global South are more of a mixed bag, a recent analysis concluded some of the inconsistencies can be pinned on bad data collection. Researchers largely agree that women are more susceptible to heat-related deaths.

Except in the United States.

Despite global trends, men are dying at far greater numbers than women across the country due to extreme heat. The most recent data from the Centers for Disease Control and Prevention (CDC), which examined heat-related deaths from 2004 to 2018, found that men died from heat-related deaths at over twice the rate of women: Of the 10,527 deaths, men accounted for 7,241. A CDC spokesperson told The 19th that a new analysis based on updated data is expected to be published in the next year.

More recent data follows this trend. In Arizona’s Maricopa County, which keeps some of the most comprehensive records on heat-related deaths in the country, men made up 75 percent of the 645 deaths last year (some of these fatalities were due to a growing homeless population that is more vulnerable to the extreme temperatures). In Clark County, Nevada last year, nearly three-quarters of the 294 heat-related deaths were men. And in Oregon’s Multnomah County—which includes Portland—a historic heatwave baked the city in 2021, leading to 72 deaths, 67 percent of which were men.

But research points to women being more physiologically vulnerable to heat. One study published in September found that women 65 and over started to overheat at lower temperatures and humidity levels compared to men of the same age. Researchers had participants swallow a capsule that monitors body core temperature while the subjects were performing low levels of exercise inside a heat chamber where they could crank up the heat or humidity. The study also found that middle-aged women were just as vulnerable as older men to the heat.

“This change in vulnerability in women occurs right around menopause, and it’s very similar to if you look at heart disease statistics up until menopause . . . Once they hit menopause, their propensity for having heart disease increases at a greater rate than men,” said Larry Kenney, principal investigator on the paper and professor at Penn State University.

Other studies have found that women sweat less than men. Sweating is one of the primary ways humans thermoregulate, or keep their bodies the right temperature. Being pregnant can also increase a person’s risk to the effects of extreme heat. 

So why are older men in the United States dying at higher rates?

One clue can be found in sociologist Eric Klinenberg’s book, Heat Wave: A Social Autopsy of Disaster in Chicago, in which he examined the deaths that occurred in the wake of the historic heatwave that hit the city in 1995. He found that race, socioeconomic status, and age all factored into who lived and who died, but he also narrowed in on two other variables: social isolation and gender.

“One of the things that we found in Chicago is that men were far more likely to die than women once you do the age adjustments,” he said. “The reason is that American men tend to be much more socially isolated.”

Women typically take on the roles of social connectors and caregivers, which foster relationships that lead to less social isolation in their old age. Men, on the other hand, are less likely to speak with friends and family on a regular basis or participate in clubs and activities outside the home. As a result, they often have less of a social network than women.

One way Klinenberg sought to quantify how social isolation might have impacted heat deaths was to look at the city’s data on who died without any family member or friend to claim them. Forty-five of the 56 unclaimed people who died during the heatwave were men.

Debra Umberson, sociology professor and director of the Center on Aging and Population Sciences at the University of Texas at Austin, said men continue to suffer from social isolation more than women, particularly as they age. She recently published a study looking at how social isolation changes over time. What she found is that isolation starts in adolescence and deepens through adulthood for everyone. But, “it’s worse for men and boys than it is for women and girls,” she said.

It could help explain why in Maricopa County, fewer women are dying alone during heat waves, despite making up a larger percentage of the population. Last year, of the 122 people over 50 living alone who died of an indoor heat-related death, 47 were women and 75 were men.

And in the 2021 heat wave that hit the Pacific Northwest, nearly three-quarters of the fatalities were people who lived alone, said Andrew Phelps, who was the director of the Oregon Office of Emergency Management at the time. The number of fatalities perplexed Phelps, because there had been plenty of warnings about the heat, and over 200 cooling centers had opened in anticipation of the high temperatures.

When they dug into the demographics of who died, he expected that they had missed a vulnerable population in their messaging, perhaps a community that doesn’t speak English. He was surprised by what they found: “What we saw was most of the fatalities were White males, 60 and over.”

Phelps has theories on why this is the case.

“This is anecdotal or speculation on my part from my lived experience, but like who doesn’t go seek help when they’re not feeling well, or if someone is having chest pain? . . . It’s the middle aged and older men,” he said. “If you think about someone sitting in an apartment or a mobile home, sweltering, and thinking, ‘Well, you know, I’m just gonna sleep it off, or it’ll be cooler when I wake up,’ and then they don’t wake up. That kind of tracks.”

Research backs up this assumption. Men are less likely to reach out to a doctor when experiencing a health problem than women and less likely to seek help when experiencing a mental health issue. Researchers point to stereotypes of masculinity—a fear of appearing weak or vulnerable—as one reason why this is the case.

Klinenberg puts it this way: “There is this culture of masculinity that stigmatizes men who seek out social support in places like senior centers and makes men feel like they are failures if they ask for help,” he said. “American men face this real burden. It is not unique in the world, but it is on the extreme side.”

Studies also find that men are more likely to stay in good health due to the women in their lives, who are typically doing things like scheduling their doctors appointments, Umberson said.

“Women are more likely than men to tell and remind and cajole and do all of these things to try to influence other people’s health behaviors.” When it comes to dealing with the heat: “If men are not in relationships they are less likely to have anyone telling them to be careful or to go to a cooling center,” Umberson said.

Maricopa County is piloting a program to stem the deaths in the elderly and disabled population during heat waves through its Senior and Adult Services Division. Last year, case workers identified 93 clients who they deemed particularly vulnerable during heat waves due to being socially isolated, having limited transportation and limited income. Throughout the summer, they called these residents when heat advisories were in effect to ask them questions, like whether they had their air conditioning on, or what temperature their thermostats read. If a resident said their AC wasn’t working, the agency would send someone to check on them and provide a portable cooling unit until it could be fixed.

But they have found gender is also a barrier to reaching residents. Women clients tend to be more receptive to help, and men, even when they are referred to a service, are more likely to turn it down, said Cristina Martinez, interim assistant director of the department. And it’s not unique to heat-related help either—it translates to other offerings like meal deliveries.

“We still see some examples of that stigma, where they have this idea of, ‘I’ve always been very independent, and I don’t ask for help.’”

Image: A man wipes the sweat from his neck as he sits in the shade of a tree at MacArthur Park during a heatwave in Los Angeles, California in September. (Etienne Laurent / AP Photo)