Winter deaths: warm housing is not enough

Editor—Olsen's article gives the impression that Britain's high winter mortality and winter crises in health care can be prevented simply by warmer housing, although one reference in it reviews evidence of the importance of outdoor cold exposure.¹,² Large scale international surveys have shown an independent association of outdoor, as well as indoor, cold with excess mortality in cold weather.³ A population of elderly people living in fully heated housing experienced similar excess winter mortality to the general elderly population.⁴ This is not surprising when people spend substantial time outdoors, since cold stress to people waiting at a bus stop in a cold wind can exceed anything experienced indoors.

Home heating has improved greatly over the past 30 years. Particular focus is now needed on exposure to the cold outdoors. Age Concern and other charities have responded by giving advice on avoidance of cold stress outdoors, but campaigns by government departments have remained fixated on indoor cold. Apart from personal measures such as warm clothing and exercise when outdoors in cold weather, there is scope for official action on physical measures such as windproof bus shelters, and in some cases heated waiting rooms. The effectiveness of such a campaign could be evaluated statistically if it were focused initially on a specific region.

With massive insulation from outdoor clothing, people in Yakutsk, the world's coldest city, already experience no excess winter mortality with midwinter temperatures that average around −40°C.⁵ It is time for more balanced official action in Britain to reduce the exceptionally high mortality and recurrent hospital crises caused by Britain's mild winters.