Winter mortality in elderly people in Britain

Editor—The paper by Wilkinson et al, on people aged over 75, makes a useful addition to the evidence that winter mortality in Britain is now not caused primarily by deprivation and failure to heat homes.¹ In addition to other evidence they quote, a recent study on younger people provides positive indications that cold exposure outside the home causes winter mortality regardless of economic status.²

Manual workers (social class 5) of working age (50-59) in Britain had low cold related mortality compared with any other class. This was not the case with their wives of similar age or for men of the same class after retirement age (65-74). It implies that internal heat production from manual work protected class 5 men of working age against daytime cold stress and consequent mortality. Elderly people in sheltered housing that was fully heated, but who often went outdoors, had as much winter mortality as the general elderly population.³

Despite considerable evidence, reduction of outdoor cold stress has been largely ignored in official campaigns to control winter mortality. Heating of waiting areas for public transport, and at least windproof shelters on bus routes subject to unscheduled delays, are obvious measures that would help. Another is to broadcast warnings when cold weather is forecast, that dressing warmly, with hats and with wind-proofs and waterproofs when necessary, can prevent not only discomfort but often illness and death. To keep moving while outdoors is also important.

Surveys in Europe and Siberia provided statistical evidence that such behaviour, as well as warm homes, is associated with low winter mortality.⁴,⁵ We have found advice on these lines to avoid outdoor cold stress, given via the media, well received by elderly people, provided that they are also given the evidence that outdoor cold accounts for much of Britain's winter mortality.