Paris when it Sizzles
The 2003 Heatwave and France’s State Health Service
France is proud of its social pact, a combination of state intervention from above and the proudly vaunted idea of the French family from below. So why did so many poor, the sick and the elderly die in August 2003?
In the first two weeks of August 2003, a heatwave struck France. It was hot, not uniquely hot, but hot enough. In Paris, temperatures reached 37C (98.6F), high above the summer average of 24C (75F).
And 14,800 people died.
This was no natural disaster but an epidemic caused by a set of social breakdowns and political failures as peculiar to France as the “pacte sociale” (social pact) on every French politician’s lips during elections. The pact is shorthand for heavy state spending on welfare in line with social and especially family values apparently unlike those in other countries.
Temperatures began to climb on 1st August. Four days later, the average high across France had reached record levels and remained that way for a week.
Forecasters for the national weather service, Météo France, had expressed concern about the health implications, but it was only when Pompes Funèbres Générales (France’s largest funeral parlour) announced that its morgues were full of heat-related fatalities that the press picked up the story on 10 August. Officials responded with an emergency “Plan Blanc” (White Plan) on the 13th but by that time the dead were in their thousands and temperatures had fallen.
Hospitals and cemeteries overflowed. News programmes showed mask-wearing firemen retrieving decomposed bodies from apartment buildings and stacking them in refrigerated containers. In Paris, an agricultural showroom was turned into a temporary morgue. In Chartres, emergency services left one body in the flat where it had dropped for ten days since there was nowhere else to put it.
It was the vulnerable that died. The Institute of Health Surveillance estimated that 80% of victims were 75 years or older. Its analysis noted a high proportion of deaths in state retirement homes. The problem was that in August, France shuts down and everyone heads south on holiday, leaving their elderly relatives without, as events showed, visits or telephone contact.
"Is it normal that last night there are three hundred people who can’t be buried because the family hasn’t turned up to claim the body? Is that the government's fault?" demanded the state secretary for the elderly, Hubert Falco two weeks after the crisis when his own handling of the emergency was under fire. "There are three hundred families who haven’t yet realised that they have a granny or a mother who is dead.”
On paper, French healthcare had been rated the best in the world - specifically, a 2000 report by the World Health Organisation (WHO), which placed France first amongst 191 countries rated. (Then again, it also ranked San Marino, second well above the US at thirty-seventh). And yet, compared with other countries, France had suffered disproportionately.
In practice, as a further 2003 WHO Report reported, the French health service displayed systemic faults from top to bottom including “lack of anticipation, organisation and coordination”. It criticised the service for closing hospital wards during August rather than providing cover for the doctors and nurses on holiday which, the report noted, would have been artificially expensive because of France’s laws regarding temporary employment.
The WHO also referred to certain “government officials, who [showed] reluctance to cut short their own holidays to deal with the crisis”. Though casualties were soon recognised to be more than seven times those of 9/11, health minister Jean-François Mattei did not leave his villa in the south of France until the 17th August while President Chirac, vacationing in Canada, chose not to cut short his salmon-fishing at all.
"If they [the government] had acted sooner, many lives could have been saved," Patrick Pelloux, head of the association for French emergency hospital physicians, told Le Parisien newspaper.
Dr Muriel Chaillet, who worked round the clock at Paris’ Saint Antoine hospital during the height of the heatwave had welcomed the “Plan Blanc” that now allowed her to open closed wards, use volunteer staff and order lifesaving equipment. But, as she said on 22nd August when the heat wave was over, “the ventilators we ordered four days ago only arrived today – it's all too late.”
The heatwave exposed not just the cracks in France’s health system but also a gigantic hole that politicians and public alike seek to cover up. For each of the last five years, the system has been overspending its budget by €10 billion. One British man went to Paris to have a hip operation and was astonished to find that the package he was given included a private room with a second bed for his wife, two weeks post-op physiotherapy, and – of course – wine with lunch and dinner. As a citizen of the EU, all this was free. The whole service is suffering from poor accounting and endemic over-prescription. One fifth of the country's health spending goes on pharmaceuticals. Government economists warned last year that the health system's annual deficit could rise to 29 billion euros by 2010 without a major overhaul.
After the heatwave, the health minister announced a reform package, Hospital 2007. It was met by a wave of strikes by healthcare workers. One group of surgeons protested at any suggestion of a wage cut by driving their Mercedes en masse to an English seaside resort for a “holiday of protest” during a union-called day of stoppages and demonstrations across the country. The government announced that turnout was low and that most public-sector workers and doctors had turned up for work.
"When a ministry is unable to count the dead from a heatwave over the summer, it's hard to see how it can count strikers on a single day," replied Patrick Pelloux, President of the Association of Emergency Hospital Doctors.
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Who’s to blame?
On 19 August 2003, a commentary headed "French barbarity” appears in Le Figaro newspaper attacking the French habit of abandoning elderly relatives and dependents to go on holiday: "It's not up to the state to take care of our elderly. It's up to us”.
Estimated Dead – Summer 2003
|
France |
14,800 |
|
Italy |
4,200 |
|
Netherlands |
1,400 |
|
Portugal |
1,300 |
|
UK |
900 |
|
Spain |
100 |
(Prepared by National Institute for Health and Medical)
Help the Aged
In 2005, with all proposals for any kind of health reform coming under fire from the public and unions, the French prime minister suggested helping the elderly sections of the population, so vulnerable during the 2003 heatwave, by abolishing one of France’s – eleven – national holidays. He asked for the nation to turn it into a "day of solidarity" to generate funds for geriatric healthcare and “demonstrate the reality of our social pact”. The reality was a little more real than he imagined. Millions of workers in the public and private sectors went on strike in protest at giving up their day off for a load of old farts too feeble to turn on the air conditioning. "Once the nation's guilty conscience for the heatwave deaths eased off", noted a reporter in Le Monde, “Wage-earners were amazed to find themselves selected as the main source of the funding for the elderly. It seems they will refuse to do so. So who is going to pay for health in the future? Noone knows. Perhaps we will win the lottery.”