Heat waves are a horrific phenomenon, killing thousands around the world annually, more than any other meteorological catastrophe. In the United States, heat waves are responsible for more than 400 deaths each year, greater than any other domestic, natural disaster. No number, however, can match the terrible death toll in France, where nearly 15,000 people died when an unprecedented heat wave struck the country and much of Europe in August 2003. Powerful and hot enough to shrink even Mont Blanc, Europe's highest peak, by two meters, the heat (around an average of 104 F) killed mostly the lonely elderly and the weak. It caught French hospitals and medical staff completely off-guard, and left many victims to die daily with astonishing frequency in crowded hospital rooms and lobbies.

Even before the temperatures relaxed, the finger-pointing began, with citizens blaming and berating the government, Prime Minister Jean-Pierre Raffarin, the health care system, and other medical institutions. While there can be no doubt that there are innate problems in French health care and government policy, the heat wave also indicates a sociological quandary that is not only plaguing France, but much of the western world.

The Health Care Problem

In June 2002, the World Health Organization placed France's health care system number one among the 191 member countries, calling it "the best overall." The French system, though certainly quite expensive, has resulted in high life-expectancy and universal health insurance to all legal residents and even foreigners waiting for residency papers. In fact, a poll taken in 2002 by Organization for Economic Co-operation and Development (OECD) Health Economics showed that 66 percent of the French were satisfied with their country's health care.

However, France's social welfare system continues to be undeniably bloated, and its health care spending, by percent of GDP, is far above the average of other comparable countries. Public hospitals have also run into trouble. Health care professionals are paid based on a fee-for-service system, and many choose to maximize volume of patients seen, causing a decline in the marginal quality of their services. In addition, state hospitals commonly perform poorly financially and do not provide adequate incentives to their staff to work at their best.

As if it were not enough, the heat wave chose to strike in the most relaxed month in France, August, the classic summer holiday season. Doctors, medical staff, and government personnel were on vacation, and this resulted in a fatal combination of hospitals flooded with victims, and a dearth of equipment with no central coordination for warnings or emergency response tactics from Paris. In addition, even though it was known among meteorologists that the heat wave would be one of the hottest in French history, "the government did not have a financial or social plan to take charge of the emergency service during or before the tragedy," according to Dr. Patrick Pelloux, president of the Association of Hospital Emergency Doctors of France. Neither President Jacques Chirac nor Raffarin was even in the country during the outbreak of the heat wave; as Pelloux remarked, "the government was on holiday."

There was also an alarming sense of miscommunication between the general practitioners and hospital doctors in France and misperceptions by the public on their roles in the system. Many of the general practitioners were of course on holiday, but oddly, those who remained in their offices did not receive substantially more phone calls than normal. For the most part, parents called them when their children were suffering from heat exhaustion. On the contrary, the elderly, who were suffering from symptoms that could otherwise have been tended to by general practitioners, flocked in large numbers (those that could) to the hospitals, thinking that any other doctor would not be able to solve the problem. This is a mystery that is still being investigated in the French government, but there is no doubt that the confining welfare-based health system was partly to blame.

Certainly the absence of an early warning system and medical staff, an effectual emergency services response, and a centralized coordinated information health system should receive the brunt of the blame placed on the French health care system in the wake of the heat wave tragedy. However, there exists another hidden problem that has been largely ignored by experts and scholars, the medical drug predicament in France.

A final problem in this general area is the shocking lack of public health education and awareness initiatives in France. Despite massive government deficit spending for health care, funds are poorly appropriated and at times even unintentionally wasted. Never mind non-existent public warning campaigns on television or radio detailing certain actions to protect one's health against the heat wave, France lacks even programs encouraging cancer screenings and frequent medical check-ups or admonishing against the hazards of cigarettes and alcohol.

The Deeper Problem Exposed

There can be no doubt that improving France's immediate response and preventive measures against a premature heat wave and streamlining the medical bureaucracy would avoid another August 2003 from occurring. However, the solution is not that simple.

The real problem is sociological. The French, the population is steadily getting older. Due to the high life-expectancy, the population of the elderly is expected to rise to as many as 6 million in 2020. In general, the elderly are also living alone and dying alone, an important demographic change. During the holiday month, families and relatives left behind their elderly, leaving the seniors unattended. If they fall ill, many are so infirm that they must rely and hope that their neighbor will notice them and contact the authorities for assistance. "They don't have the reflex to drink, they get a bit confused, disoriented," says Dr. Richard Chaillet, of the Saint Antoine Hospital. In essence, the familial ties between old and new generation has weakened and separated over the years. Historically, European families have taken in their older relatives. The trend now is that they live by themselves, less likely to live in retirement homes than elderly persons in the United States.

One only needs to examine nearby Spain and Italy to see that certain sociological and cultural dichotomies translate into a lower fatality rate. For example, Spain's official death toll was reported to be roughly 140 people, while Italy had reported about 4,000. Despite some criticisms from the World Health Organization on the accuracy of these numbers, they are far less than the French statistic. Part of the reason for this are the stronger traditional family ties that exist in those countries.