Hypothermia: the wrong message

The Lothians have seen a rise in hypothermia cases, says the Scotsman. 


This could be only the 'tip of the iceberg', as this article discusses winter deaths in general: many are not defined as hypothermia, as they take the form of respiratory or cardiovascular events but their incidence increases in cold weather. The jump seen this winter undoubtedly results from record cold temperatures in December. And yet countries with colder climates than the UK have better records than we do.


I've always been a little surprised at the silence of charities for the elderly on the subject of the smoking ban. Or did I miss something? 


Under the smoking law it is illegal to stand and smoke in a doorway. A smoker, regardless of his/her age or condition, is required (even in the absence of law enforcement agents) to expose him/herself to the elements rather than seek shelter in a doorway. A smoker, to fulfil the requirements of the law, must ignore his/her own most basic instincts to seek shelter, to the peril of his/her life.

Of course we have all seen smokers in doorways of an evening smoking. Enforcement officers issue warnings, then toddle off home at 5 pm, leaving smokers at the mercy of their fellow drinkers. There is much moaning about doorway smoking, but who would force a smoker out of a doorway? I have no idea, I've never seen it happening and can only hope that most anti-smoking vigilantes would draw the line at forcing a person bodily to stand in the rain/wind/snow.

Extreme changes of temperature and alcohol are both bad for maintaining body heat. Requiring people to leave drinking establishments to smoke in the open air (especially in winter) seems counter indicative. Surely, protection from hypothermia requires the maintenance of a regular temperature, and this is more important the older one gets, especially after a drink.

So much for pub-goers. What about those who stay at home? A recent study has emphasised people's need for social interaction, showing that isolation can have bigger health indicators than smoking itself:

Data across 308,849 individuals, followed for an average of 7.5 years, indicate that individuals with adequate social relationships have a 50% greater likelihood of survival compared to those with poor or insufficient social relationships. The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity). 

Those who don't wish to subject themselves to the indignities of the smoking ban (and others housebound for any reason) will fall all the more readily into the habits accompanying isolation, such as sitting still for long periods and failing to keep warm.

The recent struggles of acute hospital trusts to bar smoking from hospital premises spring from a fear that offering any shelter to smokers will 'send the wrong message'. Those trusts are entirely wrong about this. It is not the wrong message that people should  have access to 100 per cent shelter (when smoking), especially when they are ill or in distress, and especially when they have to emerge from warm hospital to the chill outdoor air of a British winter. It is the wrong message that the advice given for decades to elderly and vulnerable people for avoiding hypothermia (and indeed isolation) are suddenly dispensable when it comes to advising smokers. The risks of exposure to cold air are clear and present; of subjecting anyone to risk from passive smoke are distant and hypothetical. How are we to take official advice to keep warm seriously when we are ordered into the cold for the sake of using a (legal) tab?

No doubt Cameron's cronies in Downing Street aim to teach us our civic duty of caring for our elderly neighbours re the new social relationships of the Big Society. But do they appreciate how much harder the task is, now that the nation's social institutions have been snatched and remodelled so as to leave so many out in the cold?