Morning Star 11th February 2010
By Will Stone
Shocking research published in a major new report has revealed that people living in England's poorest areas die seven years younger on average than those in its richest communities.
The Marmot review shows that although life expectancy has risen overall in both poor and rich areas, distinct inequalities remain.
Along with a lower life expectancy the report also finds that for poorer areas a greater proportion of people's lives will be spent unwell.
The government-commissioned report, published by epidemiologist Sir Michael Marmot of University College London, estimates that up to 202,000 early deaths could be avoided if the NHS spent more to tackle these inequalities.
He also called for an increase in minimum wage to allow everyone the opportunity for a healthier lifestyle.
Professor David Hunter, an expert in health management at Durham University, said: "There are few votes in health inequalities. There must be a real political commitment at all levels because a fairer society will benefit all.
"As politicians of all hues become increasingly preoccupied with securing electoral advantage, it is questionable whether this important report will receive the careful and considered attention it deserves."
The report warns that doing nothing to tackle these inequalities would cost the economy more, accounting for £33 billion spent every year.
It calls for NHS spending on preventing illness with more money going to initiatives such as helping people to stop smoking.
Professor Mike Kelly, of the National Institute for health and Clinical Excellence, also argues there needs to be a shift away from medical interventions that treat existing illnesses to those preventing them developing in the first place.
President of the UK Faculty of Public Health Professor Alan Maryon-Davis added: "This report is not just about fairness and opportunity - essential though these things are. It is also about hard-nosed investment in preventive strategies that really pay off."
Health Secretary Andy Burnham welcomed the report and agreed that more work is needed to tackle inequalities.
"It's not right that where we live can dictate the state of our health," he said. But many are asking the government exactly what it plans to do.
Haringey TUC chairman Keith Flett, whose area includes some of the poorest areas in the country including Tottenham's Northumberland Park, said: "The really big question posed is what is going to be done about decent jobs and wages and the impact this has on people's lives?"He added that people in Tottenham were literally dying because they were poor
HEALTH FOR SALE
Hugh Faulkner & Barbara McPherson
Socialist Medical Association and Sigerist Society
Before the war, many valuable studies were made of the class incidence of disease and its relation to real wages and housing conditions. John Boyd Orr, George McGonigle and John Kirby, Richard Titmuss, Julian Tudor Hart and Wright, Wilkins and Marrack published facts and figures which became known widely throughout the Labour movement.
Since the war, however, the belief has been fostered that class differences have greatly decreased. The myth is spread that the rich are taxed out of existence, that slumps have been charmed away by Keynesian economics, and that the Welfare State gives us all an equal chance. This supposed happy state of affairs does not, unfortunately, survive the cold light of the Registrar-General’s Report.(i)
It is clear that the general health of the people as a whole has improved. A male child born in Britain today can expect to live sixty-seven years, whereas in 1901 the expectation of life was only forty-nine years. Many factors have played a part in this.
The development of public hygiene, a continuous period of full employment, the elimination of some of the worst slums, advances in medical treatment and its greater availability to the whole population, have all contributed. This improvement in general health which exists in Britain, and also in some of the more technically advanced countries, is by no means true of the entire world (ii).
The position in the overseas territories is quite different—in Burma, for example, the death rate actually rose from 32 per 1,000 in 1947 to 48 per 1,000 in 1949. In 1951, the U.S. Department of State gave figures showing that two-thirds of the world’s population had only half the expectation of life of the developed one-fifth (iii).
It is only just over a hundred years ago that Dr. Edwin Chadwick published his sensational report on the relation of ill-health to poverty (iv).
(i) The Registrar General’s Report: Decennial Supplement, I951: Occupational Mortality, Part I.
(ii) The Cost of Sickness and the Price of Health: Winslow, Geneva 1951.
(iii)U.S. Department of State (1950): Publication 3719: Economic Co-operation
(iv)The Sanitary Condition of the Labouring Population of Great Britain: Edwin Chadwick, London. Published by W. C. Lowes & Sons for H.M, Stationery Office, 1843
Things have improved, at least in the non-colonial countries, considerably since then. During this period two main things have happened. Firstly, the workers have forced improvements in their living conditions on the ruling class, have fought for and obtained better food, better houses, better hospitals and medical care, etc. Secondly, capitalism has gradually been forced to recognise that a minimum of health care for the working population is essential for efficient production. Capitalism made the “great discovery” that disease costs money. The result of this is seen in the steady improvement in the most developed capitalist countries in the infant mortality figures (except for war-time peaks) over the past fifty years.
The main lesson for socialists in the Registrar-General’s Report is that despite the general improvement in health, class differences in many diseases have remained remarkably constant.
The Report divides the population into five social classes:
Social Class I — professional
Social Class II — intermediate occupations
Social Class III — skilled occupations
Social Class IV — partly skilled
Social Class V — labourer
In 1950 a labourer (Social Class V) was still five times more likely to die from bronchitis than his employer. He was 31 times more likely to die from pneumonia and more than twice as likely to die from peptic ulcer or pulmonary tuberculosis.
In 1950, 2,592 more men from Social Class V who were between twenty and sixty-four years of age died from bronchitis, pneumonia, gastric ulcers and tuberculosis of the lungs than would have been expected to die if they belonged to Social Class I. In other words, by raising the social conditions of those in Glass V to that of Class I, about 2,600 deaths from these four diseases alone could have been prevented.
In many other diseases the same story is revealed. In the first month of life, the death rate amongst children of Social Class V in 1921 was 1.6 times that of children in Social Class I; in 1950 the ratio was 1.7 to 1. For children aged four weeks to one year, the ratio in 1921 was 4.0 to 1 and in 1950 it was 3.8 to 1. In other words, nearly four times as many children per 1,000 from the lowest-paid workers’ families die between the ages of one month and one year as in the case of children of the upper classes, and this relationship was almost exactly the same in 1940 as in the bitter years after the first world war.
There are approximately 7,000 fatal accidents in British homes each year. The Royal Society for the Prevention of Accidents puts bad housing as their principal cause, and thus a greater proportion of these accidents take place in the overcrowded, ill-repaired homes of the working class. For example, four times as many babies under one year are accidentally killed by suffocation in Social Class V than in Social Class II.
There are a few diseases where the death rate is higher in Social Class I—high blood pressure, diabetes, coronary thrombosis and diseases of the liver. Despite this, however, the mortality ratio(v) for men aged 20-64 in Social Class I in 1950 was 97, for Social Class V 118. The difference between the classes is particularly noticeable between the ages of thirty-five and forty-five, where the ratio is 83 for Class I to 143 for Class V. In other words, well over a third of the deaths of labourers in the prime of life could be prevented by a change of social environment.
These figures apply to men in different social classes, irrespective of the nature of their employment. Similar differences are shown by their wives. It is therefore likely that the differences in mortality are due to such general social conditions as income, food and holidays.
When we consider specific occupations, it is obvious that the risk of accident incurred by the man at the bench is far greater than that of the man in the director’s chair. Every year there are nearly a million accidents at work which lead to at least three days’ absence from work in each case. As a result of accidents at work, nearly 3,000 workers die every year and, of these, 750 are killed in the mines. In some occupations the workers are exposed to particular risks (apart from the notifiable industrial diseases). Thus a coal-face worker is four times more likely to die from tuberculosis than a farmer, and nearly twice as likely to die from pneumonia as a transport worker.
(v) The Standardised Mortality Ratio is the number of deaths occurring among men aged 20-64 in a given occupation, expressed as a percentage of the number of deaths that might have been expected to occur if the given occupation had experienced within each age group the same death rate as that of a standard population consisting of all occupied and retired men.
The figures in the Registrar-General’s Report refer only to deaths. It is always difficult to get a reliable picture of the incidence of ill-health not resulting in death, since sickness rates are rarely published. These, however, would probably show an even more striking class incidence, as many of the diseases showing an excess mortality in Class V—such as bronchitis, gastric ulcers, and tuberculosis—produce a period of chronic ill-health, sometimes of considerable duration, before causing death. Some of the few statistics available come from the U.S.A.(vi) Americans on the dole suffer over four times more from bone diseases than those with incomes of $5,000 a year or more. For rheumatism the ratio between these two groups was 3.69 to 1, for digestive diseases 3.4 to 1, for nervous diseases 2.87 to 1 and for degenerative diseases 2.68 to 1. These figures are particularly interesting as they show that there is a marked class difference in the incidence of certain diseases (diseases of bone, nervous and degenerative diseases) which, unlike tuberculosis, rheumatism and chronic bronchitis, are not commonly thought of as diseases of poverty.
In the case of the old people, no complicated statistics are needed to appreciate that a human being cannot house, clothe and feed himself on 32s. 6d. a week in Britain today. In a large Liverpool hospital in one year there were thirty-nine cases of proved malnutrition out of 792 admissions (i.e., 2.8 per cent of all admissions).(vii) Of these thirty-nine cases, thirty-three were over sixty years of age and the malnutrition of the majority of these was shown to be directly due to poverty.
Apart from the Registrar-General’s Report, further information concerning social conditions and ill-health is available from a study, between 1945 and 1948, of all the admissions to a group of hospitals in Scotland.
In the county districts of Stirlingshire (excluding the burghs of Stirling and Falkirk) there is “a fairly close correspondence between the extent of overcrowding, the number of in-patients treated, the number of patient bed-days and the number of out-patients per 1,000 of the population”, and in Ayrshire, “it seems fairly clear that in the central districts, where housing conditions are worst, the hospital load was heaviest”. In Ayr burgh, hospital attendance both of in-patients and out-patients was nearly twice as common in the two most crowded wards as in the two least crowded.
(vi) U.S. National Health Survey (1935-46): Bulletin No. 9: Disability from Specific Causes in Relation to Economic Status. Washington 1948.
(vii) The Lancet, October 34, 1953, p. 860.
In addition, it was found that the required length of stay in hospital was much longer for those in the lower income groups than in the higher.(viii).
The figures used in this article are all taken from official sources or from scientific articles about health in Britain since the end of the war. No attempt has been made to deal with the appalling health conditions in the British Empire, conditions which are not sufficiently known in the Labour movement. It will require a separate article to consider the health situation in the Empire.
We do not need, however, to look further afield than this country to realise that it is still possible to buy good health if you have the money. Good food, adequate housing and sufficient leisure can be bought and they all contribute towards good health. Under capitalism only one section of the population has the full benefit of these necessities for health. It must be emphasised that although our present evidence shows that the conditions in which we live have a very great effect on our state of health, exactly how they act is not so clear.
Each disease does not have one cause and one cure; the individual reaction to disease also differs considerably. One thing is certain, however: if diseases are studied not as isolated occurrences but as part of the interaction between the individual and his environment, a deeper understanding of their cause will result.
Health has often been taken as synonymous with the absence of disease, or the ability to carry on at work or school. That this is a very stupid attitude towards health will be seen if any group of children are watched at play; it is easy to see that some have abundant energy, bright eyes, rosy cheeks. Others lack these signs of positive health. All men, women and children should have these attributes, but no amount of medicine, hospital beds or specialist doctors can alone produce them. The minor disorders that reduce health are usually so easy to prevent, so difficult to cure.
It is clear that environmental factors, living conditions, are just as important factors in the health of the people as medical care. of the living conditions of the whole population to that of the best there are today. Only Socialism can carry out this task. The working class have many allies amongst health
(viii) Hospital and Community. Nuffield Provincial Hospitals Trust, 1950.
One of the many contradictions of capitalism is that it cannot carry out the scheme of preventive medicine which is needed—the raising workers who are genuinely seeking to improve the health of the people and to fight against the misery and unhappiness created by disease.
Yet under capitalism, their efforts are frustrated at every turn by the conditions under which so many of the population live. The wage earners stay on at work in order to keep their families, so what started as a minor complaint becomes a major disability. At the present time there is an urgent need for more funds for research, for more convalescent homes and for more holiday homes which could prevent the onset of illness due to over-strain and over-work.
Patients are returned after hospital treatment and convalescence to the same grim conditions of overcrowding and poverty which have contributed so much to their illness. Old people are treated with bottles of medicine when what they need is money to buy adequate food and clothing.
Advances in medical technique are of concern to our movement, for they can contribute to the battle against disease. The discoveries of penicillin and the other antibiotics, the advances made in this country in such fields as anaesthetics and the surgery of the chest, are causes of real pride. They have contributed enormously to the lessening of suffering by the cure or alleviation of established diseases.
Yet these are only part of the story.
In 1955 health is still distributed unevenly among the various social classes. The Labour movement must fight for better health for the whole people. The figures quoted here show that it is possible, and that thousands of people die before their time (chance of birth still affects the individual’s health and length of life). Much can be done to improve the position now, but only under Socialism, when classes are abolished, can the basis be provided for positive health for the whole of the people.
Many allies can be won for the fight for Socialism by explaining these facts to honest and sincere people.
Health for himself and his family is one of the primary desires of the human being. The socialist health workers can lead the fight, present the figures and explain the issues, but only the agitation of the organised Labour movement will obtain the required results. We must reverse the attitude where so much minor illness is accepted as inevitable, and show that positive health is obtainable and will flourish under Socialism.
HEALTH FOR SALE
Hugh Faulkner & Barbara McPherson
George McGonigle, (1888-1939) born Monkwearmouth near Sunderland, Medical Officer Stokton on Tees
Richard Titmuss (1907-1973) statistician at LSE advisor to the Labour Party
Sir John Boyd Orr (1880-1971) born Kilmarus near Kilmarnock Scottish Doctor and teacher, Member of Parliament Scottish Universities
Julian Tudor Hart 1927- born London, General Practioner, and Communist councillor Glyncorrwg, South Wales, Communist Party Health Advisory Committee