Exploring Inequality in Life Expectancy in the United Kingdom

What are the causes and consequences of low life expectancy in the UK?

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Get rich or Die Young (BBC, Panorama 2018) explores the causes and consequences of low life expectancy in Teeside, in the North East of the United Kingdom. It focuses on the experiences of three people who are living through three of the main causes of low life expectancy: smoking and poor diet, drug addiction and mental ill health.

The documentary is hosted by the ever-reliable Richard Bilton, who seems to be the BBC’s go-to guy for these social injustice documentaries.

Teeside has the largest life expectancy gap in the country. Those in poorest boroughs of the region have a life expectancy of just 67, the same as Ethiopia. Those living just a couple of miles away in the wealthiest boroughs live until 85, 4 years above the national average.

This means that the life expectancy gap between the poorest and richest boroughs in Teeside is 18 years.

The inequalities are literally written on the gravestones, where in some graveyards, 60 years seems like a ‘good innings’

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Richard Bilton points out early on that most babies in the U.K are born healthy, but a baby’s health is shaped by what comes next, and a crucial variable which influences health and life expectancy is wealth, or lack of it.

He also suggests more than once that leading an unhealthy life is not simply a matter of individuals making poor choices. Rather, being socialised into poverty restricts the kinds of choices people can make, and in extreme cases results in stress which seems to literally take 10 years off an individual’s life.

The first of the three emotionally charged case studies focuses on a 46-year-old male whose life is nearly over. He has fluid on the lungs, sciatica, and type 2 Diabetes, among other things, and is dependent on breathing apparatus.

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There’s quite a lot of footage of his 4/5 kids musing about how he hasn’t got much time left…. And I guess that’s the ultimate negative consequence of his dying in his late 40s: a partner left to bring up 4 distraught kids on her own

His Illnesses are down to smoking and poor diet: people are four times more likely to smoke than those from wealthy areas.

The second case study focuses on a gran mother who is bringing up her daughters two children because she seems to be a hopeless crack addict. We see an interview with the drug-addict daughter who just appears to have given up the will to look after her kids. (Possibly because she knows her mother will do it?).

Drug deaths in Stockton have doubled in a decade and nationally they are substantially higher in the more deprived areas.

The grandmother attends a support group for grandparents who look after their grandkids because their children are drug addicts…. And we can see clearly how the stress she’s under is reducing her own life expectancy.

Finally, the documentary visits a middle-aged woman suffering from depression and anxiety who has made multiple (unsuccessful) suicide attempts. Suicides are twice as common in the poorest areas.

One of the problems here is that mental health services have been cut. There’s nowhere for her to go. If it were not for a voluntary support group, she’d probably be another early death statistic.

So how do we tackle low life expectancy? 

This is a very short section towards the end of the documentary which visits a school in a deprived area. The headmistress of the Carmel Education Trust thinks she can turn things around. She doesn’t believe the poor-health life path of those in poverty is fixed.

She believes that therapies help kids to better at school, and if they do better at school, they get better jobs, and that seems to be the key to a healthier life…

NB the documentary doesn’t actually go into any depth about what these ‘therapies’ are. This section is very much tagged on the end of the gawp-fest.

Final critical appraisal of the documentary

What I like about the documentary is that it’s rooted in what you might call micro-statistics. It ‘digs down’ into the sub-regional variations in life expectancy in Teeside. It even distinguishes between life expectancy and health life expectancy.

If You rely on the Office for National Statistics own accessible data on life expectancy, you don’t even see these variations!

However, the documentary spends too much time ‘gawping’ at the poor sick poor people rather than analysing the deeper structural causes of poverty related health problems.

There’s no real mention of the longer term historical downturn in the North East of the U.K. which highlights the high levels of unemployment, for example.

I’m also not entirely convinced by the (too brief) look at the solutions on offer. Therapeutic interventions in schools was offered up as the solution. Relying on the education sector yet again to sort out this social mess of extreme in equality in life expectancy just isn’t practical.

Having said that, if the mission of the documentary was to alter us to the extent of the problem and shock us, I think it did a reasonable job overall.

Possibly most shocking of all is that men in the poorest boroughs have a life expectancy of just 64: the average man doesn’t even make it to retirement age. And this isn’t the only region in the UK where this happens. In the very poorest regions, men work hard, pay their National Insurance, and get nothing back for it. There’s something not quite right about that!

Ultimately, I agree with the message the documentary puts out, even if it gets somewhat lost in the emotionalism of the three case studies: the reasons people die young are complex, but the most common reason is poverty – low income limits your choices. There is also no reason why anyone should be getting a chronic illness and dying in their 40s. All of the likely soon-to-be deaths in the documentary are entirely preventable!

Relevance to A-level sociology

This documentary offers some us some qualitative insights into the causes, but mainly the consequences of low life expectancy in the poorest regions of the United Kingdom and so should be relevant to the ‘ life expectancy and death rates‘ aspect of the families and households module.

It’s also quite a useful reminder of how we need qualitative data to give us the human story behind the statistics.

If you want to find out more about variations in life expectancy in the UK, you might like this interactive map as a starting point.

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The Human Development Index

 

The United Nations use The Human Development Index (HDI) as a summary measure for assessing long-term progress in three basic dimensions of human development: a long and healthy life, access to knowledge and a decent standard of living. It provides a useful ‘snap-shot’ of a country’s economic and social development.

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The Human Development Index

The Human Development Index measures Human Development using four indicators

  • To measure health – Life expectancy at birth
  • To measure education – the average (mean) number years of adult education adults over 25 have received and the number of expected years of education children attending school can expect
  • To measure standard of living – Gross National Income per capita (PPP)

Each country is then given a rank from between 0 and 1 based on how well it scores in relation to ‘constructed minimum’ and ‘observed maximum scores for each of these criteria. The minimum and maximum scores for each criteria are as below

Minimum scores* Perceived maximums
Life expectancy at birth 20 83.2
Mean years of adult education adults over 25 have received 0 13.2
number of years of education children attending school can expect 0 20.6
Gross National Income per capita (PPP) 163 108, 211

(*This is the level below which the UN believes there is no prospect for human development!)

How does the HDI work out a country’s score? – it’s quite easy – if a country has a life expectancy of 83.2, and all the other maximums, it would score one, if it had a life expectancy of 20, and all the other minimums it would score zero. If it was half way between the minimum and maximum – it would score 0.5 – NB by the UK’s standards, this would be a pretty low level of human development!

The Human Development Index – Best and Worst Performers

Top

Rank Country IHDI
1  Norway 0.893
2  Netherlands 0.861
3   Switzerland 0.861
4  Australia 0.858
5  Denmark 0.856
6  Germany 0.853
7  Iceland 0.846
8  Sweden 0.846

Towards the Bottom 

137  Haiti 0.296
139  Liberia 0.280
140  Democratic Republic of the Congo 0.276
142  Mali 0.270
145  Burkina Faso 0.261
146  Guinea 0.261
147  Guinea-Bissau 0.254
148  Niger 0.246
149  Sierra Leone 0.241

What do the scores above mean?

  • If a country scores 1-0.788 it is classified as a ‘developed country’ with ‘high human development’ – as are 42 countries – most European countries come into this category. These are typically the countries with GNIs of $40K per capita or more, 13 full years of education and 80+ life expectancies.
  • If a country scores 0.48 or lower it is classified as having Low human development – e.g. Sierra Leonne – here you will see a GNI per capita of below $1000, 10 years or less of school and life expectancies in the 60s.

Advantages of the Human Development Index

  • It provides us with a much fuller picture of how well developed a country is, allowing for fuller comparisons to be made.
  • It shows us that while there is a general correlation between economic and social development, two countries with the same level of economic development may have different levels of social development. See below for examples.
  • Some argue that this is a more human centred approach, concerned more with actual human welfare than just mere economics. It gets more to ‘the point’ of economic development.

Two Limitations of the Human Development Index

  • Relying on the HDI score alone may disguise a lack of social development in a country – for example a very high GNI can compensate for poor life-expectancy, as is the case in the United States.
  • It is still only provides a fairly limited indication of social development – only health and education are covered – there are many other ways of measuring health and education.

 

Explaining the long term decrease in the death rate

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Explaining the long term decrease in the death rate

What are the Trends?

  • The death rate has halved in the last century, declining from 19/1000 to 10/1000 today.
  • In the first part of the century,most of this decrease was due to fewer children dying of infectious diseases, later on in the century, the continued decline is due to people living longer into old age.
  • The major causes of death have changed – from mainly being due to preventable, infectious diseases in the early part of the century to ‘diseases of affluence’ such as heart disease and cancers today.
  • There are considerable variations in life expectancy by gender and social class – people in the poorest parts of Glasgow die before 60, in the wealthiest parts of the UK (e.g. Kensington) life expectancy is nearer 90.

Explaining the decrease in the death rate

1. Economic growth and improving living standards

There are number of ways in which this had led to a decline in the death rate:

  • better food and nutrition (which in turn is related to better transport networks and refrigeration) which has meant that children are better able to resist infectious diseases, reducing the infant and child mortality rates. This is estimated to account for 50% of the decline in the death rate.
  • Better quality housing – Better heating and less damp, means less illness.
    Smaller family sizes – as people get richer they have fewer children, which reduces the chances of disease transmission.
  • More income = more taxation which = more money for public health services.
  • Evaluation – It’s worth noting that not all people have benefited equally from the above advances. The wealthy today have longer life expectancy than the poor, who still suffer health problems related to poverty.
  • Evaluation – In terms of food and nutrition, obesity is now becoming a serious problem – more food doesn’t necessarily mean better nutrition.

Medical Advances

  • Mass immunisation programmes limited the spread of infectious diseases such as measles.
  • Important in improving survival rates from ‘diseases of affluence’ such as heart disease and cancers.
  • Only really significant since the 1950s.
  • Evaluation – It’s easy to fall into the trap into thinking that modern medicine is the most important factor in improving life expectancy, it isn’t – economic growth, rising living standards and improvements in public health are more important.

Social Policies

  • The setting up of the NHS
  • Health and safety laws – which legislate so that we have clean drinking water, food hygiene standards and safe sewage and waste disposal
  • The clean air act and other policies designed to reduce pollution
  • Health and Safety laws at work.
  • Evaluation – These are largely taken for granted, but they are important!

Other factors

  • There is greater knowledge and concern about health today
  • The decline of manual work means work is less physical and exhausting and less dangerous.

Overall conclusion/ analysis points

  • 3/4s of the decline between the 1850s and 1970 was due to the reduction of infectious (fairly easily preventable) diseases such as Cholera, and improved nutrition accounts for half of this reduction. In these early years
  • More recently, the decrease in the death rate has been due to improving survival rates from heart disease and cancers.
  • The declining death rate is not necessarily all good – in the last decades we have witnessed a declining death rate and a declining birth rate – and so we now have an ageing population, which requires society to adapt in order to meet the different demands of differently structured population.

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