You can clearly see the slow down in the increase in Life Expectancy for males and females in England in the two graphs below.
For both males and females the graph above shows a clear increasing trend from 2001 to around 2011, and then a much flatter trend from 2011 to 2017.
The above two graphs also highlight the clear correlation between deprivation and life expectancy, with the least deprived (or wealthiest) quintile of males and females enjoying around 6-8 more years of life than the most deprived (or poorest) quintile.
You can’t see it from the above graphs, but the poorest decile (the poorest tenth) of women actually experienced a slight decline in life expectancy in recent years. That is to say the very poorest women now die younger.
Declining healthy life expectancy
The report also highlights a small decline in healthy life expectancy, which I personally think is important to consider, given that it’s much more desirable to live a longer life in good health, compared to a longer life in poor health!
How do we explain the stalling of life expectancy?
The Marmot report says that an increase in deaths from winter illnesses such as flu in recent years can only explain about 20% of the decline in life expectancy.
The report also highlights funding cuts to health and social services as something which has ‘undermined the ability of local authorities to improve the social determinants of health’.
NB – note that the wording of the above is very careful, the report doesn’t say that funding cuts have caused a decrease in the rate of improvement of life expectancy, probably because the report doesn’t have sufficient data to infer a significant enough correlation between funding cuts and life expectancy trends.
So while the trends may be objective, we need to be careful about jumping to conclusions about why life expectancy is stalling!
One thing we can say is that inequality clearly hasn’t improved in the last 20 years, if we use differences as life expectancy as an indicator of this!
The decline is driven by the increasing death rates in young Americans, aged between 25 to 64, which the main causes of death being ‘deaths of despair’ – alcohol and drug related deaths, suicides, obesity and drugs linked to chronic stress.
Interestingly the high death rates cut across class, gender and ethnic lines, and all regions of the United States.
Why does America have such a high mid-life mortality rate?
America has one of the highest mid-life mortality rates of high income countries, despite spending more on heath care than most other countries.
The statistics tell a depressing tale – mortality from drug overdoses has increased by around 400% since the late 1990s and Obesity rates have increased dramatically too – men now way on average 30 pounds more than they did 50 years ago.
In short, the causes of high mid life mortality are that people are just making destructive life choices and choosing not to take care of themselves, with increasing numbers of people self-medicating with alcohol, drugs (both illegal and legal) and junk-food.
There are number of possible deeper economic and social explanations as to the increasing mid-life death rate in America – we could apply Strain Theory – it could be that the people making the above choices are experiencing a sense of ‘anomie’ – these are people just working to survive with no obvious chance of ‘succeeding’.
It could also be that America is one of the most unequal countries on earth – and while many struggle to survive, they see daily success stories on the media, which enhances the sense of relative deprivation and their own failure.
Or these people self-medicating may be successful in some ways – have successful careers, but they’ve sacrificed their families because of it, so these could be deaths due to to loneliness or social isolation.
Whatever the causes, I’m just glad I don’t live in the US!
Here’s a dual line chart showing trends in life expectancy for males and females in the UK from 1948 to 2016….
The above chart is only one way of visualizing this data, starting at zero. It gives the impression of a steadily increasing life expectancy for both sexes, with little difference between them.
Visualizing starting at age 64
However, if you cut off the bottom 60 odd years, you get the impression of a much faster increase in life expectancy and you also get the impression of a more rapidly closing gap between male and female life expectancy:
Same data, two different impressions…. the first ‘calm and steady’, the second ‘rapid and intense’ – it just goes to show how easy it is to ‘distort’ even ‘hard’ data in the visualisation/ representation phase!
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’
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.
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.
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.
The United Nations uses 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.
HDI Scores in 2020
Dark Green is high ranging through to dark red which is low….
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
Life expectancy at birth
Mean years of adult education adults over 25 have received
number of years of education children attending school can expect
Gross National Income per capita (PPP)
(*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
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
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.
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.
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!
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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