Victorian-era diseases return to Britain

By Julie Hyland
17 September 2014

The UK Faculty of Public Health (FPH) states that rickets and gout—diseases of the bones and joints—are on the increase.

Poverty is the major factor in the return of such Victorian-era diseases, with poor diet leading to malnutrition and vitamin deficiencies. Figures from England and Wales indicate that there was a 19 percent increase in the number of people hospitalised for malnutrition in the last year.

The FPH’s Dr John Middleton said, “The vitamin deficiency states of gout, malnutrition being seen in hospital admission statistics are extreme manifestations of specific dietary deficiencies or excesses, but they are markers of a national diet which is poor. Food prices up 12%, fuel prices up double-figure percentages and wages down is a toxic combination, forcing more people to eat unhealthily.”

Obesity remains the largest problem as families are forced to eat cheap, highly processed foods. “GPs are reporting rickets anecdotally in Manchester, the East End of London, Birmingham and the West Midlands. It is a condition we believed should have died out.”

The statistics are based on a report by the Health and Social Care Information Centre (HSCIC). It outlined how the latest figures on patients “paint a current picture of hospital admissions for some diseases that were widespread during the 19th and early 20th centuries.”

Admissions for gout had increased by a fifth since 2009-10 in England, with almost 5,800 admissions in the 12 months to April 2014. Previously considered a rich person’s disease, it is increasingly an indicator of poor diet and deprivation. The highest rate of admissions for gout was in Greater Manchester, at 15.0 per 100,000 population.

Tuberculosis (TB) is also on the rise, with London leading the way at a rate of 15.3 admissions per 100,000 population.

The rate of admissions for gout and TB were greatest in areas of deprivation. There were 13.5 gout admissions and 16.5 TB admissions per 100,000 population in the top 10 percent most deprived areas in the country, compared to 8.3 gout admissions and 1.4 TB admissions per 100,000 population in the 10 percent least deprived.

While malnutrition had fallen as the primary diagnosis for hospital admissions from 683 in 2012-13 to 612 in 2013/14, “during the same period there was an increase in overall admissions where malnutrition was a primary or secondary diagnosis, from 5,590 to 6,690.”

In the five years between 2009-10 and 2013-14 there had been a 71 percent rise in hospital admissions where malnutrition was a primary or secondary diagnosis, the HSCIC stated.

Writing in the Guardian, Middleton referenced the rise in other diseases, thought largely eradicated, such as whooping cough and measles. Their return is a “barometer of failure and neglect,” he said, “…a civilized nation with an advanced economy and health system should see some conditions as markers for the failure of its public health policies or services.”

The National Health Service (NHS) currently evaluates “never events”—serious, largely preventable patient safety incidents—as quality of care markers, he continued. “The time has perhaps come for us to develop never events in public health.”

TB and rickets must be regarded as such “never events,” Middleton warned. They are the “strongest markers of both Victorian disease and public health never events.”

Strikingly, hospital admissions for scarlet fever have doubled. “…Historically scarlet fever is a disease of deprivation, tamed by antibiotics. It manifests long cyclical rises and falls over 40 years--the rise may be part of that cycle. But we should be concerned we are seeing a period of enforced deprivation, with the biggest cut in average wages since [Charles] Dickens’ era,” wrote Middleton.

By the general election in May 2015, workers’ wages are expected to have fallen by the greatest amount since the 1870s, just shortly after the death of Dickens, one of the most powerful literary chroniclers of poverty and deprivation in Victorian Britain.

The massive decline in wages is the twin result of the savage austerity measures introduced by the Conservative-led coalition and the efforts of employers to utilise the financial crisis to erode wages and conditions.

Welfare benefits have been slashed, leading to an explosion in the numbers having to rely on food bank charities to eat. The Trussell Trust reported that the numbers it supplied with emergency food had risen by 163 percent in the year to April 2014, meaning more than 900,000 people were dependent on aid to eat.

These include a large number of the working poor. The vast majority of Britain’s poor are in families headed by a working adult. In addition to declining wage rates, they have been hit by the government attack on benefits.

According to the housing charity Shelter, some 880,000 working parents in England skip meals to pay other bills. In addition, 37 percent of working parents reported having to cut back on buying food—some three million parents.

There has been a large increase also in the number of “breakfast clubs” providing school children with their first meal of the day. Carmel McConnell, of the Magic Breakfast charity, which provides free breakfasts to 8,500 schoolchildren, told the Guardian that teachers were expecting to see a “dramatic decline in the health of their pupils” as they return from their summer holidays.

“Teachers tell us they know even with free school meals it will take two to three weeks to get their kids back up to the weight they were at the end of the last school term because their families cannot afford the food during the holidays,” she said.

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