"The Ghost of Christmas Past"

Report shows health gap between Britain's rich and poor still as marked as in Dickens' day

A paper published in the British Medical Journal (BMJ) just before the Christmas holiday shows that the health gap between rich and poor is as wide today as it was in Charles Dickens' time. The authors of The Ghost of Christmas Past: health effects of poverty in London in 1896 and 1991argue their study shows that the passage of 100 years has had “almost no impact on the patterns of inequality in inner London and on the relationship between people's socio-economic position and their relative chance of dying”.

The paper begins with a quote from Dickens' book A Christmas Carol, written 150 years ago, describing Scrooge's journey with the Spirit of Christmas Yet to Come:

"They [left the busy scene] and went into an obscure part of town where Scrooge had never penetrated before, although he recognised its situation and its bad repute. The ways were foul and narrow: the shops and houses wretched: the people half-naked, drunken, slipshod and ugly. Alleys and archways like so many cesspools disgorged their offences of smell and dirt, and life upon the struggling streets and the whole quarter reeked with crime, with filth and misery".

The study compares the extent to which patterns of mortality in London at the end of the 20th century can be predicted from late 19th century patterns of poverty in the capital.

The authors take their starting point from the groundbreaking social survey conducted by Charles Booth in 1886, which he then massively expanded over the following years. Booth, a wealthy English ship owner and social reformer, published his survey in 17 volumes as the “Life and Labour of the People of London” between 1889 and 1903.

Booth spent a great deal of his own money on the project and his findings were produced with the aid of a series of “poverty maps,” giving a street-by-street picture of deprivation in the capital. His survey showed that more than 31 percent of London's population lived in poverty, and he became a staunch advocate of state support for the needy and the introduction of an old age pension.

The BMJ paper matches Booth's poverty maps to modern-day records based on the 1991 census, and in doing so is able to compare patterns of social deprivation.

"For many causes of death in London, measures of deprivation made around 1896 and 1991 both contributed strongly to predicting the current spatial distribution. Contemporary mortality from diseases which are known to be related to deprivation in early life (stomach cancer, stroke, lung cancer) is predicted more strongly by the distribution of poverty in 1896 than that in 1991.”

The authors looked at one street—Providence Place, in Islington, North London—to see if conditions had altered much over the course of a century. They noted that although the number of people living there had fallen, and that an open drain had been covered over, “the social position of Providence Place in the geographical ranking of London streets remains much the same.”

The status of many London districts has changed little since Dickens' day: “Millionaires' Row” can still be found in the wealthy suburbs of Hampstead and the East End remains largely synonymous with poverty and poor housing. The “gentrification” of some London boroughs only means that the pool of affordable housing for those on average or low incomes has become even smaller.

The study concluded that it remained a fundamental social fact that people living in poverty-stricken neighbourhoods would die earlier than those living in rich areas. This fact was "so robust that a century of change... has failed to disrupt it."

Danny Dorling, one of the paper's authors and Professor of Quantitative Human Geography at Leeds University told the press, "The most remarkable thing is how 100 years of social policy have failed to narrow the gap between rich and poor. All the 1906 Liberal government of Lloyd George and the 1945 Labour government achieved were to prevent it getting wider."

This research paper is only the latest to highlight the growth in social inequality and its link to poor health and mortality. In 1999, Dorling and others undertook a comprehensive study entitled the Widening Gap, looking at the period 1981-96. Their findings revealed an even greater mortality gap based on social class than had previously been reported.

Dorling and his fellow researchers have been critical of the Labour government's claims to be reducing health inequalities. In a letter to the BMJ following Labour criticism of their 1999 study, Dorling and his co-workers said, "We suggest that on current evidence the government is doing little to reduce inequalities in material standards of living”.

Their letter concluded, “If the government's commitment to reducing inequalities is to be fulfilled a more concerted effort to reduce poverty and income inequalities is needed. The government has reluctantly agreed to increase the national minimum wage but by less than the increase in average earnings and hence the income gap will continue to grow. Benefits and pensions need also to be increased so that people who cannot work can share in the increased wealth and prosperity that most people in Britain are enjoying.”

One of the most vulnerable groups to suffer poor health and above average mortality rates is the homeless. Labour's establishment of a rough-sleepers unit headed by a so-called “Homelessness Tsar” was supposed to herald an improvement in the conditions of those forced to sleep on the streets. Launching its winter appeal for the homeless, the charity Crisis said of the 800 people who had slept in their shelters, 134 had gone 12 months without medical treatment. They confirmed that the homeless were much more likely to suffer from ailments such as tuberculosis, heart problems and diabetes. When the charity said that there were still not enough beds to house all the homeless, the government accused it of “scare mongering”.

The BMJ paper concludes, “The key message of A Christmas Carol —that redistribution of wealth reduces inequalities in mortality—is as relevant today as when it was written 150 years ago; the fact that inequalities in health persist and match the 19th century pattern of inequalities in wealth so well, suggests that the message has yet to be heeded”.

New Labour has shown itself to have very deaf ears on this issue. Indeed, its policies are actively increasing the gap between the rich and poor, a fact that is confirmed in the latest release of the government's own “Social Trends” statistics, which showed income differences had widened under Labour.

When he came to power, Prime Minister Tony Blair pledged that his government would "think the unthinkable". He has been true to his promise. Labour has pursued with a vengeance the same free market policies started by Thatcher and continued under the Major Conservative government. Despite its call to end child poverty "within a generation," Labour has attacked so-called expensive welfare provisions. The latest Social Trends figures show that 25 percent of all children in Britain today live in low-income households.

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The BMJ paper The Ghost of Christmas Past: health effects of poverty in London in 1896 and 1991 can be viewed at http://www.bmj.com/cgi/content/full/321/7276/1547

Two useful sites about Charles Booth: