It’s Inequality, Stupid!
Our minds are now focused on the effects and deaths that will be caused by the Covid-10 virus. It has reminded us of our shared humanity. Austerity and the drift to a gig economy is now beginning to seem to more people to be reckless. This could be a good time to remind ourselves of the underlying trends of worsening health for some groups of people in this country, including babies, that have largely gone under the radar.
Recent headlines reminded us that, ‘Inequalities are a matter of life and death – but exist as they do by political choice.’ (The Guardian, 25 February 2020). On the same day a landmark study, The Marmot Review - ten years on drew our attention to the drop in life expectancy that has poor women in the UK leading shorter lives. What got less attention from the press were deaths of babies. Our rates in the UK for infant mortality, as well as life expectancy, are not good. When compared to other countries in Europe, we are practically at the bottom of the Western European league table for both infant and child mortality. There are difficulties with international comparisons: they are not straightforward. Countries like the UK with relatively robust reporting systems can appear worse than they are, we are not always comparing like with like, but when we look at the increase within the UK the picture is stark and bad. Although by 2013 it had become clear that across the planet parents are experiencing the fastest decline in infant mortality that has ever occurred in all of human history.
In March 2018 it was reported that UK infant mortality had risen significantly for two years in a row following austerity and spending cuts. Rates have risen for children born into poorer families in a way that would not have been considered believable a few years ago. The last time this happened was in 1939 – 41 during World War 2, but we are no longer shocked by shocking events and currently attention has been focused on failure within the NHS, on doctors and midwives failing to save babies lives, or on demographic changes i.e. women are older fatter and ‘iller’. But to understand this, rather than listening to media reports looking for health professionals to blame, or to the government pointing to women’s individual behavior as a source of the problem, lets look at what geographers have to say.
In Peak Inequality: Britain’s Ticking Time Bomb, Danny Dorling, a geographer who has been studying mortality records in the UK for the past 30 years, sets out the arguments showing the impact of inequality on health outcomes. In the UK, as in the US, we are bucking worldwide trends. (He quotes some fascinating research that shows that more babies die during a Republican government than under a Democratic one, and suggests that it is similar here).
Infant mortality rising for 2 years in a row has confirmed the concerns first raised in the British Medical Journal by Taylor-Robinson et al in 2017.
In discussing infant mortality. Dorling says:
‘In England and Wales this rise was concentrated in the years of maximum spending cuts. In 2014, 3.6 babies died for every 1.000 born. That rose to 3.7 in 2015, 3.98 in 2016 and 3.9 in 2017….Scotland by contrast had the same infant mortality rate as England and Wales in 2014 but by 2018 it had been reduced to 3.2 per 1.000 births. This did not happen by chance. Having decided to invest in mothers and babies the Scottish government diverted funds from other areas to ensure it did so’.
Among countries of the European union between 1990 and 2015 the UK dropped from 7th to 19th place for neonatal mortality and from 9th to 19th for under-5 mortality. It will be worse placed now, following two years of rises. This is quite simply because the UK has the highest inequalities between rich and poor in Europe. The figure that illustrates this most clearly is that for infant mortality rate by social class. Up until 2009 infant mortality was falling in every social class but at that point, as austerity started to be felt, the rates for professional and intermediate classes continued to fall but for the manual class it has risen sharply and suddenly as the impact of austerity has fallen primarily on the poor. This cannot be explained by the under resourcing of the NHS, or the changing behavior of women, although those factors exist.
The political choice to pursue austerity has had devastating effects. Public spending has reduced from 41% of GDP in 2006 to 36% at the end of 2019. (just above that of the US). We have been distracted from this by Brexit but now the outbreak of Covid-19 has meant that we are all looking at how many people will die directly as a result. We’re also aware of the excess deaths already caused by austerity, (possibly between 120,000 and 150,000), and the extra mortality in a society weakened by an under-resourced health and social care sector. All of which disproportionately affects the babies of the poor.
The moral we can grasp from learning from geographers is that we should resist blaming doctors, midwives and women and create a more equal society. The present pandemic might help us to do just that.