After a century of medical advances: Poor still die in higher numbers

Slide1In a study reported earlier this fall,(1) Ian Gregory examined the geographical relation between mortality and deprivation in England and Wales at the start of the 20th and 21st centuries. He used census data from 1900 and 2001 to compare mortality rates while evaluating the association of those deaths with deprivation. This researcher was investigating whether the well-known relation between economic deprivation and death showed any significant changes over an entire century. It didn’t — a damning expose of the myth of medical triumphalism.

Gregory calculated standardized mortality ratios for all census districts for both periods. He used the Carstairs Index, a measure of deprivation, to compare deprivation in these districts in the early 1900s and 2001. He had data on 614 districts and was able to calculate correlation statistics between the deprivation scores and SMRs in the 1900s and 2001.

What did he find? No significant difference in the relationship between deprivation and death between the start and the finish of the 20th Century. At the start of the 21st Century, populations with the highest deprivation scores — working people and oppressed minorities — have the highest death rates. It’s the same pattern that obtained at the beginning of the 20th Century.

Western medicine and health care delivery has changed dramatically over the course of the last century. Huge social, economic, and political changes also have taken place. Yet, one essential fact remains: social inequity continues to exist, and this social inequity is the root cause of health inequities like the increased death rates among working people and racial and ethnic minorities.

(1) Ian N Gregory
Comparisons between geographies of mortality and deprivation from the 1900s and 2001: spatial analysis of census and mortality statistics
BMJ 2009;339:b3454, doi: 10.1136/bmj.b3454 (Published 10 September 2009)

Saturday, November 14th, 2009 at 17:32