The claim
“Health inequalities in 21st century Britain are as wide as they were in Victorian times”
Prime Minister David Cameron, speech on modern public service, 17 January, 2011
The background
David Cameron spoke today of his “burning impatience” to modernise the UK’s public services.
But in his impatience, did the PM overlook the facts? Is our health really worse than in Dickensian times?
The analysis
The biggest problem with pitting modern day Britain against the Victorian era, is that they collected rather rough and ready information.
The Victorians threw a wide lasso over the gentry and the professional classes, and compared the whole group to the “labouring classes”.
Today, not only are less than 5 per cent of working men “labourers”, but we have a much finer gradation system.
The only comparable figures we can rely on begin in 1921, Professor Peter Goldblatt, a member of the Marmot Review team told FactCheck (an independent review into the health inequalities in England, led by Sir Michael Marmot and commissioned by the Secretary of State for Health.)
There are no national figures pre-1921 and before that, there was no data at all collected from 1900 to 1919, so we can’t make any comparisons to that period, Danny Dorling, Professor of human geography at Sheffield University, told FactCheck.
And looking back further than 1900, there are no “absolute” comparables, there are only “relative” comparables – otherwise known as estimates.
So Mr Cameron is on dodgy ground already – because there isn’t a right or a wrong way to report the subject, George Davey-Smith, Professor of Clinical Epidemiology at the University of Bristol told us.
Downing Street has yet to reveal to FactCheck which research Mr Cameron was using, but Professor Dorling says very little has been done on the matter.
The easiest comparisons researchers can make between the Victorians and modern Britain is on death rates.
Professor Dorling points out that in the 1880s it was pretty bad for all walks of society; for the well to-do one in ten babies died before celebrating their first birthday. Meanwhile, one in four working class babies died in the same time period.
Over the Twentieth Century there were dramatic mortality falls, after the Victorians realised the only way to improve the nation’s chances of surviving disease, was to improve it for everyone. In 2009, infant mortality was 3.3 per 1,000 births in the professional class, and 5.6 per 1,000 for the manual laboured class.
Everyone was healthier, but what happened was the relative gap between the social classes rose – so whether you were affluent or poor began to matter more.
If you take pockets of society, making “relative” comparables, then yes you can find people worse off. But that’s because the gap between the social classes has widened.
To say society as a whole today is worse off than in Victorian times is an overly sweeping statement, Professor Goldblatt told us.
The verdict
David Cameron is right to highlight the gap in health inequalities – which is worse than at any time since comparable national records began in 1921.
The geographical gap, in health, in the lead up to the economic crash of 1929 and the depression of 1930s was almost as bad as today, but not quite, according to Professor Dorling.
If the Prime Minister had claimed that health inequalities were worse than at any time since the 1920s, he’d have been on firm ground.
But he stretched it too far. There’s no water-tight evidence to show that 2011 holds a mirror to Victorian times.
Ultimately, it’s far better for your health to be poor now than it was to be rich back then – but the social gap between the rich and poor was closer back then.
