Page last updated at 02:00 GMT, Friday, 11 September 2009 03:00 UK

No change in health gap from 1900

Graveyard generic
In 1900, a third of all deaths were in under fives

The link between poverty and early death is as strong today as it was a century ago, a study shows.

Despite major changes in the causes of death since the 1900s, the association between deprivation and mortality remains "firmly entrenched", it found.

It is possible that the health effects of poverty have passed through the generations, wrote Dr Ian Gregory in the British Medical Journal.

One public health expert said inequalities may have even got worse.

The extent to which the association remained was surprising
Dr Ian Gregory, study author

Dr Gregory, a senior lecturer at the University of Lancaster, looked at census and mortality data from England and Wales from the 1900s and compared that with data from 2001.

His figures highlight the dramatic improvement seen in early deaths over the past one hundred years.

In the 1900s, 33% of deaths occurred in the under fives and only 13% occurred over the age of 75 but a century later deaths in the under fives account for less than 1% and 65% of deaths now occur in those over 75.

Life expectancy has also improved, rising from 46 to 77 in men and 50 to 81 in women.

He also found that the causes of death had changed markedly with respiratory, infectious and parasitic diseases heading the table in the 1900s compared with cancer, heart disease and stroke in 2001.

Changimg causes of death


Dr Gregory then compared the mortality rates in areas of high deprivation in the two time periods.

Although people's experience of poverty changed over the years - in the 1900s it meant not having the bare necessities for existence but a century later poverty is defined as relative to society as a whole - the association between deprivation and high mortality did not change.

This is despite widescale reforms such as the introduction of the NHS and social security in addition to large rises in standards of living and huge advances in medicine, he said.

He added that patterns from the Edwardian era are still strong predictors of ill health today.

"The extent to which the association remained was surprising," he said.

But he said it did not necessarily mean that initiatives to reduce health inequalities had not had an effect.

"The unknown factor is what would have happened if we hadn't done anything - could things have got much much worse - and I suspect they could have done.

Professor Alan Maryon-Davis, President of the Faculty of Public Health said to some extent the gap may have got even worse in recent years.

"In the 1900s, it would have been infectious diseases but now it's more about chronic diseases linked to lifestyle.

"The health threats may have changed, but the gap between the haves and have-nots is still there, and so too is the difference in mortality.

"This research really drives home the message that the surest way to reduce the health risks of poverty, is to reduce poverty itself."

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