Leading article: In death we are divided. So much for progress

Click to follow
The Independent Online
Before the First World War death rates were a powerful if crude indicator of social conditions, especially in Britain's cities. But today? For the Joseph Rowntree Foundation to worry about mortality tables at the end of the 1990s seems rather eccentric. The nation's vital signs are good. National income continues to grow and the general level of public health to rise. The average man is now a third less likely to die in any given year than in 1950, the average woman a quarter less likely. What better sign of improvement all round than more life itself?

But the latest Rowntree study has looked underneath the aggregates, at death in actual places. It does not seek to deny the general improvement - it couldn't. What it is after is difference. It is not just that there are places where babies are more likely to die than in others, and that in those same places the old, too, are more likely to die younger. What the study finds is that the places where life expectancy is significantly lower than average are the same as they were a generation ago, and probably the same as when the Rowntree family began its inquiries in the Edwardian era. The places at the head of the list are well known: Glasgow, Hackney, Southwark, Manchester, Tower Hamlets. It also includes Rochdale, Oldham, Gateshead and Stirling. They are all different but have in common a greater likelihood that their residents die prematurely.

And the gap between good and bad places seems in recent years to have increased. To report that life in Buckinghamshire and Surrey is more benign than in Greenock or Salford is to note an obvious and seemingly permanent fact of our social geography. But to discover that life, relatively speaking, is getting no better in the latter defies the expectation that a modern society necessarily becomes more homogeneous, and that in the long haul there is a process of convergence.

Today's study by Daniel Dorling at Bristol University is another blow to that confidence. It is an adjunct of Rowntree's recent big study of income difference, and it says loud, clear and incontrovertibly that modern Britain shows disturbing signs of growing inequality. Disturbing, that is, because growing inequality does nothing identifiable for economic growth while it stands as a proxy measure of growth in criminality and widespread educational and social underperformance.

We die unequally. The Rowntree study avoids emotive language. It adjusts death rates for age; its talk of "excess deaths" simply records a statistical phenomenon, that more deaths occur in the bad areas than national averages would predict. But at its heart there is a moral point: it is unfair that a resident of Glasgow is a third more likely to die prematurely than a resident of Bristol. It is even worse that Glaswegian adults had a higher mortality rate in the early 1990s than Bristol adults did in the early 1950s. So much for progress.

The point is not that these disparities offend some abstract notion of equality. They certainly do not hinge on the idea that all areas should or can be the same in terms of the life chances they offer residents. They are worrying because they expose social waste. The figures show the squandering of human lives in a society whose real resource - only resource - is its people. They also expose grave failings in public policies, notably for health, meant to guarantee reasonable equality across the country.

Evidence showing why mortality rates are so skewed is at hand. High death rates are closely associated with position in the league tables for illness, lack of material resources, unemployment. People with jobs tend to live longer. It may not be a very original conclusion but it is inescapable - the more jobs, the more people are encouraged to take those jobs, the healthier everyone will be. These figures for mortality ought to be read and remembered by those economists, City brokers and bankers who are wont to talk about unemployment as a price worth paying. They are also required reading for policy-makers, especially those, including the Chancellor of the Exchequer, confronted with demands for more health spending. It's not GPs and hospital appointments that keep people alive (on the average!) but people's capacity to look after themselves on the basis of a reasonable, work-derived income.

Chancellor Gordon Brown might say that his welfare-to-work programme is a start, a way of breaking inter-generational patterns of poverty and disease. But it will need to recognise how certain communities are going to need more than sticks and carrots to get people into jobs: they are going to need real employment opportunities within reasonable travelling time.

It would be easy to say, on the basis of the deterioration in mortality in certain areas over the past decade and a half, that all this is a Tory responsibility. That is a charge for the hustings, where argument would also have to recognise that unemployment is continuing to fall, even in those areas worst hit by cuts and closures in the last two recessions. That means, among other things, fewer children growing up in households where nobody works for their living - itself a remarkably powerful predictor of social malaise present and problems to come, the indicator of when we die.

What Labour needs to focus on, as it talks bravely of regional development agencies, is how within a single region there can be great disparities in mortality rates and economic success between nearby communities. Take the North-west, and the different fates of next-door St Helens and Liverpool. The Rowntree data suggest place does matter. Individual communities appear to have specific characteristics which may help explain their fates. This means there will have to be fierce targeting of spending on health, education, training and jobs.