The trap of blaming poverty: At last, says Digby Anderson, a pernicious 13-year-old myth has been laid to rest

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DOES poverty kill? Silly question. Of course it does. Just look at those poor people in Somalia. You don't have to be an expert to see how the lack of clean water, sanitation, food, immunisation and shelter associated with poverty is killing people, not only in Africa and Asia but in the former Communist countries. Nor do you have to be a historian to know how poverty killed in Britain in earlier centuries.

But what about the 12 million people in Britain today, nearly 25 per cent of the population, who are deemed to live in poverty? These families have sole use of a lavatory (nearly 100 per cent of the population), a bath or shower (98 per cent), and central heating (78 per cent). Theyare categorised as poor because they have less than half the average British or Western European income.

Are these people, whose incomes their grandfathers would have thought rich and who are the envy of three-quarters of the world, dying from poverty? Does this weird new strain of 'poverty' kill?

Of course not. Such people may lead hard, frustrating lives, but they do not die from 'poverty'. That is common sense.

This expert-invented relative 'poverty' is simply not characterised by the absolute physical factors that kill. You die from physical causes, not from relative comparisons. Common sense also tells you that while the raising of living standards from 1860 to 1960 may have done more to extend life expectancy than curative medicine, any further increase will not automatically deliver a further extension. Moving from a damp slum to a three-bedroom semi may improve your health. Moving from the semi to a mansion won't.

But, as so often, the experts, especially the social scientists, are trailing behind common sense. This week, after a decade of bien-pensant insistence that British-style poverty is fatal, an expert study is published that buries the myth that low income kills. This myth was based on the Black report (Inequalities in Health by Sir Douglas Black), published on August bank holiday Monday in 1980. Now, Dr James Le Fanu's study, A Phantom Carnage - published by strange coincidence on yesterday's bank holiday - effectively ends 13 years of misled public debate.

Black was famous for two assertions: that 'the unskilled have a higher rate of death than their better-off counterparts'; and that poverty makes the children of unskilled workers twice as likely to die in their first year.

The statistics themselves were correct, but they do not justify the insistent interpretation that contemporary British 'poverty' causes 75,000 deaths a year and that lots more taxes, handouts and government interference in the economy could save these lives.

The Black report itself referred to this as the 'materialist' thesis: that social class is the key to ill health. And it argued that the class divide on health was widening.

The interpretation is wrong. This is, first, because the number of people in the lower social classes has shrunk dramatically. In the 40 years before Black, numbers in social classes I and II increased by 78 and 52 per cent, while those in IV and V fell by 29 and 35 per cent. Maybe the lower classes as classes still had worse health, but the numbers suffering from that worse health fell. Thus class did not worsen the health of nearly as many people as before.

Second, and more important, over the last 50 years or so, the deaths most closely linked with income and poverty - child deaths - have declined drastically as a proportion of total deaths. They have been replaced by deaths due to diseases of comparative old age - cancer and heart disease - which are not known to be income related. In 1921, 27 per cent of deaths were child deaths (ages 0-14 years): in 1983, just 1 per cent.

Sir Douglas Black was right that the children of the unskilled are more likely to die in their first year. But the absolute numbers are tiny compared with those in the Twenties. Thus the numbers of infants surviving per thousand live births are, for class 1, 993, and for class V, 987.

The single most important cause of this tiny absolute variation is Sudden Infant Death Syndome, or cot death, which is probably related not to income but to sleeping position. With the deaths of older adults, the only diseases known to be class-related are smoking-related diseases. But here the cause of ill health is not income but behaviour. Diet, often mentioned, is not an obvious explanation for class variations in death. The mean cholesterol level of class I is actually higher than that of class V.

Dr Le Fanu does not totally exclude income as an explanation. Childhood accidents and damp may play a minor role. But the overwhelming conclusion is that explanations for such class variations as exist in ill health must be sought in genes and culture, not in income. Moreover, the actual variations are very small: 'three-quarters of all adults now live out their natural lifespan'. How many deaths does Dr Le Fanu conclude are poverty-determined, if not Black's 75,000? 'Nearer 75.'

This long-standing evidence that the true figures were much lower than in the Black report, one might have thought, would have been greeted with gratitude. But if the statistics are potentially so cheering, why have so many social scientists kept on whingeing for more than a decade since Black?

The explanation often given is that many commentators after Black were biased against capitalism and for socialism and that, if the thesis that ill health is related to class were true, it would provide them with ammunition to both denounce capitalism and promote socialism. Perhaps.

Certainly the notion Black calls materialist - the idea that income determines health - is not far from that corner-stone of Marxism-Leninism, economic determinism. The collapse and discrediting of systems overtly wedded to egalitarianism means that there are few economic arguments left for thoroughgoing income redistribution and state interference.

All the more reason to hang on to a health argument, particularly one that, with a few relativist contortions, will permit the continued use of the emotive word 'poverty' to describe some of the richest people in the world.

More generally, the poverty lobby has long espoused a 'victimology' in which those who suffer never do so because of their own behaviour, but because others have imposed suffering on them: governments 'allowing' poverty-induced ill health.

But there may be a simpler explanation. If there is one thing certain intellectuals and experts hate more than the economic system that has made their country wealthy and healthy, it is common sense. And in this case common sense was right when they were wrong. Common sense knows the difference between Somalia and London, and between 1840 and 1993.

A Phantom Carnage, Dr James Le Fanu, pounds 5.50, from The Social Affairs Unit

(071-637 4356).

(Photograph omitted)

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