Sadly the cretins are out in force again. This time it’s a repeat of the really stupid assumptions underlying socioeconomic inequality and premature mortality. This is just so obviously wrong that it’s astonishing that the medical profession takes it seriously. But, sadly, they do, and thus so do other people.
The problem is that they ascribe the difference in premature mortality to socioeconomic inequality. Which would be wrong even if we were to use poverty itself, not just inequality, as our problem to be avoided. Because, obviously enough, ill health is a contributor to socioeconomic inequality. The basic building blocks of the logic being used here are simply wrong:
We used mortality records from the UK Office for National Statistics to study all 2 465 285 premature deaths (defined as those before age 75 years) in England between Jan 1, 2003, and Dec 31, 2018. Socioeconomic position was defined using deciles of the Index of Multiple Deprivation: a measure of neighbourhood income, employment, education levels, crime, health, availability of services, and local environment. We calculated the number of expected deaths by applying mortality rates in the least deprived decile to other deciles, within the strata of age, sex, and time. The mortality rates attributable to socioeconomic inequality was defined as the difference between the observed and expected deaths. We also used life table modelling to estimate years-of-life lost attributable to socioeconomic inequality.
No, we can’t do that.
OK, let’s run with the basic idea though. The Spirit Level is correct. The mere existence of inequality kills people. Our hearts burst in jealousy at the idea that someone else has one more pair of Air Jordans than we do. Alright, we’ve ceded the idea that some deaths occur as a result of socioeconomic inequality. Can we thus say that all deaths correlated with socioeconomic inequality are caused by it?
Nope, we can’t. Because ill health itself will be – at least sometimes – a cause of socioeconomic inequality. Having some ghastly disease that stops you working in your 40s, the prime earning years for near all of us, will mean that you are poorer than if you didn’t have simoncowellitis or whatever it was. Even fully recovered you’re going to be poorer.
This is at the heart of the mistake that Michael Marmot has been making all these decades. Illhealth is a contributor to inequality therefore we cannot ascribe all inequality related illhealth to the inequality. Some perhaps, we’ve acceded to that above. But not all. Therefore any counting trying to ascribe all is wrong. Flat out, simply, wrong.
Chris Snowdon has more interesting and more complex arguments against the idea. But we are still in a world where the basic logical assumption being made is not true. Therefore the results are toss.