It is a standard part of the current political conversation that lifespans are unequal in the UK. This has the merit of being true – people do indeed die at different ages, lifespans are therefore unequal. A further contention is that said lifespans are correlated with wealth, perhaps income, certainly socio-economic status. This also has the merit of being true.
However, the further claim that lifespan is determined by socio-economic status is not true – and therefore the insistence that we must equalise status in order to level lifespans is not either. For there are, as is so often true, two effects going on here. One is that yes, richer people probably do live in healthier places, eat better, exercise more, smoke less and so on. But it is also true that, through just some vicissitude of fate, a failure of health leads to a lower income. That middle aged man with the significant heart problem is going to have a lower income than if the problem did not arise. Long term sickness and an inability to work – or even just a lower likelihood of being promoted at work – will reduce income and thus that recorded socio-economic status.
That will also mean that sure, we can agree that poorer places might well be unhealthier places. But also that unhealthier people will self-select into poorer places as they’ve less cash to pay to live in those healthier ones.
We’ve those two effects. And the general conversation – Sir Michael Marmot and all that – insists that there is only the one, that it is socio-economic position that determines health and that alone.
There is a second problem here. I checked this with the Office for National Statistics yesterday:
You asked whether our localised life expectancy figures were based on place of birth or place of death – they are based on place of death.
This poses a significant problem for the way those local lifespan statistics are used in public debate:
Let’s take Marmot’s contention that life expectancy in the poorest ward of Kensington and Chelsea is 22 years lower than in the richest. As with the Marmot Review into inequality, this fundamentally misunderstands the way life expectancy is measured.
Imagine a world in which Boris Johnson had succumbed to coronavirus – would that have registered as a change in life expectancy in London or New York? It would be recorded as one in London, the place of residence at time of death, not the place of birth. For the numbers used to calculate lifespans across geography are years lived allied with place of death – not the place of birth.
At the national level this is fair enough, even if not totally accurate. Some 15% of the current countrywide population is foreign born, so measuring lifespan by age and place of death is only ever going to be some 85% accurate. When the attempt is made to narrow this down to council ward level it’s not going to be accurate in the slightest. The assumption being made is that some useful portion die in that same little geographic area containing 5,000 or so people that we were born into. This is simply not supportable.
Thus the linkage between place of birth and lifespan might well be there, logically it probably is, but it’s not something that shows up explicitly in the data. This also means that any claims about Sure Start and lifespan, early years education, even nutrition or income levels in childhood aren’t going to be well supported either. The data is collected in a manner that doesn’t allow the extraction of that information.
We do not know how socio-economic position in childhood influences lifespan. On the very simple grounds that we don;t collect the data that would allow us to extract that information. Whatever Marmot or anyone else says, we do not and cannot know.
Probably best not to base public policy on such ignorance eh?