Updating Edwin Chadwick's seminal work on geographical inequalities by occupation

Mark A Green,Danny Dorling,Richard Mitchell

doi:10.1016/j.socscimed.2017.11.055

Mark A Green, Danny Dorling + Show 1 more

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https://doi.org/10.1016/j.socscimed.2017.11.055

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Abstract

To honour the 175th anniversary of Edwin Chadwick's seminal ‘Report on the Sanitary Conditions of the Labouring Poor’, we update Chadwick's famous analysis of geographical differences in occupational based inequalities. Much of the field of Health Geography owes both its direction of development and its initial impetus to his 1842 report. The report presented evidence for the importance of local context to health, with individuals of the lowest occupations in Rutland living longer than individuals of the highest occupations in Liverpool. Here we update the 1842 analysis using data from the Office of National Statistics on individual mortality records by occupation (2010-12) and population data from the 2011 Census. Sex-specific directly standardised premature (16-74) mortality rates were calculated for hierarchical occupational categories similar to Chadwick's categories, for the nearest equivalent areas to those used in Chadwick's report. Although there is no longer consistent evidence on individuals in the lowest occupational group having lower mortality rates than those in the highest group, there were clear social gradients in mortality within each area and the extent of these inequalities varied between areas. Individuals who live in Rutland had lower premature mortality rates across each occupational group compared to the other areas. Our results demonstrate that while life expectancy has nearly doubled since Chadwick's report, social and spatial inequalities in health have persisted. We suggest that Chadwick's legacy on the importance of locality continues.

Highlights

175 years ago, Edwin Chadwick published his seminal work ‘Report on the Sanitary Conditions of the Labouring Population of Great Britain’ (Chadwick, 1842). His painstaking documentation of statistical evidence of social and spatial inequalities in health and insanitary conditions was one of the earliest examples providing evidence based public health advice, and the findings provided the foundation for later advances made in the field by key figures such as William Farr
There is evidence of a clear social gradient by occupation, whereby premature mortality rates were larger in the ‘lower’ occupational group compared to the ‘higher’ occupational group. These mortality differences by social group were consistent within location and sex, with premature mortality rates being roughly 2-3 times larger in the ‘lower’ occupational group compared to the ‘higher’ group
While life expectancy has nearly doubled since Chadwick's report (Woods, 2003; Office for National Statistics (ONS) 2014; Szreter, 1997), social and spatial inequalities in health have persisted

Summary

Introduction

175 years ago, Edwin Chadwick published his seminal work ‘Report on the Sanitary Conditions of the Labouring Population of Great Britain’ (Chadwick, 1842). His painstaking documentation of statistical evidence of social and spatial inequalities in health and insanitary conditions was one of the earliest examples providing evidence based public health advice, and the findings provided the foundation for later advances made in the field by key figures such as William Farr. Chadwick utilised data on the average age of death by occupational group for five areas within England (Table 1) (Hanley, 2002) He did this to make a persuasive argument about the importance of local context in affecting health outcomes. There was a clear interaction between geography and socioeconomic position; individuals of the lowest occupational group in Rutland could expect to live longer lives compared to those of the highest occupational group in Liverpool

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