Sunday, 3 July 2011

How do we get healthier?

I've just finished reading Richard Wilkinson's 1997 book 'Unhealthy Societies', which explores similar themes (but is more health-related) than his co-authored book with Kate Pickett, called 'The Spirit Level'.

On page 114, Wilkinson produces a remarkable table which shows the additional increases in life expectancy in England and Wales throughout the twentieth-century (i.e. the additional years added to average life expectancy in each decade). I've reproduced the table below (male figures are in the left-hand column, female in the right):

1901/11 4.1 4
1911/21 6.6 6.5
1921/31 2.3 2.4
1031/40 1.2 1.5
1940/51 6.5 7
1951/60 2.4 3.2
1961/71 0.9 1.2
1971/81 2 1.8
1981/91 2.4 2

What is so interesting about the above table is that the largest increases in life expectancy happened during the two decades (1911/21 and 1940/51) when Britain was engaged in world wars. In other words, life expectancy increased most dramatically at a time of shortage, rationing and austerity. Such trends would run contra to what many of us would expect in the relationship between health and economics: more growth, less shortage, better health.

Why might this be? For Wilkinson, the reason life expectancy improved so dramatically is the different form of socio-economic organisation that war time demanded. Full employment was a necessity, income differences narrowed dramatically and the logic of the market was replaced by what Wilkinson calls "a deliberate policy designed to foster a sense of social unity and co-operation". In other words, individualism and social division were actively discouraged in favour of social cohesion and cooperation.

Much more research needs to be on the relationship between income inequality, market economics, social cohesion and health before anything like a causal relationship can be established. Nevertheless, if such relationships can be shown,they will raise extremely fundamental questions about the future for advanced, rich countries. It may mean that the centuries-old link between economic progress and social advancement is over.

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