Danny Dorling's Blog, page 12

Foreword to: S. Cohen et al. (Eds) Europe’s top 10% and income inequality,

There are times when it appears to be that almost everything is changing. Now might well be one of those times. This excellent and very comprehensive report details the concerns and desires of the best-off 10% of people in four European countries as measured before there was any hint of the current crisis caused by the 2020 pandemic. It combines careful quantitative and qualitative evidence to make a series of well-grounded and place-sensitive policy suggestions. The eight authors explain how the best-off in Europe are yet to be at all convinced that their take is disproportionate, or that their taking so much causes huge problems for others. It explains that Europe’s highest paid and otherwise remunerated are much more sympathetic to issues such as racial inequality, gender inequality, and wealth inequality; and that making reference to these issues was more likely to garner some sympathy from the top 10% rather than directly pointing out the inequities of some people being paid so much more than others. We have been taught to believe that ‘we are worth it.’

It is, of course, pointless to suggest that a single individual should sacrifice themselves, returning a portion of their income as some show of their piety. Apart from anything else, who would much notice? What brings income inequality down both effectively and equitably is greater proportional taxation or equivalent universal caps on extravagance. And when this is done, when the top 10% become less well-off together, they hardly notice it. They can live in the same houses, still hold the same rank position, but with less money, they are less wasteful. As this report shows, they are also safer, in Sweden the top 10% weathered the 2008 crash far better than elsewhere in Europe.

As this report goes on to show in great detail, the top 10% rely on public services as much, if not more, than everyone else. Without public higher education, their businesses could not function, their children would not be educated, their lives would be less enriched. This is the group who make by far the greatest use of public health services because they live the longest and are least likely to die a quick death at a younger age. Instead it is the best-off 10% who stagger on for the greatest time with the highest number of comorbidities. We at the top might wish for a more equitable future if those of us in this group thought a little more about how our final year of life might be like; often being cared for by people in the lowest 10% pay band in care homes (our successful children having migrated far away).

Finally, on top of all the recommendations made in this very detailed report I would like to add one more. That people in the top 10% are encouraged to think of their future grandchildren or great-grandchildren, or their great nieces and nephews if they do not have children. And think of the one that has least luck in life, who is ill on the day of the exam; whose marriage falls apart; who starts a business the year before unforeseen economic events bring it tumbling down. Rising into the top 10% is as much a matter of luck as falling a long way out of it is. Even if you do not give a damn for anyone you are not related to, a more equitable future society will protect both you in your old age, and your family long after you are dead. The alternative is not just inequitable – it is ignorant.

Professor Danny Dorling

University of Oxford, June 2020.

For a link to the full report and a PDF click here.

 

Cover of the Foundation for European Progressive Studies (FEPS) and TASC report on Inequality and the top 10% in Europe

Houses not homelessness

I wrote this chapter because homeless in my home city of Oxford had become not just a local crisis, worse than it had ever been, but also part of the national scandal. As I wrote at the end of April 2020, at a time of crisis, 90% of the people suffering homelessness in this city of Oxford have been housed by the local council and many are being helped to move on and off the streets and out of hostels after the pandemic; and again in January 2021.

If we can do this during the crisis, we can do it in more normal times too.

 

Bedding used by people sleeping rough outside the gates of Trinty College Oxford, June 2019

The death of Sharron Maasz, though the subject of a coroner’s inquest, would probably otherwise have passed unnoticed. I knew Sharron well. I taught her when I was head of her middle school. Her father, a single parent, was a friend and was for a number of years a governor. Sharron was a bright, lively and sensitive girl. She was a keen cyclist and an all-round athlete. This may be her only obituary.
She is quoted as saying: ‘I just want to get my life sorted … I always wanted to get clean.’
She didn’t get sorted or clean. Instead, she died in a short-term home, a last refuge provided for those in desperate need. She had been living alone on the freezing streets of our leading university city.
I do not have solutions. I only know that the dreams that Sharron, a lovely child, had until her death, have perished in the wreckage of an austerity programme that has literally killed her and her like. (Roger Pepworth, Headteacher, Marston middle school, Oxford 1983–91)

 

This letter, one of many in recent years, was published in The Guardian newspaper on 3 February 2019 (Pepworth, 2019). It stands out because, unlike the majority of articles or obituaries written about people who have died while experiencing homelessness, Sharron Maasz was named.

 

Anonymizing people who have died while experiencing homelessness, or shortly after having been homeless, has become commonplace, but is a practice that does more harm than good. Understandably, the families of the deceased do not want their loved ones to be remembered for having died on the streets or in a halfway house, but while we name those who have died in almost any other circumstance, we attempt to forget those for whom society has failed to provide adequate safety and security.

Furthermore, these deaths are often attributed to proximal causes, not the underlying pervasion of poverty or severe lack of adequate housing that evidence suggests create and exacerbate other health problems that lead to death. In doing so, we fail to recognise that UK housing policy has exacerbated homelessness by creating an environment of precarious inequality. Acknowledging this is the first step towards making progress. From there, we can use evidence and data to reverse the policies that have created the current situation. If we do not, there is a great danger that simply monitoring the situation (and reporting the numbers) is perceived as action that will only continue to support the status quo. Roger Pepworth, Sharon’s former teacher, ends his letter above by saying, ‘I do not have solutions …’. He should not have to; others should already be putting them in place. We know from other social policy fields that better use of evidence and data can lay the foundations to create tangible change.

 

 

Understanding the numbers

On 31 January 2019, the Ministry for Housing, Communities and Local Government (MHCLG) reported that an estimated 4,677 people were now sleeping rough on any one night in England, almost three times as many as in 2010 (MHCLG, 2019). These figures have long been disputed, with the true number estimated to be at least twice as high. In the same timeframe, the number of families housed by local authorities in temporary accommodation rose significantly, but at a lower rate, from 50,000 in 2010 to 78,000 in 2018. In London alone, there are 225,000 ‘hidden homeless’ people aged 16–25 arranging their own temporary accommodation with friends or family (Fransham and Dorling, 2018).

Reporting on its own rough sleeping initiative (RSI) in the same publication, MHCLG claimed: ‘There were 2,748 people recorded as sleeping rough across the 83 RSI areas in autumn 2018, this is a decrease of 639 or 23% from the 2017 figure of 3,387 (MHCLG, 2019). As the total figure for England hardly changed over this time period, there will have been a similar rise in those areas where the initiative was not undertaken. This could have been for many reasons, which might include people being displaced away from the 83 RSI areas to be homeless in other areas of England. MHCLG’s report on itself continued:

An evaluation of the Rough Sleeping Initiative will be published this year to help understand the impact of the range of activities in these areas on the number of people sleeping rough. There are a range of other factors that may impact on the number of people sleeping rough including the weather, where people choose to sleep, the date and time chosen and the availability of alternatives such as night shelters.

The government ministry did not mention its overall approach to housing as a potential problem, let alone that it is in fact one of the most significant factors. This is not surprising. If they realized that they were part of the problem they would surely have done something about it by now – unless the view of the ministers in charge is that some level of homelessness is necessary or inevitable.

This is not a phenomenon limited to the MHCLG. In 2017, there were estimated to be 527 deaths of homeless people in England and Wales (ONS, 2018). The Office for National Statistics (ONS) reported these numbers in December 2018, and said that:

Understanding a problem is the first step to solving it, and producing these statistics will help society make better decisions to tackle homelessness and stop homeless people dying in our communities (Brimblecombe et al., 2019). These statistics aren’t just numbers, behind each death is the story of some of the most vulnerable members of society. (Humberstone, 2018)

So what is the next step? Counting the rising number of deaths with increasing accuracy is certainly essential, but only illustrates how large the underlying problem has become. It does not tell us where the causes of that problem lie or what can be done to prevent it from happening again. The same can be said of the myopic focus on rough sleeping. Read the above quote from the ONS again and think whether you notice anything strange about the wording.

The phrase that struck me as most odd is, ‘stop homeless people dying in our communities’. Implicit in that phrase is an apparent assumption that people who are homeless have always been with us. But when I was a young boy living in Oxford, there were almost no people experiencing homelessness. What has changed in that time?
While officially supporting the target of ‘halving rough sleeping by 2022 and ending it by 2027’, in truth, policy-makers are unlikely to meet these goals if the default is to blame the weather (recent warmer winters mean that the weather has not been the cause) and suggest that a few more night shelters could help. Despite acknowledging that street homelessness is just the tip of the iceberg, in England the decision was taken not to focus on the root causes. In Scotland, the approach is different and takes all forms of homelessness into account, not just rough sleeping. Neither of these two UK governments go into detail about evidence underpinning their plans or how the impact of policies will be evaluated – a missed opportunity. These government documents are an important source of evidence for other parts of the sector, and their choice of language and areas of focus affect which issues are dealt with or ignored.

 

 

Unexplained but not suspicious

In general, policy suggestions on homelessness only address the most precarious and heart-wrenching cases. While this is useful to galvanize sympathy, it unintentionally implies that by helping those whose need is greatest, the problem can be eradicated. This is wrong. It can also create negative side effects among the wider population who, when confronted with endless terrible individual stories, begin to feel that things will never change, becoming apathetic, desensitized and fatalistic.

In spring 2018, in one of the streets where I used to play as a child, a homeless man died in a council-funded hostel. The newspaper report was brief: ‘The 61-year-old was found dead in a room in Marston Street in East Oxford on April 20. The city council said it believed there was nothing suspicious about the man’s death’ (Staff Reporter, 2018).
In autumn 2018, the same paper reported:

A homeless man who was found dead in a graveyard had been sprayed with paint three days earlier in a separate assault … someone uploaded a video onto social media of the homeless man being sprayed, with a voice in the audio that could be heard saying: ‘This is how we deal with beggars on the street’ (Press Association, 2018).

Just before Christmas 2018, a homeless man in his 30s was found dead on the main thoroughfare between Oxford rail station and the city centre. Four days earlier, a man who had been homeless died in the centre of town, in McDonald’s, where local school children go to meet. The same code words were used as in previous reports that imply nothing unusual has happened: ‘Police said on Monday that his death was being treated as “unexplained but not suspicious”’ (Roberts, 2018).

Sharron Maasz died in January 2019 (Aziz, 2019), and two more deaths were reported in the month after. The only thing that connected the three was that they were all experiencing homelessness. We have long become accustomed to such deaths, and an unhelpful tradition has developed whereby it is deemed sufficient to express shock and horror instead of using these tragedies as an opportunity to learn and improve.

Perspective matters, because unless we can be confident that we are framing the challenge in the right way, we may be misusing vital resources and wasting precious time and energy. To achieve real, lasting change it is vital that we take a much wider view of homelessness, one that considers the bigger picture of the drivers and root causes of the issue as informed by current evidence and an historical context and understanding. In 2018, the Centre for Homelessness Impact advocated exactly this approach in a report that went on to suggest that we must also better understand ‘how housing equity is connected to opportunity and life chances’ (Teixeira et al., 2018).

We have come to approach homelessness as a question of how to mitigate, subdue, and tidily deal with the symptoms of our social illness. We have learnt to cope saying these deaths are not suspicious, when in fact they are. We express horror and spend ample time ‘raising awareness’, but this is not good enough.

To achieve a step change in our efforts, a new evidence-based approach to homelessness is needed, one that aggregates evidence from other countries and our own former successes in addition to generating new research. What did we do in the past that meant fewer people were once homeless, and do we have all the evidence we need to address the most pressing questions that need answering today? What are the impact of our current interventions and what would have happened without them?

 

 

Luck matters most

Generating and utilizing the right kind of evidence also requires that we ask more complex questions, like why it is that more men die homeless. The superficial reason is that there are simply more men ‘sofa surfing’, in hostels and on the streets. And the reasons for that? Women are more likely to be parents with young children and thus have a right to be housed, while men are more likely to take to drinks and drugs to an extent that leads to homelessness. But the explanations are more complex still.[1]

The number of people dying while experiencing homelessness is now so high that it is possible to break the figures down by the characteristics of those who die and the immediate, if not underlying, cause of death. Only one in six of those who die while experiencing homelessness are women, but the women in England and Wales who die while experiencing homelessness are, on average, two years younger than the men (42 rather than 44 on mean average). Some 21 years ago, as homelessness was starting to become normalized in the UK, Mary Shaw and I made similar calculations and found that the death rates of male rough sleepers aged 16–29 years were almost 40 times higher than those of the general population. For all men aged 16–64 years, this number is about 25 times greater (SMR=2587). Very little has changed in these death rates even while the numbers of people experiencing homelessness fell, and then rose (Shaw and Dorling, 1998).

The picture for women is a little different. Back in 1998 there were too few women on Britain’s streets to be able to calculate their mortality rate by age. The latest data suggests that the number of younger homeless women is on the rise. Homeless men die 34 years earlier than most men, homeless women 39 years earlier than most women. People who are homeless are at highest risk of death where they are most numerous: in London and the conurbations of the north-west of England and, more recently, in Oxford. In early 2019, Oxford had the second highest mortality rate for homeless people in the UK,[2]  with the majority of those who died having grown up and gone to school in the city or a village within a ten-mile radius (Brimblecombe et al., 2019; ONS, 2018).

A third of the deaths of people experiencing homelessness in the UK are now attributed to drug poisoning. Doctors know that the cause they write on the death certificate is not the true underlying cause. If they knew the person and were permitted to write a more nuanced description, a few might write something far more useful. Like Roger Pepworth’s obituary for Sharron Maasz and Shaista Aziz’s later tribute and explanation (Aziz, 2019), this could give a human face to people who would otherwise become statistics and present a more honest picture of the structural causes of death for people experiencing homelessness. Here is a hypothetical example:

Died of drug poisoning after intermittent spells without a safe home. An imaginative young man who did well at school. A chance event aged 16, lead to the loss of his nearest sibling in a car crash. The resulting family breakdown began the path to heavy drug use and periods of living on the street. But he survived for some time. Had he been luckier, his overdose would not have happened. Had his local rehab centre had just one extra free space, he would not be dead now, but its funding was cut. Had he been born a few years earlier, before heroin reached his home town, he might have resorted to drink instead and not suffered this overdose. Had he been born in another European nation under otherwise identical circumstances, there is a good chance he would still be alive. But he was born in England, in the mid-1970s, and is now dead, aged 44, coincidentally at the exact mean age that people die nationally. He had rotten luck.

Luck matters above all else to individuals, but at the aggregate level all the good and bad luck is ironed out. At the aggregate level the evidence is not about luck at all. At the aggregate level it is perception that matters most and the biases inherent in the interpretation and presentation of statistics. This is always the case. Individuals all operate with a worldview that they carefully structure their evidence to support. This means that simply gathering more evidence is not enough. To accelerate progress, the sector must be prepared to put its basic assumptions to the test on an ongoing basis, and to ask whether what it is doing is fundamentally improving the situation or instead is perpetuating a bad system, while superficially appearing to help.

 

 

What constitutes good evidence?

Just a few centuries ago it was possible to amass a large quantity of evidence to show that the Earth was at the centre of the universe. Just like the moon, the sun appeared to revolve around the earth, so too the planets and the stars orbiting us reassuringly in the night sky. What it took to change that view was not simply a better telescope, it was a better way of thinking. Rooting oneself in a mode of thinking can only sustain the prejudices of your times and place.

The current pervading narrative places the responsibility for homelessness on the individual. But the causes of homelessness do not lie with the people that it affects. Consequently, the solution to the underlying problem is not just intervention on the streets. Neither is it limited to the ‘payment by results’ of ‘local social enterprises’, or the issuing of ‘social bonds’. Individual interventions may be well-meaning, but they can often be merely only superficially and very short-term successful. That is why it is vital to both address the dearth of causal evidence (as highlighted by the Centre for Homelessness Impact Evidence and Gap Maps), while also ensuring we take the bird’s eye view of homelessness and what really causes it to rise.

We know from other fields, such as public health, that to truly use evidence to drive improvements at a population level, taking a systematic and wide approach is crucial. The fitting of gastric bands, for example, may solve obesity in individual cases, but it does not have any effect at the societal level. Obesity will not be eradicated until the whole environment that makes a population fatter is dealt with.

When the ONS released their first estimates of the number of homeless people dying on the streets on 20 December 2018, section seven of their report was titled ‘Proportion of deaths of homeless people that are due to drug poisoning has increased by 51 percentage points relative to the overall number of drug deaths over five years’. The next day the title of that section was changed to, ‘Drug-related deaths of homeless people increased by 52 per cent over five years’.[3]  This attention to detail and correction of a single statistic by one percentage point gives the impression that what matters most when gathering evidence is statistical exactness, and then issues such as drugs – the precise drug that lead to death is identified in individual cases. In 2018, the ONS notes that one person experiencing homelessness died from smoking cannabis, while 115 died while under the influence of opiates.[4]  The fact that somewhere a doctor noted cannabis consumption as a potential cause of death while homeless may well be the least useful piece of information ever released by a government-funded agency.

The ONS should not be singled out here. The same could be said of much of the literature on homelessness. A report from Housing First England (2019) cites ‘A long history of alcohol dependency, heroin and crack use and anti-social behaviour’ as the main cause of homelessness for one of its service users.

The language used by leading sector organizations matters. Simple statements can, when repeated again and again in aggregate, frame a story, shifting focus from the causes to the symptoms of a problem. With homelessness, the emphasis is so often on how the people affected suffer from alcohol or drug misuse, have ‘high/complex needs’ or all of the above, while forgetting that the evidence suggests most people affected by homelessness never come into contact with the homelessness system, and can therefore not easily be labelled under any of these categories. They are in so many ways no different from you or me.

In its 2018 annual accounts, Homeless Link describes roughly £5 million of spending in a year and begins:

The Government’s commitment to halve rough sleeping by 2022 has set the policy agenda during the year. Homeless Link has made a full contribution to the Government’s process of developing a strategy to implement this commitment, with representation on the Rough Sleeping Advisory Group and all five ‘Task and Finish’ groups set up to work on components of the strategy. We welcome the appointment of Jeremy Swain, who steps down as a Homeless Link Trustee, to lead the Government’s Rough Sleeping Initiative and we are confident that the sector will play its part in reversing the shocking increases in rough sleeping we have seen in recent years. However, these worthy commitments can only be achieved with significant additional resources and we look forward to the publication of the finalised Government strategy later in the summer. (Fielden, 2018)

The call for ‘significant additional resources’ is a recurrent refrain in the sector, when in fact the massive injections of funding every decade or so have probably contributed to the problem. While adequate resources are key, throwing money at the problem does not necessarily mean those affected by homelessness will benefit. In the last fifty years, the (largely English) charity homelessness system has grown in complexity and is more costly than ever, yet the impact of the work has not reduced the scale of the problem. For this reason, the sector needs new types of evidence – particularly causal and comparative – in addition to greater accountability and transparency to ensure policy-makers are indeed drawing on bodies of knowledge when developing policy. We know from other social policy fields like international development and education that better use of data and causal evidence can help accelerate progress and help target resources more effectively.

 

 

Progressing policy

Preventing homelessness in the UK requires significant reformation of housing policy. In most areas, it is currently not fit for purpose. It is not just those who are homeless who suffer as a result. Millions of others pay exorbitant rents for low-quality homes over which they have insecure rights.

In this instance, we would do well to draw on evidence from the past and look at similar failures in public policy where an emphasis on the symptoms, not the causes, has prevailed. Acknowledging systemic problems is a rare occurrence in current UK public policy and government often focuses on treating the symptoms of a problem for short-term gain.

In the past, the UK government has tried to address the prevalence of babies with low birth weights by focusing on the health and wellbeing of individual mothers, rather than addressing the systemic factors that mean that the UK has one of the worst records for underweight infant births and highest neonatal mortality rates in western Europe (notably Scotland is now bucking this trend and infant mortality rates are now falling there and are already much lower than in England today as its government has recently begun following the prescription from Finland). The British government has looked at the individual cases of children excluded from school, instead of the wider social issues that mean school exclusions are rare elsewhere in Europe and were quite rare in the UK in past decades; but no longer. It has designed measures to address poverty that mitigate only the worst effects of living on a low income, rather than acknowledging that it is tolerance and exacerbation of high levels of income inequality that is fueling the problem. The British government, from 1979 continuously through to 2019, has treated the issue of long-term unemployment and sickness as if it were the result of work-shy individuals who should be sanctioned for not trying hard enough, rather than understanding that its organisation of the national economy results in greater sickness and wastes human resources.

Without new mechanisms to instigate change, this status quo will prevail. In a complex system, better use of evidence to identify how to prioritize things that do the most good and stop doing what does not work (or causes harm) is vital.

 

 

What is to be done?

It is not just housing policy, but social policy in general that has exacerbated homelessness by creating an environment of precarious inequality. Reliable evidence at the micro and macro levels needs to be collected and acted upon more promptly. We need to know what works in the short term, but also keep our eyes on the long-term prize. A piecemeal approach that seeks to improve one area will have little overall effect if other areas of public life are not also improving.

There are opportunities to learn from what we did better in the past, from other areas where social policy has been effective, and from other European countries with more successful social policies than our own (Dorling, 2016). While we may look back and idealize solutions that would no longer be effective, like the mass provision of traditional council housing, an evidence-based approach would clarify exactly why this is the case.

Council housing worked so well at first because of a slum sector that existed below it from which a council house provided an escape. Those are no longer the times we live in, but we can learn from knowing that. It is vital it is to learn faster and fully embrace technological and social developments, what people will need in the future will be different from what worked well for their grandparents in the past, for instance because people now live longer we need far more dwellings without stairs in future. There is a danger that the timings of research seldom work for practitioners and policy-makers. To give another example that would have meant little in the recent past, many young people, including young people who are homeless, will go without food before they go without phone credit. Knowing that is useful.

In the UK, we seem unable to scale up promising interventions, largely because three is often no real will and they are thus so often never subject to rigorous evaluation, meaning that projects then close down as and when the fashion passes. The root causes of new homelessness are almost never treated as a political priority. In England, there are a few new schemes being piloted that have fared well in Nordic nations, like ‘Housing First’. In Finland, ‘Housing First’ as a policy was successful predominantly because of Finland’s stronger social safety net – one that the UK has now largely lost. We do not yet know if it will fail in the UK, but the omens are not good given the cuts that have occurred to other services in the UK. We also know that very large numbers of people who are homeless sleep in public toilets in Finland, but at least they can sleep in public toilets (and those toilet are heated).

We should recognise that all European countries now have lower income inequality than the UK and also enshrine more tenant rights into law. Rent regulation is a vital part of that. It is the only defence against arbitrary eviction.[5]  In Germany half of all householders rent privately. Often they rent using standard leases, which permit tenants to live in a property for the duration of their lives (Hickey, 2016). Rent caps are enforced to stabilize rates for all tenants, and closely monitored to ensure they do not increase too quickly. Tenants’ groups organize to complain when landlords are not penalized for breaking the law.

In Sweden, private sector rent levels are set through negotiations between representatives of landlords and tenants in a very similar way to how trade unions and employers negotiate pay. In 2014, the whole of Stockholm was limited to increasing rents in a year by only 1.12 per cent as a result. In the Netherlands, monthly rental fees are fixed by government. Government officials inspect properties for quality and decide rents accordingly. Denmark has two forms of rent regulation and does not suffer homelessness on the scale of countries with a supposedly more ‘free market’. ‘Free’ housing markets serve only to benefit those with the most money.

In France, a new set of rent regulations came into force in the capital in August 2015, stating that private rents ‘must be no more than 20 percent above or 30 percent below the median rental price for the area’. Of course, the rules prompted anger among property agencies and landlords, who claimed they would deter investment. But the evidence from less equal countries is clear: landlords charging whatever rent they choose does not result in more housing becoming available. The USA and its enormous rate of homelessness amply demonstrates what leaving housing to the free market produces. In contrast in the European mainland These controls have helped reduce rent inflation as firms and European agencies move parts of their workforce to Paris during the Brexit process.

The dominant narrative in Britain, and especially in England, remains one that always focuses on the apparent deficits and perceived failures of people who become street homeless. Victim-blaming is an area in which much of western society excels, but at which the most economically unequal societies such as the UK and USA excel the most. Thankfully, there is now growing evidence that this may be changing, and that attitudes in the UK are finally beginning to alter (Dorling, 2018). Changing old habits will not be easy, but nurturing a learning sector that acts more promptly on existing knowledge and tests its assumptions about what works will improve the positive impact of our efforts. Much more importantly than that, though, is electing a government made up of people who both care and understand.

Sharron Maasz was one of so many who could, and should, be alive today.

 

 

 

References

Aziz, S. 2019. The death of Sharron Maasz shows why domestic abuse services are vital. The Guardian, 26 November. https://www.theguardian.com/cities/20...
BBC News. 2019. Homeless deaths nine times higher in deprived areas. BBC News, 25 February. https://www.bbc.co.uk/news/uk-england....
Brimblecombe, N., Dorling, D., and Green, M. 2019. Who still dies young in a rich city? Revisiting the case of Oxford, The Geographical Journal, DOI:10.1111/geoj.12336, Accepted Article published online on 12 November, 2019. https://rgs-ibg.onlinelibrary.wiley.c...
Dorling, D. 2016. A Better Politics: How Government Can Make Us Happier. London: London Publishing Partnership. http://www.dannydorling.org/books/bet....
Dorling, D. 2017. The Equality Effect. Oxford: New Internationalist. http://www.dannydorling.org/books/equ....
Dorling, D. 2018. Peak Inequality: Britain’s Ticking Time Bomb. Bristol: Policy Press. https://policy.bristoluniversitypress....
Feilden, P. 2018. Introduction to company account 25 July 2018 authored by Homeless Link: Reports and Financial Statements for the year ended 31 March 2018. http://apps.charitycommission.gov.uk/....
Fransham, M. and Dorling, D. 2018. Homelessness and public health. British Medical Journal, 360. https://www.bmj.com/content/360/bmj.k214.
Hickey, S. 2016. Would a rent cap work for tenants facing £1000 a month rises? The Observer, 1 May. http://www.propertyinvesting.net/cgi-....
Housing First England. 2019. Life Stories. https://hfe.homeless.org.uk/life-stories.
Humberstone, B. 2018. ONS reveals the number of people dying homeless. https://blog.ons.gov.uk/2018/12/20/on....
Kraemer, S. 2017. Notes on the fragile male. Extension of (2000) ‘The fragile male’ British Medical Journal, 321(7276): 1609–12. Extended notes online only: http://sebastiankraemer.com/docs/Krae....
MHCLG. 2019. Rough Sleeping Statistics Autumn 2018, England (Revised). London: Ministry of Housing Community and Local Government. https://assets.publishing.service.gov....
ONS. 2018. Deaths of Homeless People in England and Wales: 2013 to 2017. London: Office for National Statistics. https://www.ons.gov.uk/peoplepopulati....
Pepworth, R. 2019 Harsh reality of life and death on the street below dreaming spires. Letters. The Guardian, 3 February. https://www.theguardian.com/society/2....
Press Association. 2018. Homeless man found dead in graveyard had been sprayed in paint attack. Oxford Mail, 14 September. https://www.oxfordmail.co.uk/news/nat....
Roberts, J. 2018. Man in thirties dies on Hythe Bridge Street, Oxford. Oxford Mail, 7 December. https://www.oxfordmail.co.uk/news/172....
Shaw, M. and Dorling, D. 1998. Mortality amongst street sleeping youth in the UK. The Lancet, 29 August: 743, http://www.dannydorling.org/wp-conten....
Staff Reporter. 2018. Homeless man found dead in Marston Street hostel, Oxford. Oxford Mail, 2 May. https://www.oxfordmail.co.uk/news/161....
Teixeira, L., Russell, D. and Hobbs, T. 2018. The SHARE Framework: A Smarter Way to End Homelessness. London: Centre for Homelessness Impact. https://uploads-ssl.webflow.com/59f07....

 

ENDNOTES

[1] The consultant child and adolescent psychiatrist Sabastian Kraemer collated the evidence and has found that in a surprising large number of aspects of life men might be more likely to ‘succeed’, be promoted and be higher paid, but they are also more likely to do badly as compared to women. His examples ranged from male humans being more likely to being miscarried as a foetus, to failing to gain any qualifications at school, through to dying earlier. In the detailed notes to his analysis he made it clear that women often do very badly too and suffer systematic discrimination in society. Sabastian summed up the fundamental difference as ‘Men die, women suffer’ (Kraemer, 2017).

[2] On 25 February 2019 the BBC reported that Blackburn had the highest death rate among people who were homeless by area, followed closely by Oxford and then Camden (BBC News, 2019).

[3]  Section 7 ‘Drug-related deaths of homeless people increased by 52 per cent over five years’ (ONS, 2018).

[4] Ibid, Table 1: Drug poisoning deaths of homeless people (identified) by substances mentioned, persons.

[5] This section is based on work done for the book The Equality Effect written by the author of this chapter published by New Internationalist (Oxford) in 2017; see: http://www.dannydorling.org/books/equ....

 

For a PDF of this chapter and link to the book it is published in click here:

Employment: in Brexit and Beyond

Where have we come from?
Unemployment has not always been with us. In fact, the term was hardly used at all before 1900, and that was because the concept of being unemployed only began to take form in the early 1880s depression. Before then there were paupers, who were often assumed to be work-shy and lazy. Unemployment scarcely exists without unemployment benefits of some kind. The word unemployment is most mentioned in books scanned by Google in 1936 and 1984; the heights of the great depression of the 1930s and the great recession of the 1980s.

Employment is not the opposite of unemployment. Many adults can be neither employed or unemployed. They can be retired, caring unpaid, studying, or sick. Also people can be underemployed, or entirely dissatisfied with their work. By 2020 the majority of children living in poverty were being cared for by parents in poorly paid work which was not the case in the 1980s.

 

Where are we now?
Towards the end of 2020, unemployment and redundancies were on the increase, as ONS reported in November. At the very same time, the number of employed people living in the UK who had been born abroad began to fall rapidly; by 717,000 between March and September. At first commentators thought that such a rapid change must be due to changes in how the statistics were recorded, but then they realised that the pandemic had led to an exodus. The majority of those leaving were EU citizens who had been in employment before April. People who were unemployed were more likely to stay, but in total, 915,000 adults who were not born in the UK left the UK between April and September. Of those who stayed, 88,000 more were unemployed.

 

Where are we heading?
Employment levels, and the quality of jobs, are partly a political choice. It is not ‘the market’ which mainly determines how many people are in work, but the extent to which people are encouraged to be in paid work or not. A government can decide to make it more or less attractive to employ people. A highly progressive tax rate can make it more attractive to employ more people at a good wage, rather than fewer at a higher wage, resulting in an increase in overall employment rates.

Governments that impose punitive sanctions on those deemed not trying hard enough to find work can force the unemployment rate down. Governments can directly create employment themselves through jobs paid for by the state. Within Europe, this can be 50% higher in some countries as compared to others. The diagram below shows the extent of variation in unemployment rates within Europe and how the UK had chosen (by 2019) to be at one extreme of that distribution, copying the USA by ensuring that as few people as possible resorted to unemployment benefits. Many took inadequately paid jobs, many had to do multiple jobs, many in the UK did not like their jobs.

What may happen next? Often the most sensible predictions are also the dullest and most depressing. The UK could continue along the route it has taken in recent years. Work becomes more mandatory and more precarious for the majority. Unemployment benefits are further reduced (in real terms they are already half what they were in the 1970s). Millions of people in the UK are forced to take even more demeaning work, increasingly acting as servants for the better-off: delivering take-aways, cleaning their homes, walking their pets. Inequality rises.

I do not think the above scenario will play out. This is because of the 2020 pandemic. Rather like the second world war, it has weakened right-wing devil-take-the-hindmost politicians. Once you have to ask everyone to be ‘in it together’, once you rack up an enormous bill to pay for the war or pandemic, once you start to use the language of having to make individual sacrifices for the greater good, it is then very hard to return to a rhetoric of there being no such thing as society — just individuals and their families. A pandemic shows just how false such thinking is.

 

UK unemployment has been low compared to the EU27
Unemployment rates among 20-64 year olds in the EU, EEA and UK by country of birth, 2019.

Unemployment rates among 20-64 year olds in the EU, EEA and UK by country of birth, 2019.

[Note: EU-born and non-EU-born figures unavailable for Bulgaria, Hungary, Romania, Slovakia. EU-born figures unavailable for Latvia, Lithuania, Malta and Poland. EU-born figures for Croatia and Slovenia have low reliabiality. Non-EU-born figures for Croatia, Lithuania, Poland and Czechia have low reliability.]

 

What I think is more likely is that the UK fills up with even more of its ‘ex-pats’ returning; especially the older ones. Young, cheap and efficient workers leave these shores because they do not have equal rights, because the pound drops even further, and as their prospects dwindle. The UK middle-class is squeezed; their graduate children have no work of the kind which a (now very expensive) university degree was supposed to deliver. Above all else there is a need to take back control from those who actually took it — the richest people in Britain who took a greater share of income in the UK than that group takes anywhere else in Europe.

The UK will level out rather than level up. Taxes will rise, especially for the better-off. Government will have to create jobs. The ‘fifth option’ — to not be forced into paid employment — will return, perhaps through tentative steps towards a universal basic income, mimicking the tentative steps towards paying unemployment benefit of just over a century ago. The stigma of having to rely on benefits will decrease. And, just as has happened several times before in British history, those at the top will know not to ask for a pay rise and those at the very top will accept permanent reductions in their pay — as the FTSE 100 CEOs already have started to, albeit only slightly so far. And so Britain outside the European Union will slowly begin to look ever so slightly more like an average employment/unemployment level European state.

 

For a PDF of this chapter and a link to the report it is included in click here.

Please sir, can I have more?

On the 25th of November 2020 the Chancellor of the Exchequer decided that, in the public sector, there would be no increase at all for many and a real-terms pay-cut for millions more in 2021. People doing jobs such as teaching in classrooms and emptying our bins, people recently defined as essential workers, would have less to live on next year as compared to this year. The question is, why did the Chancellor, Mr Sunak, do that?

Luke Bartholomew, a Senior Economist at pension manager Aberdeen Standard Investments, explained to the BBC, that this was a particularly ‘disappointing’ choice given that it was made in the wake of the news that not one but three vaccines had been found to be successful in their initial trials in the weeks immediately before the Chancellor’s statement. Luke said:

“The exceptionally good news on vaccine development means that we can now start to look beyond the Covid crisis. It seems clear to us that the main problem facing the economy at that point will be one of insufficient demand and rising unemployment. In that context, it is disappointing the chancellor is already looking to prioritise public sector pay restraint. The economy would be much better helped by supporting the spending power of public sector workers. With interest rates exceptionally low, and very likely to stay that way, it is quite simply wildly premature to turn towards deficit reduction measures.”

 

The size of the pay cut to be suffered by public sector workers will depend on how high inflation rise to during 2021. As the prices of many basic goods are expected to increase when tariffs and other impediments are placed on them, following Brexit, we should not expect inflation to be very low.

The chancellor said that he “could not justify an across-the-board increase when many in the private sector had seen their pay and hours cut in the crisis.” This is an odd line of argument as neither he nor any of his Conservative predecessors ever said, in years when average private sector pay was rising in Britain, that the public sector should also see a commensurate rise!

The chancellor’s argument is also unusual because the conventional conservative argument that would be proffered is that “the country cannot afford this”. However Mr Sunak has been able to afford all kinds of things, including an enormous increase in military spending announced just a few days before the spending review. Even he did not have the gall to claim that affordability was the key issue. He could have chosen to ensure that public sector pay at least rose to be commensurate with inflation if he had wished to; it was just that he did not wish to. But why?

 

Mr Sunak, Chancellor of the Exchequer

 

So as not to be disingenuous, it is worth looking at what else the Chancellor gave as a justification, other than his key claim that it was only fair to level down public sector pay if people had been badly hit in the private sector. He said he wanted to protect jobs, with the implication that more jobs could be created, or fewer lost, if most people working in the public sector took a pay cut. However, the Chancellor will know, and as Luke Bartholomew explained on the day of the Spending Review, that if you reduce the average spending power of public sector workers by reducing their pay in real terms, they will spend less in the economy and that reduction in demand for goods and services will reduce the number of jobs overall, especially jobs in the private sector – so preserving jobs cannot be the real reason.

It is possible that the Chancellor is convinced that there will be less to go round in future and he wants to ensure that those working in the public sector consume less: less food of a high quality; less space in the homes they occupy; fewer holidays in future; and so on and on. Cutting public sector pay in real terms will dampen demand in general and there will be fewer jobs in the private sector in future and pay cuts there as well, all resulting in reduced spending on those same quality items. He may think this is all inevitable and reasonable. And he may want to try to pitch private against public in a false argument to turn attention away from the real choices he has made – choices he made before the day of the spending review and choices he will presumably continue to make.

The chancellor decided to spend more on defence just before the spending review. Military spending creates relatively few jobs per pound spent, but can of course create misery is it bolsters arms manufacturers, whose weapons eventually often maim and kill people, and not necessarily by our own armed forces. It may have been because he didn’t want these issues being raised on the day of the spending review that he announced the very large rise in military spending days earlier. Such a deliberate and manipulative separation of issues is common in politics.

In terms of future choices he has to make, the key ones concern taxation. There is a group who are not like most public sector or private sector workers, who could easily afford to pay more in taxation. That group could, for instance, easily pay taxation at the customary European rates for their income levels. Admittedly if that group did pay more in taxation, they would not be able to afford quite as much of the luxuries and extravagance that the rest of us never had, quite as many homes as they currently own, and quite as many holidays a year as they normally took – that group is people with very high incomes, very high wealth, or both: the rich.

The word ‘rich’ does not appear once in the text of the Chancellor’s 2020 spending review statement, nor does the words ‘wealthy’ or ‘redistribution’ or ‘fair’ other than ‘to ensure fairness between the public and private sectors’. The Chancellor’s statement was instead full of paradoxes, for instance promising both “The biggest ever investment in new roads” and “…the greener future we promised.” It included promises to raise the National Living Wage for a full time worker by £345 a year, or just under a pound a day. He did not explain that the wage is still not one you can reasonably live on and hence a misuse of the term ‘Living Wage’. The statement cited lower paid workers five times; because the Chancellor wants to say how much he and his government was doing for the lowest paid. It never mentioned the highest paid.

So, to conclude on the question I began with – why did Mr Sunak do this rather than, say, suggest a small public sector pay rise of 1% and make a point about how generous he thought that was being (even if that too would be a real terms cut)? The only plausible answer to the question this short article began with is that he wanted to provoke discord between people in the private and public sectors, to keep up the pretence that that is the choice he had – to support one or the other – because he wished to distract people from the real choice he has made – to protect the rich. We can get perhaps gain a better sense of his priorities form his actions rather than simply concentrate on his words, For instance, it is now well documented that his largess during the Covid crises had already enriched many of his, and fellow Conservative MPs friends through preferential dubious contracts.

And why would Mr Sunak wish to protect the rich, and why would the Prime minster and cabinet and Conservative party support him in that? I can only conclude that it is because of whom they really represent – themselves and their even richer backers.

 

A copy of the spending review speech can be found here.

And a study which suggests parallels in the USA is here.

 

for a pdf for this article and a link to its original publication click here.

Should you visit your family this Christmas? Three experts weigh in

For the third of society who live within a few miles of their parents, not seeing relatives at Christmas will make little sense if you see them most weeks anyway.

Should you visit your family this Christmas? Three experts weigh in
Roman Samborskyi/Shutterstock

Lena Ciric, UCL; Andrew Lee, University of Sheffield, and Danny Dorling, University of Oxford

Faced with rising infections and a new, more infectious strain of the coronavirus, the UK government has come under pressure not to relax COVID-19 restrictions over the Christmas period. Despite this, the government has said that the rules allowing three households to mix are “unlikely to change”. But is this wise? Here, three experts discuss the risks of mixing over Christmas, and whether celebrating separately might be better.

Lena Ciric, Associate Professor in Environmental Engineering, UCL

My answer is a definitive no. Cases are on the up and relaxing the rules will lead to a new peak in the new year. We know close contact leads to transmission, but Christmas in the UK does not lend itself to social distancing. For a start, the weather is not going to favour outdoor activities.

Spending the holiday with your family means a number of rules that we have lived by for the past nine months will have to be broken. Various generations – older ones at high risk and some too young to adhere to distancing measures – will congregate in one another’s homes. It is virtually impossible to keep one to two metres apart at home.

We then throw into the mix indoor spaces with inadequate ventilation to prevent viral transmission. We know face coverings offer some protection, but it’s unlikely that families will wear coverings throughout the holiday, especially with the amount of eating and drinking that will take place. Indeed, a Christmas Day gin and tonic or glass of champagne is likely to make us more confident in breaking the distancing rules. For me, the risk isn’t worth it.

The control measures we’ve become used to are unlikely to be practical at Christmas time.

DisobeyArt/Shutterstock

 

Danny Dorling, Halford Mackinder Professor of Geography, University of Oxford

For the third of society who live within a few miles of their parents, not seeing relatives at Christmas will make little sense if you see them most weeks anyway. If Grandad and Granny normally look after the toddler on the days when you go out to work, you are hardly going to improve their chances of avoiding the virus by not seeing them at Christmas.

But for the third whose elderly relatives live many miles away, if they have been isolating themselves already, you may be less likely to meet up. With the vaccine now being rolled out, people in this group are more likely to think: why risk being Wilfred Owen, who died a week before the Armistice? For the other third somewhere in between, there may be more of a conundrum.

No one knows the exact proportion of people who are in each group, just as no one knows the actual risk of pulling a cracker round the Christmas table – with or without gloves and masks on. What we do know is that people aged over 70 are at a much higher risk than others and have already altered their collective behaviour to reduce risk the most. In the latest ONS survey, COVID-19 infections among over-70s in England had reduced from 0.80% at the end of October to 0.48% by the start of December. And according to the latest REACT-1 survey, across roughly the same period infections among over-65s almost halved. More than 99.5% of elderly people are currently not infected.

So what is to be done? Here is a simple rule: ask the oldest person(s) what they want to do. The risk to them of meeting up is many times greater than the risk to everyone else combined. They have spent a lifetime assessing and taking risks, possibly ranging from driving a car to having a smoke, and (by definition) they have so far been more successful than you have at doing that. They might be unsure and want to talk about it, possibly even wanting to know the odds. Ultimately, Christmas means different things to different people, and their decision should be respected.

The worst Christmas is often the first one after a loved one has died. That too can change the calculus of the costs of spending Christmas alone.

Older family members are more at risk, so they should decide whether to celebrate in person or not.

DisobeyArt/Shutterstock

 

Andrew Lee, Reader in Global Public Health, University of Sheffield

At its peak, there were 25,000 new cases of COVID-19 per day nationally during the second wave. The second lockdown then reversed rising trends and brought infection numbers down to 15,000 per day by the end of November. In comparison, there were less than 1,000 cases a day in the summer. However, since restrictions have lifted, those numbers are rising worryingly again. This matters, as a proportion will translate into hospitalisations and more deaths.

Winter is always a challenging time for health services, which are stretched to the limit. The added burden of COVID-19 ill health will worsen the situation. It is also likely that the need to treat COVID-19 cases will displace non-COVID healthcare. That means delayed hospital investigations, procedures and treatments for non-COVID medical problems, which could have serious consequences.

Allowing households to mix at Christmas is akin to adding fuel to the fire and boosting the spread of infections. Households are the highest risk setting for transmission of COVID-19 – if someone is infected, early research suggests those around them have just under a 20% chance of then catching the virus.

Moreover, household mixing cannot be made risk-free. Infections in a household can lead to household-level outbreaks that are likely to disproportionately affect vulnerable family members. In turn, rising numbers of infections will then spill over into other settings, such as schools, care homes and workplaces, causing wider socioeconomic disruption.

With the promise of vaccine protection on the horizon, every effort now should be focused on buying time for the NHS to vaccinate as many of the vulnerable as possible. Allowing families to mix at Christmas is an unnecessary risk to take and comes at a price in lives lost, which is not worth paying for the few days of relaxed restrictions.

Lena Ciric, Associate Professor in Environmental Engineering, UCL; Andrew Lee, Reader in Global Public Health, University of Sheffield, and Danny Dorling, Halford Mackinder Professor of Geography, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

For a PDF of this article or a link to the original click here.

Letter: Social infrastructure is also vital to recovery plan

UK chancellor Rishi Sunak plans to set up a national infrastructure bank to “channel billions of pounds into capital projects” (Report, November 21).

We write to urge the chancellor to broaden his vision. The regeneration of Britain’s “national infrastructure” must include investment in “social infrastructure” such as childcare, schools and universities, regional theatres, orchestras, common spaces and local sports.

The pandemic has shown these economic activities are just as vital to society and the economy as the physical infrastructure of asphalt roads, green energy and safe bridges. And research demonstrates that investment in care has multiplier effects many times those of investing in construction, while generating far fewer greenhouse gas emissions. Furthermore, these investments can be kickstarted in less time than construction projects.

Under-investment in social infrastructure before the pandemic was a false economy; it would be even more so as we move into the recovery phase. Channeling money into Britain’s social infrastructure and especially into its care, education, arts and training sectors would create jobs, generate income for workers, the Treasury, and the wider economy, and contribute to a more robust and sustainable economy.

Patrick Allen, Danny Dorling, Susan Himmelweit, Ann Pettifor, Robert Skidelsky, Carolina Alves, Daniela Gabor, Stephany Griffith-Jones, Will Hutton, Michael Jacobs, Sue Konzelmann, Natalya Naqvi, Kate Pickett, Josh Ryan-Collins, Guy Standing, and Jan Toporowski (Council Members of the Progressive Economy Forum London NW1, UK)

December 11th, 2020

 

For a PDF of the letter and a link to where it was published in the Financial Times click here.

 

Image of men in hard hats used in the original Financial Times Report to which this letter is a response

Why is COVID-19 more severe in the north of England? The story in four graphs

An article published in the Conversation, 2 December 2020 Why is COVID-19 more severe in the north of England? The story in four graphs

Danny Dorling, University of Oxford and George Davey Smith, University of Bristol

England has emerged from lockdown and entered the second phase of its tier system – in which different parts of the country are placed under a different set of coronavirus restrictions. The scheme has been controversial, with many pointing out that the system is more heavily applied in the north of the country, which has been hit hard by the disease.

What are we to make of the geographical differences in infections and deaths from COVID-19?

gov.uk

You would expect that when the proportion of people testing positive for COVID-19 rises, the number that subsequently die will also rise – but this article illustrates that, following the first wave and the fall to low numbers of daily cases in summer, it has been only since autumn that this can actually be seen to be occurring clearly, and then only for people aged over 70. More than 80% of all those who died in England with COVID-19 mentioned on their death certificate have been in this age bracket.

To help us understand the geographical relationship between testing positive for this disease and dying from it, it is helpful to concentrate on these over-70s. One reason for this is that modelling has suggested that at younger ages cases may rise, but the total number of deaths fall if those younger people mix less with older people; and young people, once infected, have a significantly lower chance of dying from COVID-19.

Since May 2020, researchers working for the Office for National Statistics (ONS) have been conducting a COVID-19 infection survey which reports estimates of the proportion of people infected in each region of England. We can use this data to shed some light on the issue of geographical differences in the spread of coronavirus.

How COVID hit the north first

According to ONS data, in the first two weeks of September only 84 new infections were found in the English survey out of almost 90,000 households that were being tested each week at that time. But as the number of people sampled rose to more than 200,000 households per week, and as the disease spread more rapidly, just over 1,000 new infections were being recorded in the middle two weeks of October.

The first graph below shows there was no clear geographical relationship between the proportion of people aged 70 or older who tested positive for COVID-19 in the four weeks to September 19 and the numbers who were recorded as having died with COVID-19 mentioned on their death certificate in the week after. Both the disease and deaths from it had become rare in August and September, but that situation would quickly change.

 

Regions key – WM: West Midlands, EM: East Midlands, SE: south-east, SW: south-west, NE: north-east, East: East of England, YH: Yorkshire and Humber.

Danny Dorling, Author provided

 

Exactly two weeks after the situation described above, the picture was very different. Indeed, we had to update the horizontal and vertical axis scales on our graph due to the increases in cases and deaths in the north.

By October 3, cases had risen the most in the north-east of England (the most northern region in the country); by almost as much in the north-west (the next most northern); and by half as much in Yorkshire and Humberside. Deaths in all three of these regions rose similarly in the week starting October 3.

 

Regions key – WM: West Midlands, EM: East Midlands, SE: south-east, SW: south-west, NE: north-east, East: East of England, YH: Yorkshire and Humber.

Danny Dorling

 

Did the rates of infection rise most in the north of England because autumn starts earlier further north? We do not know. The rises in COVID-19 this autumn have been geographically distinct; but then so too is the onset of autumn. As all gardeners know, autumn always begins in the north of England and sweeps down to the south-west, arriving there last of all.

Other factors to consider are regional variations in susceptibility by the autumn – in August 2020 the ONS found that only 3.9% of people in the north-west were found to have antibodies to SARS-CoV-2 as compared to 10.0% in London, meaning that in London there were more people with higher levels of immunity. COVID-19 may also have spread more quickly in the north-west because there are more essential workers in these regions who cannot do their jobs from home. More may live nearer to their elderly relatives and rely on them for childcare, or be medically more susceptible to catching or dying from the disease.

What we do know is that when the proportion of people over 70 who tested positive rose in the four weeks before a particular date in a region, the proportion of people of that age who died in the week after that date similarly rose. This relationship is also stable, but not quite as strong, if you move that four-week window back by two weeks.

 

A clearer picture

It is what happened in the subsequent two time periods which most clearly suggests that there is a now a strong and strengthening geographical relationship between infections among the elderly and mortality overall.

Every two weeks, as another batch of survey data was released, the picture became more convincing because it is repeated with independent ONS data, collected for a new time period along with data from the Imperial College London REACT study.

In the four weeks before October 17, there is still not much of a pattern between cases and subsequent deaths in more southern regions where fewer than 1% of those under the age of 70 tested positive at that time. But the northern regions of the country showed a strengthening relationship.

 

Regions key – WM: West Midlands, EM: East Midlands, SE: south-east, SW: south-west, NE: north-east, East: East of England, YH: Yorkshire and Humber.

Danny Dorling, Author provided

 

The most recent picture is shown in the graph below. Now there is an even stronger correlation between prior positive tests and subsequent deaths. The north-east has fallen back one more place, and both Midlands regions are rising slightly. It was on the day before the end of this most recent period, on November 5, when the UK entered its second nationwide lockdown.

 

Regions key – WM: West Midlands, EM: East Midlands, SE: south-east, SW: south-west, NE: north-east, East: East of England, YH: Yorkshire and Humber.

Danny Dorling, Author provided

 

By early November 2020, when 1% of people aged over 70 tested positive for the disease in a month in any region, as many as 200 per million people of that age group would die in the next week. That proportion could be lower if people who are more likely to catch the disease are less likely to take part in the ONS survey (which is very possible). Infections had risen most in the north, and then in the Midlands.

What happens next is unknown – the testing data up until November 14 has already been released, suggesting a possible fall in deaths in the eastern, east Midlands and Yorkshire and Humberside regions in future weeks and a plateauing in the north-east, north-west and London.

There are many reasons for why this might occur, including both a possible fall in the proportion of people who are most susceptible where the disease has already spread the most, and possibly also greater voluntary isolation of people aged over 70 as it has spread. But as England exits full lockdown and re-enters tiers, the full effects of colder weather are yet to come.

Danny Dorling, Halford Mackinder Professor of Geography, University of Oxford and George Davey Smith, Professor of Clinical Epidemiology, University of Bristol

This article is republished from The Conversation under a Creative Commons license. Read the original article.

For a PDF of this article and another link to the original source click here.

Want to understand the Covid map? Look at where we live and how we work

It’s social, not medical, science that tells us most about the disparate spread of this pandemic.

Why does the late November map of the three-tier system in England look so much like a depiction of the north-south divide? In one sense, the explanation is simple: the tiers are principally set according to prevalence of the disease in each area and that is higher in much of northern England.

But why is the disease currently more common in the north? Why, in early autumn, were you more likely to be infected if you lived there? In part, this might be due to the seasonal nature of the virus and autumn comes first to the north. However, that does not explain why North Yorkshire and Cumbria are not now in the highest tier.

 

Social science links how we live to Covid rates. Illustration: Dom McKenzie/The Observer

 

The greater truths are that in poorer, more often northern, parts more people have jobs that cannot be done from home and more use public transport. Frequently, childcare is provided by the extended family who live nearby – wages and benefits are usually too low to allow other childcare options. There is less early retirement and more pensioners need to work too. Further, overcrowding in homes in cities is more common and anyone out of work exacerbates that.

There is also the question of taking a test. People are often not sure whether they have symptoms or not. If the implication of volunteering to take a test is that you and your family are then trapped in a small home for two weeks, that your older children cannot go out to work, that your school-age children will be trying to learn at home with whatever computer you have (if any), and that you and any partner you have also cannot go out – would that influence whether you thought a test was worth it? Of course it would.

The picture is different in the more leafy suburbs of southern towns. People are less likely to have relatives who live nearby and with whom they mix. They are less likely to have work that requires them to have frequent contact with many others. Indeed, they are less likely to be out of work and have time that can only meaningfully be filled by human contact. If they take a test and the result is positive, they can more often carry on working. What’s more, their children might all have their own bedrooms and their own parents might not be reliant on them popping round.

 

England’s new lockdown measures

The Geographical Tiers for COVID_19 rules coming into effect on December 2nd 2020

Measures coming into effect on 2 December:

Tier 3 (RED) Very high alert

Indoor household mixing banned. Pubs and bars closed except for takeaways. Indoor entertainment venues closed. No unnecessary travel outside area

Tier 2 (ORANGE) High alert

No indoor household mixing, including hospitality. Pubs and bars can only open to serve alcohol with ‘substantial meals’. Indoor entertainment venues open. Restricted spectator sport resumes

Tier 1 M(YELLOW) Medium alert

Rule of six applies indoors and outdoors. Pubs and bars can serve just alcohol. Indoor entertainment venues open. Spectator sport less restricted than in tier 2

 

 

In short, the geographical map of the disease today is a product of various factors, many of them deeply embedded in the diverse ways Britons live their lives. But in the discussions around Covid, social scientists – those who look at people’s lives in the round – are too often absent.

We need to look, for instance, at the economies that have evolved in different places and the networks of care – to look, in short, at the extent to which there is a close-knit and well-connected society in each place. It’s not just about examining individuals and their small, nuclear families. So, socially and economically, much of Kent, south Gloucestershire and northern Somerset is a little more like the north of England than other parts of the south; it is therefore not so surprising that these areas have been placed in the highest tier.

In the next few months, before both the warmth of spring and the distribution of vaccines kick in, the pattern we see today might change little. While we wait, some people can afford, and are able, to isolate and distance far more easily than others. Because of this, southern counties will tend to report lower rates of infection and remain in lower tiers (or be put in them earlier).

There are, however, complications to the geographical story. We also need to know why rates of transmission in London, which contains some of the poorest places in the UK, have remained so low. Perhaps because the virus can no longer spread as easily there as it did initially. Again the explanation is, in large part, sociological.

…

When Covid-19 first arrived in the UK, it did so disproportionately in the home areas of those who had skied in Italy in February – largely, affluent districts of southern England. (At one point, there was a lot of Covid-19 in Kensington and Chelsea.) However, it quickly spread from those areas and to the rest of London more than any other place in the UK.

London has by far the greatest density of population and, in February and March, it experienced the most travel in and out. London had the most social mixing and, very likely, the highest rate of infection before voluntary social distancing began. (We will never know for sure, as surveillance testing of the population did not begin until months later.)

Today, London is a little less crowded and much less busy, but we know, from the Office for National Statistics’ (ONS) survey of large random samples of the population, the proportion who have antibodies. That figure is at its highest in the capital. London is also very well served with hospitals per person (compared with the rest of England) and has a relatively small elderly population. Last week, the ONS revealed that its central estimate for the proportion of people aged 70 or over with the disease in the capital had fallen slightly to 0.55% and was lower than in every region in the north. It had never risen above 0.58%.

Like London, the Liverpool City region is now to be in tier 2 because transmission rates there are now falling. This is only speculative as yet, but perhaps it is because so many people recently had the virus in Liverpool that, as in London, susceptibility might have fallen, at least enough to make a difference in reducing transmission.

It is inevitable that national and local politicians will want to claim credit for any fall in disease rates. However, it is worth being patient and waiting for the longer-term, cross-national studies to emerge. These will, hopefully, reveal which political approaches and specific interventions helped most, which were largely irrelevant and which might have made things worse.

What’s certain is that the key to understanding the map is the underlying social and economic geography of England. To understand the changing medical geography of this pandemic, you must first understand how the country lives and works.

 

 

• Danny Dorling is Halford Mackinder professor of human geography at Oxford University. He is the author of All That Is Solid, Injustice: Why Social Inequality Still Persists and A Better Politics.

For a PDF of this article and a link to the original publication click here.

The unprecedented rise of mortality across poorer parts of the UK

Danny Dorling discusses recent findings from a major study of mortality across UK countries and cities, and highlights unprecedented worsening mortality among the UK’s poorest communities:

 

Because of the pandemic of 2020 people are worrying about their health and the health of those around them more this year than has been the case for many years.

However, in the years immediately prior to the pandemic, the health of women in the UK, when measured using age standardized mortality rates, was hardly improving at all. For men it was only improving ever so slightly, about three times more slowly than it had improved during the 1980s and 1990s and five times more slowly than in the 2000s! In contrast to how acutely aware we are of the pandemic, most people were unaware of these changes because they were not the subject of news bulletins.

This is because slow changes in population health do not create news stories. However, it is truly shocking, as this BMJ Open paper reveals, that in poorer parts of the UK in the six years up to and including 2017, mortality rates actually rose. Outside of wartime, pandemics and epidemics, increases in mortality rates are unprecedented in the UK in the twentieth and twenty-first centuries. This rise in deaths has coincided with the imposition of austerity which has most harmed people in poorer cities.

In Scottish cities such as Dundee and Aberdeen, mortality rates worsened for both men and women in the years shortly after the Westminster coalition government was elected in 2010, and they continued to worsen during those years when the Conservatives were in power alone from 2015 onwards. In England too, for men in Liverpool and women across Birmingham, mortality rates rose.

 

 

Graph source: Walsh D, McCartney G, Minton J, et al. Changing mortality trends in countries and cities of the UK: a population-based trend analysis. BMJ Open 2020;0:e038135. doi:10.1136/ bmjopen-2020-038135

 

 

In all the most deprived areas of Scotland and Northern Ireland, combined mortality rates rose in the second decade of the twenty-first century quickly, after having improved so very quickly before. In England there was no improvement in male rates in the poorest areas, and so the gap between them and the more affluent areas widened; for females in England, however, death rates among the poorest again increased (see Figure above). Respiratory disease, cancers and what have been called ‘diseases of despair’ rose abruptly in the poorest parts of Scotland in the years immediately prior to 2017. Before 2013 there had been such great improvements.

It cannot be stressed enough that these changes were unprecedented. The 2020 pandemic is not unprecedented – the UK has suffered many pandemics before including pandemics with similar mortality tolls in the 1950s and 1960s, and higher mortality rates for younger people then than in 2020. However, the deterioration of the health of the population in the decade before the pandemic struck meant that when it struck, we, and especially those in the poorest places, were weaker than before.

When you look at the maps of areas which suffered the most in 2020, think back to this paper and which areas had already seen mortality rates rising year on year before the arrival of any new disease into the UK.

 

 

For a PDF of this article and a link to the original source click here.

 

 

And for the original study see:  Walsh D, McCartney G, Minton J, et al. Changing mortality trends in countries and cities of the UK: a population-based trend analysis. BMJ Open 2020;0:e038135. doi:10.1136/ bmjopen-2020-038135

 

Past pandemics, fear, dread and hope

In 1890, when he was still at school in Harrow, Winston Churchill wrote a poem entitled “The Influenza”. The outbreak he was describing may not have been of influenza. Several suggestions have been put forward to suggest that this was the advent in 1889 of the beta coronavirus now labelled OC43. Whether that is true or not, it was not a very good poem, perhaps because Winston was only aged 15 at the time he wrote it:

The rich, the poor, the high, the low

Alike the various symptoms know

Alike before it droop.

Winston, from a wealthy family, was especially concerned that the rich and the ‘high’ were suffering too. But he was also reflecting the widespread panic around him at the time, and the fact that there had been no similar pandemic for 42 years. When it has been that long (as you reading this may well know) it feels as if it has never happened before.

The population in 1890 was much younger than today. Nethertheless, 146 people died per million from the disease that year, 544 per million in 1891 and 531 per million in 1892. In total around twice the mortality rate suffered in 2020. Diseases spread through a population more quickly today, we have more treatments and possibly even a vaccine soon, so it is possible that there will be few deaths in 2021 and 2022 and that the overall mortality rate of 1890-1893 will remain roughly twice that of 2020.

In 2005 when writing about the 1889-93 pandemic Mark Honigsbaum suggested that: “the rapid progress of the influenza across Europe and the morbidity of leading politicians and other members of the British establishment occasioned widespread ‘dread’ and in some cases panic. This dread of influenza was fuelled by the high mortality rate in northern towns such as Sheffield, as well as by the disease’s association with pneumonia, neurasthenia, psychosis and suicide. However, the key factor was the growth of mass circulation newspapers and the way that the influenza drew on fin de siècle cultural anxieties about urbanisation and the increasing speed of modern life.” This may sound very similar to some, the new technology of the local newspaper was as new then as social media is for us today. And, just as with COVD-19, men succumbed a little more often than women, especially older men, and even the Conservative Prime Minister, Lord Salisbury fell very ill from the disease.

Twenty-eight years later what was undoubtably influenza struck in 1918-1919. It was far worse than anything before in living memory (or since). As the writer Anthony Burgess explained when writing about his very early childhood: ‘In early 1919 my father, not yet demobilized, came on one of his regular, probably irregular, furloughs to Carisbrook Street to find both my mother and sister dead. The Spanish Influenza pandemic had struck Harpurhey. There was no doubt of the existence of a God: only the supreme being could contrive so brilliant an afterpiece to four years of unprecedented suffering and devastation. I apparently, was chuckling in my cot while my mother and sister lay dead on a bed in the same room.’ Anthony was born on 25 February 1917.

Thirty-years year on, in 1957 a new variant of influenza struck again, as deadly as COVID-19, and then again just a dozen years later in 1968/69; and then nothing that was as abrupt for almost 50 years (although there were slower new killers such as AIDS). Hundreds of thousands saw their lives cut short in the 1980s and 2010s due to austerity in those years, but spread over several years, rather than 40,000 dying in just a couple of months or so in 2020.

COVID-19 is the latest in a long string of pandemics to have swept the world. This current one may now be drawing to an end in Europe. It is far too early to know for sure, but today we have surveillance, knowledge and science as never before. However, we also have a recurrence of the dread seen in 1890 and we do not have the fortitude (or resignation) of previous times.

I’ll end this short note with a graph that two colleagues and myself published on October 1st 2020 as it gave us a little hope. You can find a detailed explanation of it in the article pointed to in the final note given below. For now, it might just help to know that in England in the days between 1 August and 18 September 2020, the number of cases of the disease did not rise in those places which had suffered worst earlier in the year. This is how outbreaks of diseases such as this begin to end. As yet this curtailing has only been observed in very few parts of England, mostly in London, but at least it has now – finally – begun to be observed.

First published in: Dorling, D., Brookes, A. and Davey Smith, G. (2020) Why are coronavirus rates rising in some areas of England and not others? The Conversation, October 1st

 

Notes

On the fourth coronavirus and the possibility that is was source of the 1889 epdeimic see: Vijgen, Leen; Keyaerts, Els; Moës, Elien; Thoelen, Inge; Wollants, Elke; Lemey, Philippe; Vandamme, Anne-Mieke; Van Ranst, Marc (2005). “Complete Genomic Sequence of Human Coronavirus OC43: Molecular Clock Analysis Suggests a Relatively Recent Zoonotic Coronavirus Transmission Event”. Journal of Virology. 79 (3): 1595–1604. doi:10.1128/JVI.79.3.1595-1604.2005. PMC 544107. PMID 15650185; and Knudsen, Jeppe Kyhne (13 August 2020). “Overraskende opdagelse: Coronavirus har tidligere lagt verden ned” [Surprising discovery: Coronavirus has previously brought down the world]. DR (in Danish). Retrieved 13 August 2020: ‘A presumed influenza pandemic in 1889 was actually caused by coronavirus, Danish research show.’

On Winston Churchill’s poem see Mark Honigsbaum (2010) The Great Dread: Cultural and Psychological Impacts and Responses to the ‘Russian’ Influenza in the United Kingdom, 1889–1893, Social History of Medicine, Volume 23, Issue 2, August 2010, Pages 299–319, https://doi.org/10.1093/shm/hkq011, Published: 09 June 2010.

On Antony Burgess’ memories of what his father had said to him, see: Alice Reid (2005) The Effects of the 1918–1919 Influenza Pandemic on Infant and Child Health in Derbyshire, Medical History, 49(1): 29–54.

Dorling, D., Brookes, A. and Davey Smith, G. (2020) Why are coronavirus rates rising in some areas of England and not others? The Conversation, October 1st, https://theconversation.com/why-are-c...

For a PDF of this article and its original publication details click here.