Danny Dorling's Blog, page 28

The public health record of the 2010-2018 UK Government

In the eight years since the May 2010 general election, the health of people living in the United Kingdom has faltered. At first the only evidence came from surveys in which people started to say in greater numbers that their health was getting worse. Then they started dying a little earlier than before, and then a lot earlier. By early 2018 we were seeing slowdowns in health improvements not experienced since at least the 1890s.

In some areas of the country life expectancy began to fall. It then fell for all the poorest of infants born in the country.

Infant mortality rate (95% confidence interval) by socio-economic classification 2008-2016.

However, whenever any suggestion was made that central government austerity and health policies might had an adverse impact on the health of the nations of the UK, these suggestions were always (and without exception) dismissed out-of-hand by the department of health media representatives as being preposterous suggestions.

In this talk the story is told, some of the evidence presented and the question raised as to who in government did not know. Who might have known and did not care. And who knew, cared, but thought all this was a price worth paying for what they really wanted to happen to health and other public services. To privatise a service first you have to run it down.

Danny Dorling speaking on the public health record of the 2010-2018 UK Government, Bristol Population Health Science Institute Annual Stephen Frankel Lecture, University of Bristol, June 7th 2018.

Peak Inequality: Danny Dorling and Faiza Shaheen

In Peak Inequality: Britain’s Ticking Time Bomb Danny Dorling presents the evidence that in 2018 the growth in UK income inequality may have finally peaked. Inequality began growing in the 1970s and the damaging repercussions may continue long after the peak is passed. There will be speculation and a little futurology.

Danny will be in conversation with Faiza Shaheen, director of the think tank CLASS and former Head of Inequality and Sustainable Development at Save the Children UK. Faiza recently explained that the rich, like viruses, also develop resistance, in their case to redistributive taxes. They use their wealth and power to carve out tax loopholes and lower tax rates. Their fortunes ballon. Inequality grows. In which case why should inequality peak now?

London Review Bookshop – Tickets available here: for 7pm Wednesday July 11th 2018

Peak Inequality: Britain’s Ticking Time Bomb

 

Is our NHS fit for purpose?

This summer is the 70th anniversary of the founding of the National Health Service. On June 30th a demonstration will be held in London in defence of the NHS.

Prior to the national demonstration many debates are being held. One was recently introduced by Amelia Womack, Deputy Leader of the Green Party. A recording of it is below. This recording is of a discussion and debate between Louise Irvine (a GP and Health Campaigner), Danny Dorling (an Academic and Writer) and Jonathan Ashworth (current Shadow Secretary of State for Health). In the discussion they cover many of the threats to the NHS. They were talking at the Peoples’ Assembly meeting in London, held on June 2nd 2018 at St Pancras New Church.

Mental distress has external causes

To better tackle mental illness, look to the societies in which it occurs.

The enjoyment of the highest attainable standard of physical and mental health is a human right. That’s according to the Office of the United Nations High Commissioner.

Few Prospect readers would argue against human rights. But we usually view health, particularly mental health, as an individual affair, seeing it only as an internal state. In truth we are all greatly influenced by wider society.

When large numbers of people become unwell, we need to look beyond biology and consider what is happening at the societal level.

In their new book The Inner Level, Richard Wilkinson and Kate Pickett reflect on the social factors influencing mental health. They reveal that the incidence of mental illness in the UK is twice that in Germany. Americans are three times more likely than the Dutch to develop gambling problems. The mental health of children is worse in New Zealand than it is in Japan.

Wilkinson and Pickett examine the effects of living in such different societies. And this new understanding of powerful societal influences chimes with much other recent work.

People working in separate disciplines are coming to the same conclusion: that our social worlds impact on us, they can give us health or cause us harm. As the UN puts it, “mental health policies and services are in crisis—not a crisis of chemical imbalances, but of power imbalances. We need bold political commitments, urgent policy responses and immediate remedial action.” This recent report calls for a shift from biomedical models of mental distress to a more radical, human rights-based approach, acknowledging the impacts of social inequality.

Another recent report published by the British Psychological Society, “The Power Threat Meaning Framework,” looks at the contextual factors which may make us sick. PTM acknowledges power inequalities and the impact of oppression. Being on the wrong side of power can lead to feelings of entrapment, shame and humiliation, as well as a sense of lacking control.

The framework highlights links between “poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress or troubled behaviour.” Adverse childhood experiences have a negative impact on health and wellbeing, for example.

Both The Inner Level and PTM reframe the narrative around why people get sick—refocusing the question from “What’s wrong with this individual?” to “What’s going wrong in this society?”

Whilst these new ways of thinking are works in progress, they open up new vistas. There is a renewed possibility of collaboration between geographers, sociologists, psychologists, public health and local communities to really understand the pathways from oppressive inequality to ill health.

But as Wilkinson and Pickett say, “Change on the scale needed… can only be achieved if large numbers of people commit themselves to achieving it.” And as they conclude in a recent newspaper interview: “It is clear that differences in cognitive development and intelligence are the consequence of inequality rather than its cause.”

That is a call to action, and we need to rise to the challenge for the sake of a healthy and sustainable future.

The original article by Danny Dorling and Khadija Rouf that this post is based on was published in Prospect Magazine on June 1st and is available here. The Book, ‘The Inner Level’, is available here

The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing by Richard Wilkinson and Kate Pickett (2018)

Paul Scarrott speaking at the Anti-Racism Summit, Sheffield, 2 June 2018

We have to stand up to these things because otherwise we are faced with a very simple situation. Today’s unacceptable becomes tomorrow’s norm.“There is no end to it. But we do know there is an end to it, it ends in people dying; either in their dozens, their hundreds, their tens of thousands, or their millions. And that’s why we have a duty and a responsibility to not allow today’s unacceptable to become tomorrow’s norm. That is not going to happen.”

Paul Scarrott speaking at the Anti-Racism Summit, Sheffield, 2 June 2018

Can the UK afford to leave the EU?

The UK voted to leave at the peak of its economic inequality. In hindsight this appears to have influenced the decision. Many British citizens are likely to be impoverished as a result. Those without citizenship already live in great fear. So, can we actually afford to walk out on this relationship?

Danny Dorling’s annual lecture on Brexit given at the Hay Festival on May 25th 2018, speaking with Tom Clark of Prospect Magazine:

 

On Brexit, the UK will almost certainly leave, but mainly in name only, and mainly because its politicians simply can’t afford to do much other than that – its all a bit humiliating.

But perhaps we’ll learn a lot about ourselves in the process and grow up a bit as a set of nations? At the very least we will all be learning some basic geography such as that Britain is not a country, and that the Irish border matters – really matters – much more than many in England ever realised it did.

 

The new book referred to in the talk, the one on ‘Peak Inequality‘, is published on July 17th 2018:

Peak Inequality: Britain’s Ticking Time Bomb

Inequality the Big Picture

The first of three Free Summer Lectures on Inequality. Given by Danny Dorling in London on Tuesday May 22nd 2018 at 6:30pm in Bethnal Green. A video of the recording of the lecture, with slides embedded, can be played below.

The second free lecture will be given by Sadiah Qureshi on June 21st 2018 entitled: ‘There is Black in the Union Jack’: Britain’s forgotten history, tickets available here.

The third free lecture will be given by Rosemary Ashton on July 19th 2018: on: ‘Affordable Education for All: The Pioneering Contribution of Victorian Bloomsbury’, tickets to be found here.

‘Inequality the big picture’ was based on the forthcoming book ‘Peak Inequality: Britain’s Ticking Time Bomb” – to be published on July 17th 2018.

Peak Inequality: Britain’s Ticking Time Bomb

“Inequality – the big picture”, Danny Dorling kicking off the summer lectures at the IF Project (a free university), St Margaret’s House, Bethnal Green, London, May 22nd 2018

Thanks are due to Drew McFadyen for recording the lecture, and Jonny Mundey, Barbara Gunnell and Peter Wilby for arranging it.

As the video above conclude, it is always worth remembering that:

When change truly happens it at first strikes seasoned commentators as frankly impossible – a pipe-dream; then undesirable and full of negative consequences; then ‘just about possible’ once the clamour for change becomes overwhelming.

Finally change happens and their memories change with it. They will say that they believed in the change as desirable all along; they somehow saw it coming and so, too, were on the right side of history.

Then we can all forget that just a few years ago they had so vehemently opposed the change, had justified the status quo, were so very scornful, and ultimately wrong.

That matters little.

It is just history.

What matters is ensuring that we are now at the peak and starting on our way down.

…

It’s a long way down.

 

 

What might a progressive economy look like?

A progressive economy might seem like a pipe dream, but is it achievable?

The future is another place a long way away. Look forward one hundred years; what do you see? We will hopefully be better housed, schooled, and employed, but how?

How might we control the rich, live better alongside each other in Europe, elect our politicians, police ourselves, deal with terrorists, with unemployment, and with our current obsession with the market?

Look back a century and you see the year of the worst flu pandemic the world has ever known, back to a world at war. Now imagine looking forward from then to the present day, to 2018. In the turmoil of 1918, it would have been hard to envisage the magnitude of the social progress that would manifest over the coming hundred years.

In a similar way, our current levels of inequality actually harm the imagination. Otherwise we, in Britain, would more easily see what we need to do. We are currently the most economically unequal country in Europe. That will very likely end soon.

Once we imagine what could be, then it becomes easier to know what we should be dreaming of and aspiring to. The future will be very different, even though we find it far easier to keep on imagining more of the same.

In a progressive economy, house prices would reflect how much it costs to build a home, including the costs of the material that each home is built from, but not the hyper-inflated land value. The costs of renting will relate to the cost to the landlord of maintaining the fabric of a home and the landlord’s actual time and effort, and not to the power imbalance that comes with sharp inequalities of wealth. Rents would be regulated, hidden charges banned.

In a progressive economy, school funding would be at least raised to normal Western European levels, and state schools would not be privatized (‘academized’) and turned into businesses with scant oversight of their financial behaviour.

If you think none of this is possible please remember that the beating of children was only outlawed in UK state schools after someone like me left school, in 1986, and in private schools only a dozen or so years later! Teachers used to beat children!

So, given all that, we should be asking ourselves the following question: what is happening now that we might regard as abhorrent in future? This constant asking, demanding and then winning, is what it means to be progressive.

A progressive economic outlook alters how we view key issues such as immigration and ageing. Our current obsession with immigration is partly driven by a fear that there is not enough work to go around. However, work in the near future will be very different. Our obsession with ageing is due to a fear that the old will be a burden on the young; but our economy in the future will be so very different to today. The majority of the largest firms in the UK in 1918 were no longer in existence by 2018, and the few that did survive were no longer at all large.

Today the largest UK firms are involved in oil, banking, supermarkets, mobile phones, chemicals, pharmaceuticals and making weapons Almost all of these did not exist a hundred years earlier (or were tiny then), and many will be much diminished in size in much less than a hundred years’ time. Not only will work change, but what work needs to be done will fundamentally alter, as it has been doing for some time.

With respect to health, our current health crises are temporary aberrations. Across Europe there is a continuum from Finland and Norway, where life expectancy continues to increase at a rate of one additional year in every three or four, down to countries like the UK, where improvements in life expectancy have now stalled, largely thanks to inadequate public spending on vital care and other cuts – such that austerity has been linked to 120,000 excess deaths. In a progressive economy, we will shudder when we remember what we accepted today.

The extreme inequality, the continuous crisis, and the awful austerity that we experience today will soon be history.

When change truly happens it at first strikes seasoned commentators as frankly impossible – a pipe-dream; then undesirable and full of negative consequences; then ‘just about possible’ once the clamour for change becomes overwhelming.

Finally change happens and the memories of the commentators change with it. They will say that they believed in the change as desirable all along; they somehow saw it coming and so, too, were on the right side of history.

Next, we all forget that just a few years ago they had so vehemently opposed the change, had justified the status quo, were so very scornful, and ultimately wrong. That matters little. It is just history.

What matters is ensuring that we are now at the peak and starting on our way down. It’s a long way down.

read more and PDF here

Or listen to three short talks given in London on the same day as the Progressive Economy Forum was launched:

The Gender Pay Gap – what the first reports revealed

In April 2018 we heard an enormous amount about gender pay gaps as all the data was revealed.

It concerned the arithmetic mean average of hourly pay of men in a workplace, the total pay received for an hour worked by all men divided by the number of men working in that workplace compared to the same for women, and the gap is then calculated as the difference between the two divided by the men’s pay.

In contrast, the median pay for each group is what the middle man and women receives when all men and women are separately sorted by their hourly rate of pay. All the data discussed below comes from here.

Early in March 2018 we learnt that the median average women worker at (alcohol shipping firm) Diageo Ltd is paid more than the median average man there . However as in almost workplaces, the mean (arithmetic) average male pay is higher than women in that company receive, as is the case in most workplaces today. This means that the gender pay gap in Diageo is widest for those men and women who are the best-paid in that firm.

The deadline for reporting pay gaps was Wednesday April 4th. Almost invariably the gaps were widest among the highest paid. Male and female cleaners tend to be paid similar amounts to each other, but not male and female managers, bankers or aeroplane pilots.

The early data showed the airlines to be most unequal. Thompson, Tui Airways, Jet2 and EasyJet, are all paying men at least 50% more than women on (mean) average. Think of Richard Branson carrying a female flight attendant over his shoulder for an image of this inequality. Airlines represent the industrial sector of Britain sector most out of touch with times.

Next there are the banks. Barclays pay 48% more to the men who work there than the women.

But very similar are the advertising firms. To keep up their mad-men credentials: WPP have been paying 52% more an hour to men. The legacies of Bob Diamond and Martin Sorrell live on. When Martin retires the WPP gap will drop substantially. Very often the pay of the ‘top man’ (occasionally top woman) makes a noticeable difference to the ratios of whole organisation, even large organisations.

Note that Martin stopped working for WPP in the very same month as this first pay gap data was revealed and: “less than a fortnight after it was confirmed the company was investigating an allegation of personal misconduct against him.” The times are a changing.

So, what was the variation see in a public service like education and how does it compare? By early March the Ocean Learning Trust based in Bournemouth, reported its men were receiving 40% more an hour than its women workers. Hopefully by the time you read this its explanatory report will be on the trusts’ website.

That report will undoubtedly say that men and women do very different jobs in the organisation, but that excuse can’t wash for the sector as a whole. The Ocean Learning Trust website does contain details of its male ‘thinker in residence’ who is helping them look forward to the future. I wonder if he saw this coming?

The Peninsula Learning Trust in Cornwall has been paying men, each on average for every hour worked, 35% more than women. The Eastern Multi-Academy Trust in Norfolk had a male pay rate that was 33% more per hour for men.

Men who work at the Greenhead College in Huddersfield are paid, on mean average, 24% more than women, and the median male worker is paid 40% more than the median female there. There is a terse 2 page ‘equality and diversity’ policy available on its website but that policy does not explain why –the (mean) average a man who works at Greenhead is paid for 6 hours a day the same that each women is paid for working 8; and the median pay divide is even more stark.

In my search for statistical answers I headed across the Pennines and into the private sector. Manchester Grammar School reports that its male workers are paid 15% more on the mean measure and 17% more on the median measure as compared to its women workers. A majority of workers at the school are female, including almost two thirds of all the workers paid below the median wage.

What about universities? The University of Salford ‘only’ pays women 14% less on mean average than men and the median man is paid 21% more for men there than for the median woman worker. This is probably better than the university sector as a whole.

In comparison, and a long way South-East, the University of Kent doesn’t do as well on the mean pay as Salford (women get 18% less than men in Kent), but it does do better on median pay (the median woman gets 10% less than the median man in Kent) . It would be useful to know if both universities interpreted the rules over who is included in these calculation in the same way.

Searching through the statistics of some of the first organisation to report in March 2018, I found the educational establishment that was then winning in the gender pay gap to be the Northern School Trust in Liverpool. Women there are paid a little more than men, 9% more on the mean average, 2% more on median pay! It is not preordained that women have to be paid less than men and to date there is no rule to explain the diversity of pay we currently see being revealed.

We will need more information in these reports in future to be sure that no one has made a big mistake in calculating their figures and that all establishments are interpreting the guidance in the same way. We will also need the reports that will accompany future releases every 12 months to begin to explain why the figures have changed as they have and why, if they are not favourable when compared to the sector as a whole, they have not improved. Simply saying we are doing better than the airline industry would not be ‘excellent’.

These are the first reports of their kind. Without them people in the sector where I work would never have known that gender pay inequalities in education were wider than on average. We would have continued to kid ourselves that we were a little more enlightened than the average industry. What we are finding is that we are not.

read more and PDF of this article in Public Sector Focus.

The Gender Pay Gap – what the first reports revealed

Government must investigate rising excess deaths in England and Wales

Health researchers have urged the government and MPs to investigate rising numbers of deaths in England and Wales, after new figures showed over 20,000 “excess deaths” so far in 2018.

Gareth Iacobucci writing in the British Medical Journal on May 11th 2018 continued:

Earlier this year an analysis of the Office for National Statistics’ data on weekly provisional deaths in England and Wales, published in The BMJ, found that by week seven of 2018 (ending 16 February) 10 000 more people had died than the average from the past five years.

Lucinda Hiam, honorary research fellow at the London School of Hygiene and Tropical Medicine, and Danny Dorling, professor of geography at the University of Oxford, who carried out the study, said that neither flu nor winter weather seemed to be the main cause of the increase.

A subsequent analysis from the same authors, posted on 8 May as a rapid response to the original article, shows that by the end of week 16 (ending 20 April) 20,215 more people have died than the average for the past five years.

The authors found it unlikely that this trend was a “blip” and urged the government and the House of Commons Health Select Committee to investigate the issue.

They wrote, “The latest Office for National Statistics data on weekly provisional deaths in England and Wales sadly provide little reassurance of this being a ‘blip’ as some have suggested. Yet, still, no action taken or even mention of a possible investigation has been heard from the Department of Health and Social Care. How many deaths will it take for the government to take note?”

Last year an analysis by Michael Marmot, a leading public expert, found that the rate of increase in life expectancy in England had almost halved since 2010 and was close to stalling.

In response to Hiam and Dorling’s analysis, a spokesman for the Department of Health and Social Care said, “We keep all research in this area under review, but the ‘age standardised mortality rate’—which has been broadly stable in recent years—is considered a much more reliable measure, as this type of research doesn’t take into account fluctuations in population numbers and the ageing population.”

But Dorling and Hiam strongly criticised the department’s response, saying, “The age standardised rates should not be ‘broadly stable’—they should be getting better as they have for almost all years since 1945, and are doing in all other European countries in recent years (2011 to 2015). “There is no other country in western Europe that has experienced a stalling in mortality improvement across the board as poor as that in the UK in recent years.”

They said that the Health Select Committee should carry out an investigation and “call ministers from the Department of Health and officials from Public Health England to answer their very specific questions without evasion.”

. . .

The British Medical Journal included a graph in their news report illustrating the continued elevated levels of overall (all age) mortality:

Excess Mortality in the first 16 weeks of 2018, England and Wales

read the full rapid response  here with all the graphs shown in this post embedded in a single PDF file, fully referenced.

Another rapid response to the original March 14th 2018 BMJ article was posted by David Robinson and his colleagues on 18 March 2018:

In this they revealed that “Death rate continues to rise for poorest infants in England and Wales” explaining that:

” Last year we raised concern about the rise in infant mortality in England and Wales in a letter to the BMJ.(1) The latest data released by the ONS this week shows that infant mortality has risen for the second year running. In 2016 there were 2651 infant deaths, compared to 2578 and 2517 in the preceding two years. The statistically significant increase in infant mortality rate from 3.6 to 3.8 deaths per thousand live births over these two years (p-value = 0.037) is explained by the 5.3% increase in infant deaths, rather than by any change in the denominator which showed only negligible change. …”

A few month earlier, on October 13th 2017, the Office for National Statistics published the following graphic under the title: “Neonatal mortality rankings, European Union countries, 1990 to 2015”

In late 2017 ONS reported that “The UK has dropped several ranks in the European Union rankings of child mortality since 1990, recent analysis of WHO and ONS data has found”. They explained that “The neonatal mortality rate indicates the probability of dying in the first 28 days of life. In 1990, the UK was seventh in the European Union with a neonatal mortality rate of 4.5 deaths per 1,000 live births. Germany, Sweden, France, Finland, Luxembourg and Denmark were ahead of the UK with lower neonatal mortality rates. The worst performing countries were Romania, Hungary and Estonia, which had neonatal mortality rates of 13.5, 13.6 and 13.8 respectively. Yet by 2015, Estonia had managed to overtake the UK, coming in at fifth place with a rate of 1.5, while the UK was pushed back to 19th with a slightly higher rate of 2.7. Other countries with a similar neonatal mortality rate to the UK include Croatia (2.6) , Lithuania and Denmark (both at 2.5), and Spain (2.8).”

 

Neonatal mortality rankings, European Union countries, 1990 to 2015

And then the UK neonatal mortality rate rose during 2015 and 2016.The overall infant mortality rate rose as well. This accelerated the rate of fall of the UK in the league table above.

An interactive version of the ONS graphic can be found here. Readers should note that the reality today is even worse than that shown above. Already, by 2015, the UK had experienced the sharpest and fastest relative fall in its ranking in the EU, worse than any other EU country, as measured by neonatal mortality. Then, after 2015, the rates rose and the relative decline shown in the graph above accelerated. To date (Sunday May 12th 2018) the Department of Health has declined to comment on the rising numbers of dead babies in recent years, either just within England, or those across Great Britain and Northern Ireland as a whole.