Danny Dorling's Blog, page 30

The Demography of Inequality

Re: Rise in mortality in England and Wales in first seven weeks of 2018: Rapid response by Lu Hiam and Danny Dorling, published in the British Medical Journal, March 23rd 2018

On 20th March 2018, speaking in the House of Commons, Dr Paul Williams MP referred to this editorial. He asked the Secretary of State for Health and Social Care, Jeremy Hunt, ‘why did all these extra deaths occur?’. Mr Hunt replied:



As the hon. Gentleman will know, these figures cover England and Wales. He will also know that they do not take account of changes in population or changes in demography, so we use the age-standardised mortality rate, which, according to Public Health England, has remained broadly stable over recent years.

To take each point in turn, firstly, the Secretary of State is correct: these figures do cover England and Wales. However, this distinction is trivial. If the figures for weekly provisional deaths by ‘region of usual residence’ are used, the total for Wales is 5,841 for weeks 1-7 of 2018, and the average for the last 5 years 5166. England deaths, therefore, are 88,149 compared to a 5-year average, without Wales, of 78,449. This gives an extra 9,700 deaths in England. These Office for National Statistics (ONS) data are available to the Secretary of State and his advisors if they wish to know about trends solely in England.

Secondly, a change in population or demography does not happen suddenly. However, we agree it would be useful to examine the age-standardised mortality rate. Given the gravity of the concerns raised, we hope Public Health England will urgently calculate this, using the ONS projection of the population at risk in 2018, to compare what was expected in 2018 to what has been seen. We do not believe this will alleviate our concerns. The ONS projections do not include a sudden very large influx of elderly people, and there is no evidence that this has occurred.

Finally, last week saw publication of statistics not only raising the alarm at mortality rates in adults, but also in infants. Infant mortality has risen two years in a row. This confirmed the concerns first raised by Taylor-Robinson et al in 2017, and re-iterated in their rapid response. Among countries of the European Union, between 1990 and 2015 the UK dropped from 7th place to 19th for neonatal mortality, and from 9th to 19th for under-five mortality.

Infant mortality is rising, life expectancy is stalling, and there have already been 9,700 extra deaths above what is usual in England in the first 7 weeks of 2018. This leaves us wondering—what will it take for the Government to investigate? We hope the Secretary of State for Health will significantly and urgently re-consider his response.

The full rapid response and be read here along with the editorial it refers to, and discussion of issues recorded the day before is in the podcast below.

Bodleian Quad, Oxford

 

Recent deaths in prisons and for people in mental health detention in the UK

Decent rights, trust, and fairness all require greater economic equality. Without greater economic equality we cannot expect people to trust each other; rights to be upheld, maintained or respected; or for fairness to be preserved.

There is an un-egalitarian fantasy that it is possible to continue with great economic inequalities, but somehow for people to know their place and behave well in it. That fantasy has, unfortunately, become current government policy. So who should be held to account when official policies result in mortality rates rising: within mental health institutions most recently, prisons generally, and society more widely?

In the UK the situation has recently worsened. According to an editorial published in The Lancet on 10th March 2018:‘In 2016, the likelihood of self-inflicted death of offenders in custody was 8.6 times greater than the likelihood of suicide in the general population… It is lamentable that the UK’s prison system should have been allowed to decline to its current unsatisfactory levels, bringing with it a rise in depression and suicide as prisoners find themselves part of a system that puts containment above reform.‘

The editorial continued: ‘As with so much of the discussion around public services in the UK, the sense that a tipping point will soon be reached is tangible. The UK’s prison system has shed 30% of staff since austerity began in 2010. The average amount spent on suicide investigations in UK prisons has more than halved since 2012–13. Until conditions are improved, guidelines like these are a firefighting effort in a situation where the fires themselves may be preventable.’

Two years ago on 23rd September 2016, Richard Garside reported that the prison population had risen from 46,000 in 1985 to 85,000. He explained that earlier that month the Prisons and Probation Ombudsman, Nigel Newcomen, had reported that prison violence was now at a ‘wholly unacceptable level’ [but we accepted it]. Six prisoners were killed in the 2015-16 year, he observed. This is up from four in 2014-15 and that was the highest number since records began in 2000. ‘Buildings are crumbling, infested with rats and cockroaches‘, The Economist noted in 2016. ‘In the year to June 2015,’ it pointed out, ‘105 prisoners killed themselves, compared with 59 in 2010‘. And that has now also worsened.

By May 2017 we learnt that ‘Deaths in state detention (excluding Deprivation of Liberty orders) increased by 19%, to 574 deaths being reported to coroners in 2016, with the largest increase seen in deaths while detained under the Mental Health Act (252 in 2016, up 34%) and deaths in prison custody (298, up 14%).’ Numbers of annual deaths of people held under the Mental Health Act are now almost as high as those in prisons and the population detained is roughly half as many people.

Today, in 2018, across the UK, twice as many detained patients die, per 1000, as prisoners die in prison in the UK, and the number dying in prisons has risen greatly. The overall situation is worsening.

A quarter of million British children currently have a parent in prison. One in seven children have had a parent in prison at some point but nobody talks about it, and nobody knows how many children, parents and siblings have a parent, child, brother or sister in a mental health institution. All of whom are now at greater risk than they were a few years ago. We only know this because  the numbers of deaths in custody have recently been rising more quickly than the number of people deprived of their liberty.

In 2017, prisons were using ‘cruel‘ punishments that restricted inmates from seeing their children. Hundreds of children had contact with fathers reduced to just two hours a month.

As David Scott explained on January 10th 2018:’We’ve been trying to reform the prison for 200 years. It’s failed. It’s time for us to think about doing something different‘.

A society that has learnt to tolerate some people being worth so much more than others, with such high income inequality, will then tolerate so many other injustices.

Blame education’s ‘macho leader’ cult for shocking gender pay gap

For years schools have been sending pupils the message that women are worth less than men. It’s our moral duty to fix that.

The cult of the macho “strong leader”, which dominates education, has been damaging in so many ways. I always seem to be reading fatuous accounts of the apparently super-human workloads of our academy trust principals and university presidents. They rise at 5am to lead their institutions forward with an hour of emails, followed by breakfast meetings, and fall late into bed having worked tirelessly all day for their underlings. It is narcissist guff and to most of us is unimpressive, but given how much educational leaders pay themselves, it is perhaps not surprising that they try to justify their worth in this way.

But perhaps the worst effect of the “strong leader” has been the resulting failure to address the gender pay gap. It is through pay that we demonstrate exactly how much we respect each other. Pay is always about respect.

Writing in the Guardian recently, Fran Abrams revealed that the gender pay gap within the first 40 academy trusts to report under the new legislation was 19.5% – much higher than the 11.8% average for the first 1,000 institutions that filed their reports.

Experts said this was not surprising, “as schools have large low-paid workforces of classroom assistants, lunchtime supervisors and cleaners which are largely female”. However, almost all companies have cleaners, so that is hardly an excuse for why schools pay men so much more.

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The wealth parade by Ella Furness

Brexit: The result of rising inequality, not rising immigration

Immigration has been suggested as the reason for why a narrow majority of people in the UK voted for Brexit. The concept was used to stoke up fear in areas of low immigration.

However, immigration is not what sets the UK apart from other EU nations as unusual.

The real reason for the Brexit vote was widespread and rising dissatisfaction with living standards as a result of rising inequalities.

This talk concentrates on that and on what the UK and especially England may learn about itself in the coming years, partly as a consequence of the Brexit vote.

Talk and discussion afterwards recorded at “Imagine: Belfast’s festival of ideas and politics”, held at the Crescent Arts Centre, Belfast, March 17th 2018 (St Patrick’s day)

Top ‘Remuneration’: Have we reached Peak Inequality?

A fall in inequality can begin without policy and political changes, but they help sustain it. In December 2016 the City of Portland in Oregon announced that it would surcharge

companies that paid their CEOs (Chief Executive Officers) more than 100 times their

median workers’ pay.

In 2016 in the USA the average pay of the top 500 CEOs had fallen to 335 times the

income of the average worker.

That is still incredibly high but in 2014 it was 373 times, although this compares to 42

times in 1980 and 107 times in 1990.

In the UK the average CEO of big British companies was paid 131 times average workers

in 2016 (up from 47 times in 1998). However, on the 3rd of August 2017 the UK’s High

pay centre revealed that the average UK FTSE 100 CEO pay had dropped by 17% in just

one year, down to £4.5million from £5.4million.

The ratio of top bosses pay to average workers’ pay in the UK has only in the very latest

year started to fall, just as has happened in the USA a year earlier.

Whether that fall continues will be determined by remuneration committees meeting at

the start of this 2018 year. Top CEO pay matters also because it is used by ‘hedge fund

managers’, ‘investors’ and others who reap even greater ‘rewards’ to justify their

behaviour and the way governments in the UK and USA allow them to behave.

Last year it was the average pay packet of the highest paid 25% of UK CEOs which fell

the most among all the top CEOs so inequality within that group also fell. CEO pay

matters because it is used to justify excess pay for other top officials. In the 1930s it was

when pay at the top began to fall that income inequality overall began to rise.

That rise continued into the 1940s, to when we had never had it so good in the 1950s,

though to the swing 1960s and then throughout most of the 1970s, the decade which saw

the fastest ever improvement in UK living standards, access to education, improvements

in health, and the building and fair distribution of so much good quality housing for the

people who most needed it. But then, in the 1980s in the UK and USA, instead of

improving the lot of all most and more began to be taken by those at the top who said

they needed it to make everyone work better.

Other affluent countries did not follow suit to this extreme degree and now almost all

have higher life expectancy that is still rising, less poverty, better educational outcomes

than the USA and UK.

In 2017 the Prime Minster said she would consider introducing new rules to ensure such

pay ratios were published for all companies. Many large public institutions publish them

already and most soon have to publish their gender pay gaps.

Theresa May is no radical, but she recognizes that moral sentiment has changed and she

has to at least pretend that she cares about the incredible heights inequality has reached.

She must not appear to care simply because of how unpopular it makes her political

party among young voters. Inequality has many other detrimental effects than causing

enormous and justified resentment.

When inequality is high people lose face, they lose confidence, they suffer from

comparisons in which it is implied that the vast majority warrant little or no respect.

Improvements in life expectancy stall or even reverse, you fear for your children and

their future. Life feels like a game of chance with most of the odds heavily stacked

against you.

Fear divides one from another; loneliness increases, even as we become more crowded in

cities. Our greatest fear is other people, and inequality becomes the enemy between us.

Where inequalities have risen the most, the rich are terrified both of becoming poorer

and of the poor. The poor and everyone in between cannot believe how much the rich

waste. Great economic inequalities rose at the end of both the nineteenth and twentieth

centuries as the greedy few took advantage of the confusion created by great social

change.

This was not because their huge greed was needed, but because it was not well enough

understood and so not well enough controlled.

Today the pace of social change is slowing, global populations are stabilizing, and we

better understand the pathology of greed. We should not be surprised to see economic

inequalities slowly fall.

Children aged between 8 and 14 today could live all of their working lives in countries

becoming more and more equal, as most of their great-grandparents did.

The alternative is catastrophe. But even if that is our fate, most catastrophes end with

economic inequalities reducing. None of us can any longer afford the extent of inequality

we currently tolerate – and be safe.

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This is an updated and edited extract from Danny’s new Book: Do We NeedEconomic Inequality?

Do We NEED Economic Inequality?

 

Rapid rise in mortality in England and Wales in early 2018 – an investigation is needed

Until recently we had been using the rising profits of undertakers to gauge how unusual recent rises in mortality have been. However, we can no longer do that. Alongside the most recent increase in deaths, there has very recently been an abrupt shift towards booking the lowest cost funerals. The UK’s second-largest undertaker lost more than half its market value in the first few weeks of 2018. The number of deaths in this period has risen rapidly.

In contrast, the operating profits of some private pensions firms have risen by almost a third in recent years, as it becomes clear that fewer people are living as long, and hence will not receive as many years of pension payments in future.

The slowdown in life expectancy for the average person in Britain is worse than anything seen since the early 1890s, and no other country in Europe has experienced as rapid a slowdown as the UK. In the UK, it is the poorest groups that have suffered the most harm, both to their health and their income since 2010, when austerity policies were first enacted.

On March 7, 2018, ONS released figures revealing that a man living in one of the poorest neighbourhoods of Blackpool, a deprived area in the northwest of England, can now expect to enjoy 32 fewer years of life in good health, compared with a man living in wealthy London boroughs, such as Knightsbridge and Belgravia.

This gap will now be growing in size as the poorest groups and areas have suffered more. And the gap for women has become even wider than for men, at 35 years between what can now be expected for women living in the poorer parts of Middlesbrough, compared with women living in some of the most affluent neighbourhoods of the Home Counties.

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Both adult and infant mortality now rise in the UK

In March 2018 we learnt that, in contrast to all other countries in Europe, both adult and infant mortality are now rising in the UK making an already awful situation worse.

On March 14th 2018 the Office of National Statistics reported that infant mortality in England and Wales had been rising in recent years, having steadily fallen every year until 2015. In 2015, just before the rise started, ‘Health and Social Care Secretary Jeremy Hunt announced an ambition to halve the rate of stillbirths and infant deaths by 2030.’ This is the second year in which the rate has risen, resulting in the UK now having one of the worse records on infant mortality in the affluent world.

The overall rise in infant mortality coincides with a rapid faltering in adult health in England and Wales. The worse increase in mortality for many years has now been reported for the first seven weeks of 2018 . The recent rise in adult mortality was not due to an unusual number of deaths from influenza. It was also hitting middle class people hard as they made up the bulk of people living to the ages that were most effected. Even people affluent enough to hold private pensions were dying faster, but it was the poorest who suffered the most.

Problems in underfunded NHS hospitals and social care have played a part. Health chiefs of all kind have so far failed to investigate the causes thoroughly, or even in most cases acknowledge that there is a problem. This is despite mortality for the poorest infants in the UK rising every year since 2011. It is despite mortality continuing to improve in all other European countries, which often still benefit from very rapid improvements in health; no longer seen in the UK.  The most recent rise in premature deaths is now leading to a situation where overall life expectancy could begin to fall for all groups. It is already falling in the poorest areas and for the poorest groups.

The situation may be worse in Scotland.

Only a year ago tabloid newspapers were dismissing reports such as this as ‘biased’. Now the same newspapers call for health officials to give an indication of the possible causes. An urgent investigation by the Health Select Committee of the House of Commons is needed and is now being called for by people far and wide.

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Tragically this was foreseeable as long ago as 2013. It need not have happened:

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. 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 free public lecture, to be given at the University of Bristol on June 7th 2018, this story is told, some of the evidence presented, and the questions 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.

For more details and booking: click here

Danny Dorling

May and Cameron have a terrible record on health, and it could be cutting lives short

Life expectancy in the UK has stalled. In many places, and for more vulnerable groups, it is now falling – on-line report in the New Statesman (March 2nd 2018). On March 1st 2018 the Office for National Statistics produced a report that revealed:

“The changes in life expectancy and healthy life expectancy between 2011 to 2013 and 2014 to 2016 were generally most favourable among those living in the least deprived 10% of areas in both countries. There were noticeable falls in female life expectancy at birth in the 20% most deprived populations in England. The growth in the inequality in life expectancy was a result of more favourable longevity gains among less deprived populations.”

Between them, David Cameron and Theresa May have managed to secure the worst health record of any post-war prime ministers. Life expectancy in the UK has stalled. In many places, and for more vulnerable groups, it is now falling. No other country in Europe has had such a bad record in health between the years 2010 and 2018. It is not just the elderly who are suffering, although the large majority of untoward deaths are in this group, it has also been people of working age, especially those who have had their disability benefits slashed, and infant mortality rates in the UK have risen for children born into poorer families.

The recent UK health record is not only awful in terms of rising mortality for some groups, ranging from poorer babies to elderly women, but also in declining mental health. Some of greatest declines in mental health have been for people who are so ill that they required government employment and support allowance to survive with any decency. By 2016 over 40 per cent of this group between the ages of 16 and 64 and living in England were known to have made suicide attempts in recent years [1].

Epidemiological studies have shown that new more stringent government tests result in an additional six suicides a year for every 10,000 people re-assessed in an area, an unknown (but of course much higher) increased number of suicide attempts, and many times more suicidal thoughts [2].

British politicians who have held power since 2010 are trying to impose the US model by stealth. This results in poor health in the US, with little “regulation over powerful food and drug companies blinded by greed and arrogance”, according to Columbia University’s Jeffrey Sachs [3].

More and more British health services are now “delivered” by “private providers”. More and more state facilities are now run by private companies.

Those who suffer the most are the weakest and least powerful. The number of prisoners who have died in custody each year has increased by over 60 per cent since the Conservatives first came to power as part of a coalition in 2010. At the same time deaths among patients with mental illness have increased by more than 200 per cent between 2011 and 2016 and may soon be greater each year than the number in prisons.

The NHS Winter Crisis

Reports of “third world conditions” in NHS hospitals dominated the media this winter. Pictures of ambulances queuing outsides A&Es and patients lying on floors in corridors confirmed the fears many leading medics and academics had warned of: the NHS was not sufficiently funded to be able to respond to a surge in demand.

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Notes

[1] McManus, S., Bebbington, P., Jenkins, R., Brugha, T. (eds.) (2016) Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014, Leeds: NHS Digital, Figure 12j, p.310

[2] Barr, B., Taylor-Robinson, D., Stuckler, D., Loopstra, R., Reeves, A., Whitehead, M. (2016) ‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A longitudinal ecological study, Journal of Epidemiology and Community Health, 70, 339-345.

[3] Sachs, J., America’s health is declining — and corporations are stoking this crisis, CNN, December 27th 2017.

Trends in UK self-reported health

Housing prices in the UK and London fall, homelessness rises, more children than ever sleep in B&Bs

The Nationwide Building Society has reported today, March 1st 2018, that prices fell by 0.3% last month, crushing expectations of a rise” Commentators explain: “Brexit and a weaker economic outlook reinforced a slowdown in the property market”.

In London people are now trying extremely hard not to sell at these lower prices: ‘Pre-tax profits at London-focused estate agent Foxtons dropped more than 65 per cent last year, it said today [March 1st], as sales in the capital fell to “near historic lows“.’

More than 103,000 children were homeless in the UK at Christmas in 2015, almost all in England. That then rose to 124,000 in 2016. By Christmas 2017 the figure was approaching 130,000 children, all waking up in temporary B&B accommodation on Christmas day.

When a child looks down from the windows of a block of flats in the UK what they see is the most economical divided country in Europe and these divisions are made most obviously visible, and increasingly most strongly felt, through our ever more segregated housing. That child will see people living and sleeping on the street. That child will have friends who have been housed by the council because they are homeless. That child may well grow up having to sofa surf if they live in London. That child will hear the rich talk in a different language about ‘asking prices’ and ‘school fees’.

1) We have known since 2005 that most children growing up in the tower blocks of London and Birmingham – the majority of children ‘living in the sky’ in Britain – are black.

2) The number of people officially recorded as sleeping on the streets of England rose from 1,768 in 2010 to 4,134 in 2016, and then 4751 in 2017 but charities estimate the true figure to be more than double this.

3) Homeless families housed by local authorities in temporary accommodation each year, are rising from 50,000 in 2010 to 78,000 in 2017.

4) In London alone there are an estimated 225,000 “hidden homeless” people aged 16-25 – arranging their own temporary accommodation with friends or family.

5) The upper middle class are most concerned that no one is paying the asking price in Fulham any more.

6) The majority of schools and hospitals in Kensington and Chelsea are private – the rich live parallel lives.

A competent government would enact: Emergency powers to house the roofless, rent regulation for private landlords, and introduce capital gains tax to stop speculation (for when house prices eventually rise again).

These are extracts from a 14 minute talk given on February 23rd in London as part of a wider discussion about Grenfell, Housing and the Welfare State: