On regional inequality in lifespans


You'll have seen the headlines yesterday: The National Audit Office report showing that people in poor areas die younger, on average, than people in not poor areas and that the government and NHS has been failing to do something about it. The report is here.

While the basic contention, that poor people die younger than rich people (or people living in poor places die younger than those in rich places), is clearly true, there's a great gaping hole in the methodology used to monitor all of this. It's the same error made in the recent Marmot Review which should be read alongside this NAO report. The error comes in two parts.

1) There is no acknowledgment at all that people migrate over the course of a lifetime. Not everyone does, of course, and yet it's also true that not everyone doesn't. So concentrating on particular local areas (local authorities in this case) will take no account of the way in which, say, someone hale and hearty in their 60s might leave some industrial Midlands town and move to Bournemouth upon retirement. Reducing the life expectancy in that Midlands town by removing someone likely to live long (for life expectancy of someone hale and hearty in their 60s is longer than that of the general population) from the pool we're measuring and similarly increasing it in Bournemouth.

2) No acknowledgement or discussion of the point that while poverty might lead to ill health and shortened lifespans, it is also true that ill health can lead to poverty. Being struck down by a chronic illness during your working years will make you poor: and will ally with point 1) to make it less likely that you will move from a poor area to a rich one.

As I say, I've no doubt at all that a shortened lifespan is yet another indignity that is heaped upon the heads of the poor. But as I constantly try to point out, we have to measure these things (as I've been shouting about for years about the gender pay gap) properly before we can decide what, if anything, we're going to do about them.

Unless we know how much of the poverty is caused by ill health as opposed to the ill health being caused by the poverty we're fumbling around in the dark. And unless we account for the way in which people move around, migration as a result of both health and wealth, we're similarly blind to what is actually causing the inequalities we can see.

We're not, as yet, measuring this properly so we cannot, as yet, decide what to do about it.