Dying too young: Maps show little has changed in 170 years

Healthcare in the UK has vastly improved since Victorian times, yet the geography of coronavirus deaths closely follows the pattern of poor health in the 19th Century.

A succession of studies has found a link between Covid-19 and poverty, with the latest describing a “jaw-dropping” fall in life expectancy in Greater Manchester due to the pandemic.

That pattern of “deeply entrenched” deprivation and ill-health stretches back at least 170 years, according to the chief medical officer for England.

“If you had a map of Covid’s biggest effects now and a map of child deaths in 1850, they look remarkably similar,” Prof Chris Whitty told an NHS conference in June.

Experts say the problems of crowded housing, insecure work and poor underlying health are echoing down the centuries.

Here is that map of child deaths in the middle of the 19th Century.

“We know that you cannot turn around health inequalities within a political cycle.”

And the Covid death rate from March 2020 to April this year.

Now relatively rare, childhood mortality was high in England and Wales in the 1850s, with a quarter of children dying before the age of five.

Overcrowded industrial cities and London were the hardest-hit, says Dr Alice Reid, who leads the Populations Past project at the University of Cambridge and created the map above.

Children fell victim to highly infectious diseases such as measles, whooping cough, diphtheria and scarlet fever.

“Fertility was higher so people had more children so they were more likely to give one of these diseases to a sibling,” Dr Reid says.

The countryside generally fared better but even in relatively rural coal and tin-mining areas like south Wales and Cornwall, children were vulnerable to deadly lung diseases, exacerbated by pollution.

In large cities such as Manchester and Liverpool, crowded, poorly built housing without bathrooms allowed the rapid spread of stomach bugs which could prove fatal to small children.

Diarrhoea was a major cause of death in this age group, says Dr Reid. “While it was common throughout the year, it usually came in warm summers when flies could breed on refuse heaps and in pit latrines.”

Early childhood death rates in England started to improve in 1870, helped by a range of factors including better sanitation and falling family sizes.

Fast-forward 150 years, and although overall living standards have massively improved, the underlying causes of ill-health haven’t changed, says Prof Sally Sheard, head of department of Public Health, Policy and Systems at the University of Liverpool.

Families who have to rely on insecure income end up in poor quality houses and crowded conditions, she says.

“And that’s exactly what we’ve seen with Covid – the highest rates have been in areas that still have problems with overcrowding.”

Newham, in east London, was found to have the highest percentage of overcrowded households at the 2011 Census and the highest death rate from Covid in England and Wales, once the age structure of the population is taken into account.

It’s followed by nearby Barking and Dagenham and Tower Hamlets which also have high levels of overcrowding.

Work was another vector for disease both in Victorian times and during the Covid pandemic.

Then, as now, workers in low-paid and insecure jobs were exposed to infectious diseases simply by having to come into contact with larger numbers of people.

“They would recognise the gig economy in the 1840s,” says Prof Sheard.

“Most people didn’t have fixed work contracts. In the Liverpool and Manchester docks, men would go every day and would queue up to get work.”

It’s easy to see how infectious diseases are spread in such conditions, whatever the century.

But in recent decades, the vast majority of deaths before the age of 75 in the UK were from non-infectious causes, such as heart disease, lung cancer and stroke.

These, too, match patterns of deprivation, with Glasgow, Dundee and Inverclyde having the highest rates of early death in Scotland, while Blackpool and Manchester top the table in England.

It’s a similar pattern in the south Wales valleys and Rhyl in the north.

Poverty increases the risk of bad health, Prof Whitty said in a recent Gresham Lecture, as it leads to worse diet and housing, potentially more dangerous work, fewer educational opportunities and higher rates of smoking.

Despite the inequalities, the UK’s health has still seen “substantial improvements” over the long term, he said.

Life expectancy has “shifted across the whole country, everywhere has got better, even those areas that are more deprived”.

Overall, early deaths from heart disease and lung cancer have also fallen, although a recent Lancet report found that the gap had widened between rich and poor.

Post Covid, says Prof Sheard, the UK needs to be “ambitious” in tackling deprivation.

But she warns it won’t be a quick fix: “We know that you cannot turn around health inequalities within a political cycle.”