8.3 Endurance of inequalities through time

Planning of health provision by some governments attempts to distribute the available resources so as to minimise health inequalities. Health inequalities are the differences in health outcomes and experiences between different groups, typically expressed either in terms of geography, socio-economic status, or ethnicity. For example, in the UK, the Black Report of 1980 described how health service provision could be used to address inequalities in health outcomes (see Chapter 8 of the reference below).

But how successful is this strategy and does it really work? A review of health inequalities in the UK which took place in 1998 (the Acheson report – see references) found that little had changed since the earlier 1980 Black Report. More recently, a study undertaken in the UK (Dorling et al, 2005) looked at 1991 health inequalities for mortality from all causes of death and for diseases known to be related to deprivation. Examples of such diseases include stroke and lung cancer. However, the study had a twist to the usual studies of health deprivation: rather than looking at how mortality and disease related to deprivation and poverty in 1991, the researchers looked at the links between 1991 health inequalities and deprivation in 1896. To do this, they drew on a study of poverty conducted by Charles Booth in 1896, which resulted in a ‘Descriptive Map of London Poverty’ for that period.

The results of this study were somewhat surprising. Firstly, a combination of historical deprivation and present-day deprivation did a better job of predicting ill health and mortality than present-day deprivation on its own. Secondly, perhaps more surprisingly, for many of the diseases considered in the study, the nineteenth century pattern of deprivation was at least as good a predictor of disease patterns as that from the present day. Why was this?

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