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What can History tell us about current health inequalities?

9 June 2015

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Reported by Leanne Melbourne, NERC-funded CSaP Policy Intern (April - June 2015)

Professor Simon Szreter, Professor of History and Public Policy, delivered the 2015 BHRU annual lecture in collaboration with CSaP. Professor Szreter used historical cases in Britain to demonstrate how the nature and scale of health inequalities within a society are produced by the social and cultural environment of values and incentives experienced by the rich, as much as by the poor (who are the usual focus of attention).

Chairing the lecture, Professor Theresa Marteau (Director of the Behaviour and Health Research Unit) described Britain's inequality gap:

"Inequality is big and it is growing; in terms of size, the five richest families in Britain are worth more than the poorest 20% of the population".

Theresa Marteau at BHRU Lecture 2015

Professor Szreter discussed the Elizabethan Poor Law (1601-1834), also known as the Forgotten Poor Law, a foundational institution in Britain’s early economic success which was extremely good at protecting the poor - unlike the 1834 new poor law which was seen as the enemy of the working class.

The Elizabethan Poor law had been successful in reducing fundamental health inequalities. Demographic analysis of parish records after 1623 showed a lack of evidence in regards to national or regional famine crisis mortality and also showed no correlation between grain price rise and mortality in England after 1623. This contradicted what was happening in Western Europe at the same time where the periodic rise in grain price coincided frequently with high mortality rates.

"The welfare state of England is not something invented after World War II by Beveridge; it has a full 400 year history"

Simon Szreter speaking at BHRU 2015 lecture

Interestingly, Professor Szreter also presented statistics on life expectancy at birth, which steadily rose up until 1820 where it stalled for a number of decades. This stall occurred at a time when the economy was booming and trade was up, however life expectancy was very low. This discrepancy was in part due to the new poor law – where the original 2% of GDP spent on the poor in the old poor law was now slashed in half.

Professor Szreter then took us on a whistle stop tour of the history of welfare through the Edwardian period, the world wars and right up until today, with the major theme indicating that life expectancy and well-being increased with welfare spending.

"The public have a completely unreal perception of this [benefit fraud] problem…"

The final part of Professor Szreter’s talk discussed the government’s proposed plan to address inequality by cutting benefits and tackling benefit fraud in which he showed official statistics on benefit expenditure. Benefit fraud only accounts for 0.6% of the total amount spent (this is smaller than what is lost due to error) and interestingly, a recent Yougov poll established that the public believe that 22% of government welfare budget is fraudulently claimed (equivalent to £40bn out of the total £205bn spent on benefits). Actually this figure is quite close to the official figure of £34bn for tax avoidance and evasion.

Professor Szreter ended his talk on his political conclusions in which he believes that maximising the development and healthiness of all human capital within society is key to long term productivity and that austerity, cutting welfare and key benefits e.g. education, do not provide a long term economic plan and will only exacerbate and increase health inequalities.

The lecture concluded with a lively question and answer session covering government cuts, the voting system in the UK, and the measures of inequality; with the general consensus that the way things are going the health inequality gap will only increase.

"Health inequalities are a symptom; they are reflecting the health of our welfare state and our associated social security system. To the extent that when they are wide, they are telling us that the system is not delivering in an equitable universalist way." Professor Simon Szreter on what health inequalities say about our system.

If we consider Professor Marteau’s quote at the beginning of this article, it just shows that our system is not working and the way it is being tackled will only make things worse.

(Banner image from Casey Fleser via Flirckr)

Professor Dame Theresa Marteau

Institute of Public Health, University of Cambridge

Professor Simon Szreter

Faculty of History, University of Cambridge