Health inequalities: Lifecourse approaches 9781447342229

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“This book provides the epidemiological background for a new and important way of thinking about how and when we intervene to reduce health inequalities. Professor Davey Smith’s research on the life course and health is truly innovative and unique. Many academics from diverse disciplines will want this as part of their permanent libraries.” John Lynch, School of Public Health, University of Michigan, USA

Health inequalities: Lifetime approaches:

• presents a large volume of innovative, empirical research which demonstrates the importance of social disadvantage, throughout the lifecourse, with respect to inequalities in life expectancy, death rates and health status in adulthood; • contains an extensive overview of lifecourse epidemiology as applied to socioeconomic differentials in health. This book is essential reading for academics, students and policy makers with an interest in public health, epidemiology, health promotion and social policy.

George Davey Smith is Professor of Clinical Epidemiology at the University of Bristol. He has contributed extensively to the health inequalities literature, particularly from a lifecourse perspective.

Poverty, inequality and social exclusion remain the most fundamental problems that humanity faces in the 21st century. This exciting series, published in association with the Townsend Centre for International Poverty reserach at the University of Bristol, aims to make cuttinig-edge poverty-related research more widely available.

ISBN 978-1-86134-322-2

Edited by George Davey Smith

Studies in poverty, inequality and social exclusion Series Editor: David Gordon, Director, Townsend centre for International Poverty Research

HEALTH INEQUALITIES

The lifecourse perspective on adult health, and on health inequalities in particular, is one of the most important recent developments in epidemiology and public health. This book brings together, in a single volume, the work of one of the most distinguished academics in the field. It is the first to specifically take a lifecourse approach to health inequalities.

studies in poverty, inequality and social exclusion

Health inequalities Lifecourse approaches

www.policypress.co.uk Cover photographs by Mary Shaw

AT053 cover 4POD.indd 1

9 781861 343222

Edited by George Davey Smith 23/04/2010 15:19:40

Health inequalities: Lifecourse approaches Edited by George Davey Smith

First published in Great Britain in July 2003 by Policy Press First Floor, 1-9 Old Park Hill Bristol BS2 8BB UK Tel +44 (0)117 954 5940 e-mail [email protected] www.policypress.co.uk © George Davey Smith 2003

North American office: Policy Press c/o The University of Chicago Press 1427 East 60th Street Chicago, IL 60637, USA t: +1 773 702 7700 f: +1 773-702-9756 e:[email protected] www.press.uchicago.edu

British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN 978 1 4473 4222 9 EPDF Reprinted 2006 Transfered to Digital Print 2010 George Davey Smith is Professor of Clinical Epidemiology at the Department of Social Medicine, University of Bristol. Cover design by Qube Design Associates, Bristol Front cover: photographs kindly supplied by Mary Shaw (www.social-medicine.com/photogallery/) The right of George Davey Smith to be identified as editor of this work has been asserted by him in accordance with the 1988 Copyright, Designs and Patents Act. The publishers would like to thank the following for permission to reproduce George Davey Smith’s works: American Journal of Epidemiology (Chapter 21) American Journal of Public Health (Chapters 5, 6, 19, 25), with permission from the American Public Health Association British Journal of General Practice (Chapter 30) British Medical Journal (Chapters 9, 10, 11, 15, 17, 27, 28, 29, 31, 32 34, 35, 38, Afterword)) Critical Public Health (Chapters 24, 36) RSM Press, London (Chapter 37) Health Economics (Chapter 39) International Journal of Epidemiology (Chapter 14), with permission from Oxford University Press Journal of Epidemiology and Community Health (Chapters 1, 3, 4, 7, 12, 16, 20, 22, 23) Journal of the American Medical Association (Chapter 18) Lancet (Chapters 2, 8, 26) Routledge, London, a member of the Taylor & Francis Group (Chapter 33) Social Science and Medicine (Chapter 13), with permission from Elsevier Science All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of Policy Press. The statements and opinions contained within this publication are solely those of the editor and contributors and not of The University of Bristol or Policy Press. The University of Bristol and Policy Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication. Policy Press works to counter discrimination on grounds of gender, race, disability, age and sexuality.

Contents List of co-authors Acknowledgements Introduction

vii x xii

Section I: Patterns of health inequality

1

1

Health inequalities in Britain: continuing increases up to the end of the 20th century Davey Smith, Dorling, Mitchell and Shaw, 2002

3

2

Shrinking areas and mortality Davey Smith, Dorling and Shaw, 1998 9

3

Population change and mortality in men and women Davey Smith, 13 Shaw and Dorling, 2001

4

Area-based measures of social and economic circumstances: cause-specific mortality patterns depend on the choice of index Davey Smith, Whitley, Dorling and Gunnell, 2001

17

5

Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: Part I – results for 300,685 white men Davey Smith, Neaton, Wentworth, Stamler and Stamler, 1996

21

6

Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: Part II – results for 20,224 black men Davey Smith, Wentworth, Neaton, Stamler and Stamler, 1996

47

7

Individual social class, area-based deprivation, cardiovascular disease risk-factors and mortality: the Renfrew and Paisley study Davey Smith, Hart, Watt, Hole and Hawthorne, 1998

65

8

Is control at work the key to socioeconomic gradients in mortality? Davey Smith and Harding, 1997

83

Section II: Voting and mortality

87

9

“I’m all right, John”: voting patterns and mortality in England and Wales, 1981-92 Davey Smith and Dorling, 1996 89

10

Association between voting patterns and mortality remains Davey Smith and Dorling, 1997

11

Analysis of trends in premature mortality by Labour voting in 107 the 1997 General Election Dorling, Davey Smith and Shaw, 2001

103

iii

Health inequalities

Section III: The Whitehall Study 12

Magnitude and causes of socioeconomic differentials in 113 mortality: further evidence from the Whitehall Study Davey Smith, Shipley and Rose, 1990

13

Confounding of occupation and smoking: its magnitude and consequences Davey Smith and Shipley, 1991

14

Socioeconomic differentials in cancer among men Davey Smith, 137 Leon, Shipley and Rose, 1991

Section IV: Health and lifetime social circumstances: the Collaborative Study

129

151

15

Lifetime socioeconomic position and mortality: prospective 153 observational study Davey Smith, Hart, Blane, Gillis and Hawthorne, 1997

16

Education and occupational social class: which is the more important indicator of mortality risk? Davey Smith, Hart, Hole, MacKinnon, Gillis, Watt, Blane and Hawthorne, 1998

171

17

Adverse socioeconomic conditions in childhood and cause-specific adult mortality: prospective observational study Davey Smith, Hart, Blane and Hole, 1998

191

18

Socioeconomic factors as determinants of mortality Davey Smith and Hart, 1998

205

19

Lifecourse socioeconomic and behavioural influences on cardiovascular disease mortality: the Collaborative Study Davey Smith and Hart, 2002

209

Section V: Further lifecourse influences on health

iv

111

219

20

Social circumstances in childhood and cardiovascular disease 221 mortality: prospective observational study of Glasgow University students Davey Smith, McCarron, Okasha and McEwen, 2001

21

Childhood socioeconomic position and adult cardiovascular 225 mortality: the Boyd Orr cohort Frankel, Davey Smith and Gunnell, 1999

22

Height and risk of death among men and women: aetiological 233 implications of associations with cardiorespiratory disease and cancer mortality Davey Smith, Hart, Upton, Hole, Gillis, Watt and Hawthorne, 2000

Contents

23

Leg length, insulin resistance, and coronary heart disease risk: 251 the Caerphilly Study Davey Smith, Greenwood, Gunnell, Sweetnam, Yarnell and Elwood, 2001

Section VI: Ethnicity and health inequalities

269

24

Ethnic inequalities in health: a review of UK epidemiological evidence Davey Smith, Chaturvedi, Harding, Nazroo and Williams, 2000

271

25

Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the US Davey Smith, 2000

311

26

Mortality differentials between black and white men in the US: 327 contribution of income and other risk factors among men screened for the Multiple Risk Factor Intervention Trial (MRFIT) Davey Smith, Neaton, Wentworth, Stamler and Stamler, 1998

Section VII: Diversions

357

27

Socioeconomic differentials in the mortality of pets Davey Smith and Bonnett, 1998

359

28

Death in Hollywood: life-style excess, social comparisons or publication bias? Davey Smith, 2001

365

29

Sex and death: are they related? Findings from the Caerphilly 369 Cohort Study Davey Smith, Frankel and Yarnell, 1997

30

Health, health services and health politics in Britain: 1952-2002-2052 Davey Smith, 2002

381

Section VIII: Health inequalities – past and present

385

31

Socioeconomic differentials in mortality: evidence from Glasgow graveyards Davey Smith, Carroll, Rankin and Rowan, 1992

387

32

The ghost of Christmas past: the health effects of poverty in London in 1896 and 1991 Dorling, Mitchell, Shaw, Orford and Davey Smith, 2000

399

33

Does early nutrition affect later health? Views from the 1930s 411 and 1980s Davey Smith and Kuh, 1996

v

Health inequalities

vi

Section IX: Social inequality and population health

437

34

Income inequality and mortality: why are they related? Davey Smith, 1996

439

35

Understanding it all: health, meta-theories, and mortality trends 445 Davey Smith and Egger, 1996

Section X: Reducing health inequalities, now and in the future

451

36

The widening health gap: what are the solutions? Davey Smith, Dorling, Gordon and Shaw, 1999

453

37

Inequalities in health: what is happening and what can be done? 475 Davey Smith and Ben-Shlomo, 1997

38

How policy informs the evidence – ‘evidence-based’ thinking can lead to debased policy making Davey Smith, Ebrahim and Frankel, 2001

507

39

Rationing for health equity: is it necessary? Davey Smith, Frankel and Ebrahim, 2000

513

Afterword: Still wanting to be James Dean Davey Smith, 1991

523

Index

527

List of co-authors Yoav Ben-Shlomo, Department of Social Medicine, University of Bristol David Blane, Division of Neurosciences, Imperial College of Science, Technology and Medicine, London Brenda Bonnett, Department of Ruminant Medicine and Epidemiology, Swedish University of Agricultural Sciences, Uppsala, Sweden Douglas Carroll, Department of Health Psychology, Birmingham University Nish Chaturvedi, Department of Primary Health Care and General Practice, Imperial College of Science, Technology and Medicine, London Daniel Dorling, School of Geography, University of Leeds Shah Ebrahim, Department of Social Medicine, University of Bristol Matthias Egger, Department of Social Medicine, University of Bristol Peter Elwood, Department of Social Medicine, University of Bristol Stephen Frankel, Department of Social Medicine, University of Bristol Charles Gillis, Department of Public Health, University of Glasgow David Gordon, School for Policy Studies, University of Bristol Rosemary Greenwood, Department of Social Medicine, University of Bristol David Gunnell, Department of Social Medicine, University of Bristol Seeromanie Harding, MRC Social and Public Health Sciences Unit, Glasgow Carole Hart, Department of Public Health, University of Glasgow Victor Hawthorne, School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, US

vii

Health inequalities

David Hole, Department of Public Health, University of Glasgow Diana Kuh, Department of Epidemiology and Public Health, University College London David Leon, Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London Peter McCarron, Department of Social Medicine, University of Bristol James McEwen, Department of Public Health, University of Glasgow Pauline MacKinnon, Department of Public Health, University of Glasgow Richard Mitchell, Research Unit in Health, Behaviour and Change, University of Edinburgh James Nazroo, Epidemiology and Public Health, University College, London James D. Neaton, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, US Mona Okasha, Department of Social Medicine, University of Bristol Scott Orford, Department of City and Regional Planning, Cardiff University Sandra Rankin, Department of Psychology, Glasgow Polytechnic The late Geoffrey Rose, formerly of the Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London David Rowan, Department of Psychology, Glasgow Polytechnic Mary Shaw, Department of Social Medicine, University of Bristol Martin J. Shipley, Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London Jeremiah Stamler, Department of Preventive Medicine, Northwestern University Medical School, Chicago, US

viii

List of co-authors

The late Rose Stamler, formerly of the Department of Preventive Medicine, Northwestern University Medical School, Chicago, US Peter Sweetnam, Cardiff Mark Upton, Department of General Practice, University of Glasgow Graham Watt, Department of General Practice, University of Glasgow Deborah Wentworth, Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, US Elise Whitley, Department of Social Medicine, University of Bristol Rory Williams, MRC Social and Public Health Sciences Unit, Glasgow John Yarnell, Department of Epidemiology and Public Health Medicine, Queen’s University of Belfast

ix

Health inequalities

Acknowledgements My principal acknowledgement and thanks is to all the co-authors of the papers reproduced in this book, many of whom were either already – or became – friends. The collaboration involved in writing these papers has been the most stimulating and enjoyable part of my working life. Mary Shaw has helped enormously with this volume, having organised the photographs (several of which she also took), helped with proof reading, assembled much of the material in Chapter 36 and generally contributed more than it is reasonable to hope for. Danny Dorling and Stephen Frankel are particularly thanked for allowing me to reproduce papers on which they were first authors. Besides the co-authors, I am indebted to Mel Bartley, Eric Brunner, Jane Ferrie, Nancy Krieger, Helen Lambert, Debbie Lawlor, John Lynch, John Macleod, Michael Marmot, Rich Mitchell, Jerry Morris, Jake Najman, Neil Pearce, Chris Power, Stephen Stansfeld and Richard Wilkinson, with whom I have discussed and debated many of the topics covered in this book over the years (sometimes with considerable disagreement). Angela Neale, Marie-Claire Hamilton, Claire Snadden and Anne Rennie typed (or re-typed) many of the papers in a way which belied the disorganisation of the material given to them. Dawn Rushen and Karen Bowler from The Policy Press were more tolerant of my laxity and general indolence than I deserved. I was a Robert Wood Johnson Foundation Fellow (‘An individual and population lifecourse approach to the determinants of health’) during the assembly of this book and the writing of the Introduction.

Note on the text These articles are reprinted as they originally appeared (although with correction of typographical errors) with the exception of Chapter 26. This was greatly shortened for publication in the Lancet; the version here is considerably longer. There is some duplication of the description of the methods of those studies that contribute to more than one chapter. This, however, does not greatly lengthen the book and it allows the individual chapters to be read independently. There is one notable piece of textual duplication, with the first paragraph of Chapter 24 and of Chapter 25 being very similar. I guess the only excuse for this is that I was plagiarising myself. I have resisted the temptation to revise some of the discussion sections of earlier articles where they contradict views I now hold, which leads to occasional (but perhaps informative) discrepancies in interpretation.

Photographic credits Cover and pages 111, 357, 437 and 451: Mary Shaw Page 269: Mark Power (from the series ‘The shipping forecast’) Pages 1 and 87: Wellcome History of Medicine Photographic Library Page 151: Wolf Suschitzsky Page 219: John Pemberton Pages 388 and 392: Robert Perry Page 522: Gerald Welsby

x

For Zachary Davey Lambert born 19 April 2002

Health inequalities

Introduction: lifecourse approaches to health inequalities Discussions of health inequalities often begin with the statement that such inequalities are ubiquitous: the less affluent have always had worse health, they have worse health wherever they live, and they suffer more from all forms of ill-health. I entered the field thinking along these lines, but, as with most generalisations, a more than superficial acquaintance with empirical studies revealed that there were important exceptions; indeed it seemed to me that we could perhaps learn more about the processes generating inequalities in health by considering the exceptions, rather than carrying out more and more studies to prove the rule. The lifecourse perspective offered one way of moving beyond simple generalisations about health inequalities. In Britain a major stimulus for embracing lifecourse approaches within epidemiology was the work of David Barker and colleagues on the early-life origins of adult disease. To me, and perhaps to other contemporary readers, Barker’s initial 1986 Lancet publication in this area1 appeared to develop the earlier ideas of Anders Forsdahl on how adverse environmental conditions in infancy and early childhood could increase the risk of cardiovascular disease in late adult life2,3. Forsdahl was concerned with the high mortality in the Norwegian county of Finnmark, and drew attention to a possible cause “which has not been discussed earlier, namely that the considerably high mortality today is a late consequence of the adverse circumstances to which a large part of the population was exposed during their childhood and adolescence”2. He showed that the main contributor to this high mortality was coronary heart disease (CHD) and that the current pattern of conventional risk factors – such as smoking and diet in adulthood – did not seem to account for this4. He then analysed data across the whole of Norway and demonstrated that infant mortality rates early in the 20th century correlated strongly with CHD mortality rates 70 years later3 (Figure 1). Forsdahl speculated that permanent damage could be caused by nutritional deficit in early life that rendered individuals less able to tolerate particular forms of fat in their adult diet, a hypothesis he went on to test5. In their initial studies building on the work of Forsdahl, Barker and colleagues interpreted their findings as indicating an influence xii

Introduction: lifecourse approaches to health inequalities

Figure 1: Correlation between mortality from arteriosclerotic heart disease (1964-67), in men aged 40 to 69 years (standardised rates/100,000 population) and infant mortality rates (1896-1925)3 Males 600

Death from arteriosclerotic heart disease/100,000 per year

550 500 450 400 350 r = +0.86 p