Variations
in the conditions that make people sick are on grim display in the US
city of Baltimore, Maryland. Such conditions do not lead only to
ill-health. In early 2015 Baltimore erupted. Civil unrest broke out.
The
precipitant of the riots was the killing of a black man in police
custody. Or should I say one more killing of a black man by the police.
But the underlying cause of the riot was inequality of social and
economic conditions. As Martin Luther King said: “A riot is the language
of the unheard.”I said Baltimore erupted, but it was one part of Baltimore, the poor inner city, that erupted. Not the rest. I had been studying health inequalities in Baltimore before there was civil unrest. In the poor part, where the riots broke out, life expectancy for men was 63 years. In the richest part it was 83 years. A 20-year difference in life expectancy in one city.
If you live in the rich part of Baltimore and want to see what it is like to live in a place with male life expectancy of 63, you could fly to Ethiopia. Easier is to travel a short way across town. Life expectancy for men in the poorest part of Baltimore is two years shorter than the Indian average.
A link between riots and ill-health is not unique to Baltimore. In summer 2011 in London, riots broke out. They started in Tottenham in north London. Eerily, the precipitant was the killing of a black man by the police.
For men, life expectancy in the most down at heel part of Tottenham was 17 years shorter than in the ritziest part of Kensington and Chelsea. No surprise that the rioting should have broken out in Tottenham, not in Kensington and Chelsea.
Why this link between ill-health and crime? I don’t think that ill-health causes civil unrest or that riots cause ill health, except in the obvious way that people can be injured. No, I think the social conditions in which people are born, grow, live, work and age are strongly determinative both of risk of ill-health and of likelihood of engaging in civil disorder.
When the Tottenham riots broke out a politician commented: this is criminality, pure and simple. To paraphrase Oscar Wilde: the riots were not very pure and the causes were not simple. It was clear, though, that social disadvantage was among the causes.
The Guardian newspaper reported that of 1000 rioters going through the magistrate’s court, fewer than 9 per cent had a job or were in training; 91 per cent of these young people were what is known in the jargon as NEET — not in employment, education or training. Nationally, at that time, the NEET figure was about 10 per cent. A stark contrast: 91 per cent of rioters not in employment, education or training versus 10 per cent among non-rioters.
There were no trainee lawyers, accountants and doctors among the rioters, or plumbers, drivers and shop assistants, but people who had little to lose and uncertain futures.
The link between deprivation of social conditions, ill-health and crime is all too obvious in Australia. The life expectancy gap between the indigenous and non-indigenous populations of Australia is about 11 years. It had been reported to be 17 years. Either the gap is closing a bit or there have been changes in the method of calculation. Whichever it is, the gap is enormous. Australian Aboriginal men are six times likelier and Aboriginal women 11 times likelier to die of ischaemic heart disease than non-indigenous men and women.
For diabetes, the differences are more alarming. The diabetes death rate is 19 times higher in Aboriginal men and 27 times higher in Aboriginal women than in the non-indigenous population. Incarceration rates, too, fit with the pattern of ill-health and crime clustering together. Aborigines make up 2.5 per cent of the population of Australia and 25 per cent of the prison population.
At this point I am going to make a grand claim. So close is the link between the nature of society and health that we can tell a great deal about how well a country meets the needs of its citizens — provides the conditions for them to lead flourishing lives — by the health status of its citizens.