Health inequality in Britain before 1750

TY - JOUR

T1 - Health inequality in Britain before 1750

AU - Kendall, Ellen J.

AU - Brown, Alex T.

AU - Doran, Tim

AU - Gowland, Rebecca

AU - Cookson, Richard

N1 - Funding Information: This research was funded in whole, or in part, by the Wellcome Trust [Grant No. 205427/Z/16/Z ]. For the purpose of open access, the authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The views expressed in this paper are those of the authors and not the Wellcome Trust. Publisher Copyright: © 2021 The Authors

PY - 2021/12/1

Y1 - 2021/12/1

N2 - Background: This study examines the claim that social inequality in health in European populations was absent prior to 1750. This claim is primarily based on comparisons of life expectancy at birth in England between general and ducal (elite aristocrat) social classes from the 1550s to the 1870s. Methods: We examined historic childhood mortality trends among the English ducal class and the general population, based on previously published data. We compared mid-childhood to adolescent mortality (age 5–14) and early-childhood mortality (age 0–4) between the ducal class and the general population from the 17th to 19th centuries. Results: Prior to 1750, ducal early-childhood mortality was higher than the general population. However, mid-childhood to adolescent mortality was lower among the ducal class than the general population in all observed periods for boys, and almost all periods for girls. Among the ducal class, but not the general population, there was a sharp decline in early-childhood mortality around the 1750s which may partly explain the divergent trends in overall life expectancy at birth. Conclusion: Health inequality between the ducal class and general population was present in England from the 16th to mid-18th centuries, with disadvantages in mortality for ducal children in infancy and early childhood, but survival advantages in mid-childhood and adolescence. These opposing effects are obscured in life expectancy at birth data. Relatively high early-childhood mortality among ducal families before 1750 likely resulted from short birth intervals and harmful infant feeding practices during this time.

AB - Background: This study examines the claim that social inequality in health in European populations was absent prior to 1750. This claim is primarily based on comparisons of life expectancy at birth in England between general and ducal (elite aristocrat) social classes from the 1550s to the 1870s. Methods: We examined historic childhood mortality trends among the English ducal class and the general population, based on previously published data. We compared mid-childhood to adolescent mortality (age 5–14) and early-childhood mortality (age 0–4) between the ducal class and the general population from the 17th to 19th centuries. Results: Prior to 1750, ducal early-childhood mortality was higher than the general population. However, mid-childhood to adolescent mortality was lower among the ducal class than the general population in all observed periods for boys, and almost all periods for girls. Among the ducal class, but not the general population, there was a sharp decline in early-childhood mortality around the 1750s which may partly explain the divergent trends in overall life expectancy at birth. Conclusion: Health inequality between the ducal class and general population was present in England from the 16th to mid-18th centuries, with disadvantages in mortality for ducal children in infancy and early childhood, but survival advantages in mid-childhood and adolescence. These opposing effects are obscured in life expectancy at birth data. Relatively high early-childhood mortality among ducal families before 1750 likely resulted from short birth intervals and harmful infant feeding practices during this time.

KW - Childhood mortality

KW - Early modern England

KW - Historical demography

KW - Life expectancy

KW - Social inequality

UR - http://www.scopus.com/inward/record.url?scp=85119334658&partnerID=8YFLogxK

U2 - 10.1016/j.ssmph.2021.100957

DO - 10.1016/j.ssmph.2021.100957

M3 - Article

AN - SCOPUS:85119334658

SN - 2352-8273

VL - 16

JO - SSM - Population Health

JF - SSM - Population Health

M1 - 100957

ER -