6 May 2020

The problem with claiming that ‘inequality kills’


Polly Toynbee is at it again. The latest iteration of her terminally wrongheaded approach to public policy is that “inequality kills”. To support her argument she prays in aid the work of Sir Michael Marmot, who has stated as much in The Lancet. The problem is, the whole case is built on the sandiest of foundations.

Let’s take Marmot’s contention that life expectancy in the poorest ward of Kensington and Chelsea is 22 years lower than in the richest. As with the Marmot Review into inequality, this fundamentally misunderstands the way life expectancy is measured.

Imagine a world in which Boris Johnson had succumbed to coronavirus – would that have registered as a change in life expectancy in London or New York? It would be recorded as one in London, the place of residence at time of death, not the place of birth. For the numbers used to calculate lifespans across geography are years lived allied with place of death – not the place of birth. 

At the national level this is fair enough, even if not totally accurate. Some 15% of the current countrywide population is foreign born, so measuring lifespan by age and place of death is only ever going to be some 85% accurate. When the attempt is made to narrow this down to council ward level it’s not going to be accurate in the slightest. The assumption being made is that some useful portion die in that same little geographic area containing 5,000 or so people that we were born into. This is simply not supportable.

Thus the linkage between place of birth and lifespan might well be there, logically it probably is, but it’s not something that shows up explicitly in the data. This also means that any claims about Sure Start and lifespan, early years education, even nutrition or income levels in childhood aren’t going to be well supported either. The data is collected in a manner that doesn’t allow the extraction of that information.

It is known how old people are when they die in that place. It is not known how long people live when born in a place. Simply because it’s not something that is worked out – the assumption is made that births and deaths coincide over geography and at the microscale that just isn’t true.

It follows that drawing conclusions based on those stats is likely to be somewhere between suspect and wrong – less wrong as we climb the size of the population grouping being examined, but logically worthless at the smallest scale.

Having made his original dodgy contention, Marmot then goes further. Something happened in 2010, he says, to worsen the effects he describes, one of two possibilities is that “public expenditure went from 42% of gross domestic product (GDP) in 2010 to 35% in 2018 “.

For starters, this isn’t even true, it was 40% in 2018. But let’s just assume it was and that it was the cause of worse health inequality. Over recent decades public expenditure has ranged from 46% (1976), 40% (1980), 35% (1990), 38% (1993), 35% (2000) to 40% (2008, before the Crash).

For Marmot’s claim about the link between public spending and life expectancy to hold there should have seen the same rollercoaster in lifespans and inequality them. Except, as he himself says, this didn’t happen. As Marmot writes: “An increase in life expectancy in England, of about one year every four years, that had lasted from the end of the 19th century slowed in 2010 and more or less ground to a halt.

It is also possible to make cross-country comparisons which further erode his argument. Singapore, for example, has more inequality, smaller government, longer lifespans and who knows what the inequality of lifespans there is?

But once again let us, for a moment, just assume that it is true that public spending is inextricably linked to life expectancy and that childhood poverty, the absence of Sure Start and inequality does indeed limit lifespan.

That 15% of the population that have moved to this country largely – because most of the world is poorer than Britain – came from places where they were poorer and deprived of those early years services. Mass immigration would therefore be expected to reduce the average lifespan in the UK.

If we really want to boost life expectancy then shoudln’t we be limiting immigration from places that are poorer than the UK? And if not, why not? Of course, I’m not suggesting this is what we should do – but it is just the sort of conclusion you can arrive at with the kind of logical contortions that the likes of Marmot and Toynbee employ to justify their arguments.

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Tim Worstall works for the Continental Telegraph and the Adam Smith Institute.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.