It's good to be the King. Isn't it?

post by Bill Gardner

From Angus Deaton, in a manuscript about the health gradient, the finding that social advantage is associated with better health. The health gradient is found in societies through out the world; which makes us believe that it is somehow baked into social life. But health and social advantage have not always been associated.

It is sometimes supposed that the gradient has always been with us, that rich people have always lived healthier and longer lives than poor people. That this supposition is generally false is vividly shown by Harris (2004, Figure 2) who compares the life expectancies at birth of the general population in England with that of ducal families. From the middle of the 16th to the middle of the 19th century, there was little obvious trend in general life expectancy. For the ducal families up to 1750, life expectancy was no higher than, and sometimes lower than, the life expectancy of the general population. However, during the century after 1750, the life prospects of the aristocrats pulled away from those of the general population, and by 1850–74, they had an advantage of about 20 years. After 1850, the modern increase in life expectancy became established in the general population. Johansson (2009) tells a similar story for the British royals compared to the general population, though the royals began with an even lower life expectancy at birth.

I suppose we could have learned this from Shakespeare. 

The health gradient is, in my view, the central injustice. It has not always been here, so perhaps we can make it go away again.

 

Comments

[Kathi]

So I wonder what happened in the mid-18th -19th centuries that changed this. Changes to the general population from industrialization and the accompanying increases in accidents, occupational toxins, tenements, and accompanying disease and stress?

[Bill Gardner]

I think the question has been much debated, and if I can quickly get up to speed on it, I will.

[Cash McCall]

This is a bit like saying that for ducal families up to 1750, auto accident fatalities were no better or worse than they were for the general population.

Of course not. There were no cars and few effective tools for fighting disease. Once we developed better medical technologies (and safer cars), wealthy people got more, and benefited disproportionately.

[Bill Gardner]

Hi Cash,
Thanks for the comment. I think that is roughly his point. But, why 1750? One might have expected that aristocrats would have survived longer before 1750. Warmer clothes? More / better food? Bodyguards? The physiological benefits of higher status, if there are any? Moreover, were there effective tools for fighting disease in the late 18th century?

[Peter Sheppard]

At the risk of being Cassandra before my time ... does Harris's work allow for comparison with a larger pool of the generally well to do, say, extending the analysis toward the members of the lesser nobility, or to the clergy? I've always been impressed by the great ages Pepys attributed to the clergy recorded as dying in his time ... I've assumed that (after the age of 5) there were professions and lifestyles, albeit small in number, that enhanced longevity; which frankly the ducal families may not have tended toward (especially given the periodically violent nature of British politics until after 1745)

[uff the fluff]

This doesn't seem like nearly enough evidence to prove that social status has no inherent effect on lifespans. To throw out the Whitehall studies or "Length of life and the pensions of five million retired German men", among others, seems rather premature.

However, if true, this points to a past that was much more fundamentally egalitarian than is commonly thought. Very interesting.

[uff the fluff]

Perhaps the intrusion of high social status individuals into the lives of the common people and status imbalances in general were less likely to effect everyday living conditions, thereby negating any negative outcomes? It's hard to see what new technological benefits became available to the nobility in 1750(http://perfline.com/textbook/local/mvinas_chronol.htm#18TH), but not hard to imagine that their reach was greatly increased by the early industrial revolution.

[Daniel S. Goldberg]

Bill,

It has indeed been much debated, and in exactly the context you are writing about here!

I would Google "McKeown Thesis" as a way of beginning, and if you want the definitive treatment that directly links it to contemporary social epidemiologic work on the social gradient of health, run to the nearest library and check out Simon Szreter's Health and Wealth: Studies in History & Policy (University of Rochester Press, 2004).

[Bill Gardner]

This is what is so great about blogging -- you start conversations where learn what you need to read. THANKS, DANIEL!

[Bill Gardner]

uff,
I too am skeptical of Deaton's quick (implied) dismissal of Marmot's work.

[Bill Gardner]

Peter,
I am not an historian, but it would be very interesting to look at the chances of dying by violence before 1750 as a function of profession and class. For example, perhaps there were norms that meant that clergy did not become involved in duels?