IJE Advance Access originally published online on March 3, 2005
International Journal of Epidemiology 2005 34(2):479-480; doi:10.1093/ije/dyi036
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Published by Oxford University Press on behalf of the International Epidemiological Association
Letters to the Editor |
Response
St John's College, Cambridge CB2 1TP, UK. E-mail: srss{at}cam.ac.uk
I am grateful to Razzell and Spence for their commentary. However, I find both the data which they deploy in the first half of their letter and their social class analysis in the second half of the letter are somewhat at cross-purposes with the evidence and arguments being deployed both in Szreter and Woolcock1 and in the supporting research and interpretation on which its summary of British mortality history is based.2,3 Consequently, while what they say is interesting, I do not find it especially relevant or persuasive as a critique of the interpretation, which was offered in Szreter and Woolcock.
As Razzell and Spence4 note, in summarizing the thesis presented in Szreter and Woolcock (2004), this article is primarily about the towns of Britain and their health, focusing particularly on the period c.1800–1914. My focus has always been primarily on the urban industrial populations throughout this period, defined mainly as towns of more than 10 000 residents (though some secondary sources use a definition of more than 5000). This has been for the very simple reason that it is the fate of this urban population and its living conditions, which constitutes the primary demographic dynamics in this period. Their disproportionate growth is the salient fact of the nineteenth century, becoming a clear majority of the national total for England and Wales by the 1890s (having constituted, <13% in the first decade of the nineteenth century).2 By contrast, London throughout the same century grew very modestly in proportionate terms, from 11 to 14% of the nation's total. This is not, of course, at all true for earlier centuries when London's growth was of cardinal importance and when provincial towns of more than 10 000, let alone 100 000 were virtually non-existent. The crucial question about demographic and mortality history after 1800 is: ‘What happened in the provincial towns and cities, especially those fast growing industrial towns and cities?’
Consequently, the data adduced by Razzell and Spence in the first half of their letter relating to London and to such southern townships as Ampthill in Bedfordshire or Truro in Cornwall really are beside the point, in so far as the article in question is concerned.1 I hasten to add this is not to say that they have no value or relevance for a more general account of mortality during this period, but the mortality histories of these places are a quite distinct matter from those of the industrial urban centres which were our main focus of attention. As I have observed before, when presenting the life expectancy estimates for nineteenth-century provincial cities, London's nineteenth-century mortality history is also quite different (including ‘its spluttering smallpox vaccination machine’ as Mooney has shown5) and I would expect it to be so, according to the causal account I have offered, in terms of the disruption and subsequent political repair of urban administration and social capital, which was a particularly significant factor in the rapidly expanding industrial centres.3 Rural places, very small towns and, no doubt, southern market, cathedral, and county towns also all had quite different mortality trajectories during the nineteenth century, more consistent with a continuation of the patterns of improvement found in the late eighteenth century. I judge these to be much less important (though not of course ‘unimportant’) in order to explain overall trends in nineteenth-century population health for the simple reason that, as a category, they contained an ever-shrinking proportion of the national population throughout the nineteenth century.
Like it or not, Razell and Spence cannot get away from the fact that all of the several independent, available sources of evidence for the first half of the nineteenth century indicate significantly deteriorating mortality in Britain's industrial cities and towns in the 1830s, long before the refugee Irish poor arrived in large numbers. A recrudescence of smallpox was a part but only a small part of this catastrophe in the 1830s and 1840s. What happened in London or in Ampthill is another matter. The attempt in their article to cast doubt in readers' minds by referring to evidence of differences in levels of life expectancy in different cities in the decade of the 1850s is not relevant to the key issue of trends during the previous five decades. Their observation in the subsequent paragraph that gains in life expectancy in industrial cities like Birmingham after the 1870s were not greater than elsewhere is, again, beside the point. The crucial point is that these cities were able to make any gains at all in life expectancy over the levels prevailing in the 1820s, having had such a difficult time over the intervening half-century, let alone record cumulative increases in life expectancy, decade after decade down to the Great War and beyond—as they did.
It follows that places, not classes, were in many ways the key to explaining the major trends in mortality and epidemiological change in nineteenth-century Britain (which is not a way of saying that class was unimportant—quite to the contrary, the social capital interpretation offered in Szreter and Woolcock 2004 made it clear that urban places could only be made healthy when a political transformation, involving enhanced cross-class relations, became possible in Britain's late Victorian municipalities). The countryside generally experienced gradual improvement during the nineteenth century; London and those other towns whose established social and political relations were not too disrupted by rapid, industrial growth, experienced relatively minor problems only (though London's experience was also very diverse of course).5,6 The industrial towns and cities, however, experienced terrible problems, which were only resolved—and were resolved politically—in the last quarter of the century and the first quarter of the next, as each of them began to act—some with more vigour than others. Although in their final footnote, Razzell and Spence cite Garrett et al.7 in support of their argument for a class view of mortality decline, they seem to be unaware that the principal importance of the analysis of mortality that was mounted on the exceptionally high quality, individual-level data that was available for this study was its breakthrough demonstration of the important finding that in the decades around the turn of the nineteenth and twentieth centuries, environment or ‘place’ of residence exerted a much more powerful effect on differential survival chances among the very young than the ‘social class’ affiliation of individual households.7
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1 Szreter S, Woolcock M. Health by association? Social capital, social theory, and the political economy of public health. Int J Epidemiol 2004; 33:650–67.
2 Szreter S, Mooney G. Urbanisation, mortality and the standard of living debate; new estimates of the expectation of life at birth in nineteenth-century British cities. Econ Hist Rev 1998; 50:84–112.
3 Szreter S. Economic growth, disruption, deprivation, disease and death: on the importance of the politics of public health. Popul Dev Rev 1997; 23:693–728.[CrossRef][Web of Science]
4 Razzell P, Spence C. Social capital and the history of mortality in Britain. Int J Epidemiol. 2005;34:477–78.
5 Mooney G. ‘A tissue of the most flagrant anomalies’: smallpox vaccination and the centralization of sanitary administration in nineteenth-century London. Med Hist 1997; 41:261–90.[Medline]
6 Hardy. The Epidemic Streets. Infectious Disease and the Rise of Preventive Medicine 1856–1900. Oxford: Oxford University Press, 1993.
7 Garret E, Reid A, Schurer K, Szreter S. Changing Family sise in England and Wales. Place, Class and Demography, 1891–1911. Cambridge: Cambridge University Press 2001, pp. 139–85, esp.162–63 on ‘Model 5’.
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  P. Razzell and C. Spence Social capital and the history of mortality in Britain Int. J. Epidemiol., October 1, 2005; 34(5): 1163 - 1164. [Full Text] [PDF]
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