UK and African death rates

There will be statisticians out there who can unpack this better than I:

Data released in Parliament show that in the most deprived areas of the country, the mortality rate is as high as 1,500 deaths per 100,000 people in a single year.

By contrast the death rate is 1,427 in Rwanda and 1,452 in Botswana, according to the World Health Organization.

They point out a number of caveats. The areas being discussed are tiny, so simple statistical variation will have a large impact (the national average death rate is some 462 per 100,000).

The presence of a hospital or hospice will alter the figures dramatically (which means, I think, that the figures are drawn from place of death, not place of residence at time of death?).

But do not doubt that this will be taken as proof perfect of the shameful iniquities of the rampant inequality in the country.

And as ever, the elephant will be missed.

Yes, we know there is health inequality. We also know that there is socio-economic inequality. We even know that there is a correlation between the two.

However, in the usual public health discussions it is assumed that the causation runs from socio-economic inequality to health inequality. And I would certainly be open to the argument that some of the correlation does run that way.

However, I would also insist that some of the correlation runs the other way. That health inequality leads to socio-economic inequality. Become ill with some chronic disease and your employment and income prospects simply are going to decline.

And sadly, at least as far as I can see, that\’s not a causation that is allowed to enter into the discussions of inequality and public health. Certainly I looked through the Marmot thing and could not see any evidence at all of it being discussed, even to reject it.

If it is and I missed it please do correct me. But if it isn\’t then we\’ve another one of those lying with numbers things, don\’t we?

11 comments on “UK and African death rates

  1. Using the example given in the paper (Bryncethin) and multiplying the death rate by the population gives 19 deaths per year, if my calculations are right. So it’s a small number, subject to random fluctuation, and a figure based on one year is utterly meaningless. IMHO.

  2. A better comparison would be life expectancy rather than death rates. Life expectancy in Rwanda is about 55-60, depending on your source.

    According to the ONS release in Oct last year, the lowest life expectancy (2008-10 stats) in any area of the UK was Glasgow – 71 years for blokes and therefore significantly better than Rwanda. For Bridgend, it is nearly 77 years for blokes and 81 years for women.

  3. Actually the UK crude death rate appear to be around 900 per 100,000 – the ONS website says there were 561,666 deaths in a population of 63.2m in 2010.

    Much will depend on the age structure of the population in question. Eastbourne probably has a high crude death rate, for example, because there are so many care homes there.

  4. “Those who are in excellent health earn between 4-7% more per hour than those whose health is average, controlling for other characteristics; while those whose health is poor earn 7-15% less than those whose health is average.”

    From here:

    http://www.hse.gov.uk/research/rrpdf/rr639.pdf

    Seems you are right – being ill tends to make you poorer and (although this is to be proven) more likely to live in places where living, typically housing costs, are cheaper.

  5. That death rate of 900 seems more reasonable. Over the long term surely death rate = 1 / life expectancy? OK, not quite true for increasing population but should be close. 900 per 100,000 gives expectancy of 111. High but in the right ball-park. 462 per 100,000 would give 216 years.
    So, basically, taking thousands of tiny samples of the national data and looking at the worst sample out of those several thousand has given a result about 66% over the average. I would say that is a surprisingly modest difference.

  6. Death is not the only way to leave a population – you can emigrate. And if (as one suspects happens) the young and fit move out of shitholes leaving behind the elderly and infirm, they reduce the denominator without affecting the numerator, making the apparent death rate higher than it really is.

    Also the emigration thing means the life expectancy/death rate correlation is never going to be perfect. There will be plenty of people from, say, Malawi who move to the UK to make money and retire back home. They therefore bolster the population numbers in the UK, but the death numbers in Malawi.

  7. It’s odd to treat Life Expectancy as a fact – it’s presumably a prediction? It’s even odder not to say whether it’s Life Expectancy at Birth that’s meant, or some variant thereon. So I can see the advantage of reporting mortality rate, with the same sort of caveat – if it’s per place of death, say so.

  8. In those bits of Africa with rapidly-growing young populations, wouldn’t you expect low mortality rates? Particularly if you make (say) a decision to leave out some sorts of death – just as, no doubt, British figures exclude abortions.

  9. Those bits of Africa with rapidly-growing young populations also tend to have atrociously high infant mortality.

  10. And regarding correlations, I think some obvious ones are missed altogether, like the fact that both health and wealth are impacted by other factors, such as bad habits. Drinking and smoking, in particular.

    People who smoke tobacco are, on the average, poorer because they burn their money instead of investing it into something that is profitable in the long run. People who smoke also suffer from many diseases, particularly cardiovascular illnesses and cancer.

    This is not an indicator that people are ill because they are poor, or that people are poor because they are ill. They are ill and poor because they smoke.

    Nevertheless, I do not wish to ban anyone from smoking. I don’t smoke myself but I’m rather disgusted by my own country’s silly tobacco rules where the authorities at the same time both bully smokers and squeeze out every possible tax penny out of them. They try to ban the so-called electric tobacco, although it is much less harmful to health, on the pretext that electric devices for inhaling vapors are “advertising tobacco”. The real reason is, of course, protecting the tax income.

  11. It’s even odder not to say whether it’s Life Expectancy at Birth that’s meant, or some variant thereon.

    As it was me that said it – those were all at birth figures.

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