Health inequality in Britain before 1750

Abstract

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 17^th to 19^th 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 16^th to mid-18^th 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.

Keywords: Childhood mortality; Early modern England; Historical demography; Life expectancy; Social inequality.

Fig. 1

Life expectancy at birth (e0) from the 1550s–1870s, comparing ducal males and females (data from Hollingsworth (1977), Table 3, p. 328) with the general population of England (data from Wrigley et al. (1997), Table A9.1, p. 614).

Fig. 2

Ducal life expectancy at birth and child mortality (deaths under 5 years) from the 14^th-19^th centuries by sex (life expectancy data from Hollingsworth (1957), p.8; data for deaths under 5 years from ibid, p. 9; the unevenly spaced cohort intervals are original to the Hollingsworth data).

Fig. 3

Under-5 mortality (0–4 years) risk from the 17^th-19^th centuries, for ducal and wider English population by sex (data for ducal deaths from Hollingsworth (1964), p.54-55; data for English children calculated from 1q0 and 4q1 in Wrigley et al. (1997), p. 296 using WHO method for CME (2013)).

Fig. 4

Infant (top panel) and child mortality (bottom panel) risk for ducal and wider English population by sex from the 17^th-19^th centuries (data for ducal deaths from Hollingsworth (1977), p.327; data for English children in Wrigley et al. (1997), p. 296).

Fig. 5

Probability of dying in childhood between the ages of 5 and 14 years during the 17^th and 18^th centuries for males (top panel) and females (bottom panel) in ducal (T. Hollingsworth, 1964, pp. 54–55) and English children (English data calculated from 5q5 and 5q10 in Wrigley et al. (1997), p. 296 using WHO method for CME (2013)).