Douglas Noble and Dianna Smith on historical health inequalities

This month we published a report on risk of type two diabetes in East London, with an accompanying paper in BMJ Open, and underpinned by a previous systematic review in BMJ. We took a risk scoring algorithm, the QDScore, and used it on just over half a million electronic records to identify high risk groups. QDScore is validated based on certain risk factors. For example, deprivation, body mass index, and certain ethnicities result in a higher score.  

We went a step further and mapped the geographically high risk of type two diabetes and deprivation. Surprisingly there were some similarities to Charles Booth’s maps of poverty in London from 1898. This was puzzling given the scale of change in the area over the last century, including populations, buildings, and infrastructure. The Daily Mail led with the headline: “The changing face of poverty: Updated maps of London’s poorest areas show epidemic of ‘junk food’ diabetes in same streets where Victorians died of malnutrition.” We were initially horrified. But there is a point in this newspaper interpretation; similar social determinants a century apart are producing different health problems, but in similar localities.

The presence of significant health inequalities over a relatively small area is not a revelation in the UK, nor is the damaging effect that deprivation may have on the health of multiple generations.  Over a decade ago Danny Dorling and colleagues examined the issue of persistent poverty and ill health in the BMJ, concluding that some impoverished areas in the Booth maps were still quite poor in the late 20th century, with high rates of stroke and some cancers.

How it is that just living in a deprived area may affect individual health above and beyond individual “predictors” of illness is captured in well known concepts such as the “Glasgow effect” and deprivation amplification.

Yet, questions remain. Why do geographical inequalities persist over such long periods of time?  Should we investigate this further, or just concentrate on the here and now? Should this historical perspective be used to guide public health interventions? Might this knowledge itself inspire community transformation?

Booth produced a series of findings which were important to late Victorian and early Edwardian London, inspiring significant public health action which has been vastly successful.  Today we’ve got a different challenge in similar areas.

Douglas Noble is a public health doctor and lecturer at Queen Mary University London. You can follow him on twitter @douglasnoblemd

Dianna Smith is an MRC Research Fellow at Imperial College London.  You can follow her on twitter @geodianna