Economy

Despite all our gains, poverty is still a killer

Children born today can expect to live up to 30 years longer than their great grandparents

Mothers at the entrance to a Dublin tenement building, circa 1945. Before the first World War, on average, children born in Ireland could expect to live to just 54. Photograph: Picture Post/Hulton Archive/Getty

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John FitzGerald
Fri Mar 22 2024 - 06:00

When we consider improvements in living standards, the first port of call is often national income per head, measuring welfare in financial terms. However, a far more important measure of wellbeing is what has happened to life expectancy. Here there has been a dramatic improvement since the foundation of the State.

Children born today can expect to live up to 30 years longer than their great grandparents born a century ago. That is a real improvement in our way of life.

Before the first World War, on average, children born in Ireland could expect to live to 54. By 1926, just after Ireland gained independence, this had risen to 57. However, over the last century or so we have seen huge progress, so that girls born today can expect to live to 84 and boys can expect to live to 81.

Across the developed world, most countries have had Increases in life expectancy over this period. Nonetheless, Ireland has had a particularly strong performance over recent years.

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Life expectancy for men in Ireland is the fifth highest in the EU, while for women we are ranked 9th. Countries that perform a bit better than Ireland are Sweden and Italy, where men and women can expect to live between 6 months and a year longer than in Ireland.

A range of factors have contributed to this dramatic improvement over the last century – safer childbearing, better infant health, better housing and sanitary conditions, antibiotics, and vaccinations.

While poverty often led to short lives a century ago, this was exacerbated by the high prevalence of disease in overcrowded city slums.

Although life expectancy in Ireland was very low in 1911, we still scored better than England. Ireland’s tenements of that era were grim, however with a higher rural population share, the spread of disease was lower than in our more urbanised neighbour. For similar reasons, Ireland’s infant mortality in that period was also lower than England’s.

Nevertheless, infant mortality a century ago was exceptionally high by today’s standards. In 1922, seven per cent of children died before their first birthday. But a truly shocking third of all children born to lone mothers that year died before age one, more than twice the rate in England, and with a particularly appalling death rate for children born in institutions.

Although this was particularly highlighted in the statistical report of 1923 on births and deaths, we know that nothing happened to address this shameful and avoidable record for decades.

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A century ago, maternal death rates were high in Ireland and right across Europe. In the early 1920s approximately one in every 200 mothers died in childbirth. Up to the 1960s, progress in reducing such deaths was slower here than in Britain. Thankfully both here and across the developed world, maternal deaths are now exceptionally rare.

The biggest factor in the increase in life expectancy after the second World War was the invention of penicillin and other antibiotics. This effectively ended the curse of TB which had accounted for one in ten deaths a century ago. Routine vaccinations have virtually eliminated many killer and disabling diseases, like smallpox and polio.

Since the turn of the millennium, life expectancy has got a further boost from three significant changes – the smoking ban, the cancer strategy, and a halving of road deaths.

It was politically courageous of Mícheál Martin to ban smoking in public places – and now most of Europe has followed suit. Likewise, it took political courage for Mary Harney to centralise cancer services in eight centres of excellence, rather than one for every hospital – but the cancer strategy has paid dividends in lives saved.

Stricter drink driving laws, and a change in culture, have played a part in reducing avoidable road deaths, particularly among young men, though worryingly road deaths have picked up over the last year.

Good public health, better lifestyles, decent living conditions, all play a big role in extending life expectancy. Across Europe, higher shares of public spending on health services do not necessarily lead to longer lives. Italy, with just nine per cent of national income spent on health, below the European average of 10.9 per cent, enjoys very high life expectancy. Germany, which spends a higher share than us, has life expectancy below ours.

The link between poverty and lower life expectancy, which was such a feature of life a century ago, does however remain. Poorer people continue to die younger, and to experience worse health outcomes during their lifetimes. So an effective anti-poverty strategy has a clear role to play in tackling premature deaths.

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