‘Vital Statistics’ sheds light on inequalities in life expectancy

CSO figures show a strong class gradient in health status and life expectancy

While the standard of living today, measured in terms of income per head, is a multiple of what it was a century ago, a much more dramatic improvement in the quality of life has been due to the rise in life expectancy over that period.

In 1926, just after the foundation of the State, life expectancy for men and women was just under 58 years. Eighty-five years later, in 2011, at birth boys had a life expectancy of about 78 years and girls had a life expectancy of about 83.

There is a strong class gradient in health status and life expectancy. CSO data on life expectancy for 2006 documents that men aged 20 with no educational qualifications can expect to live six years less than men with a Leaving Cert – there is a similar, but smaller, gap for women.

Young men with a minimal education have a high risk of dying young – more than 6 per cent of those aged 20 die before 35, more than three times the rate for young men generally.*

Few deaths of young men are from natural causes, with traffic accidents being a major cause. Progress in road safety in the last 10 years should have a real impact in reducing these premature deaths. The rise in life expectancy has arisen from many individual improvements in health care and life style. However, progress over the last century has been uneven.

Since 1926, the improvement in life expectancy for girls at birth amounted to 25 years, whereas for boys the improvement has been less, at about 20 years. A significant reason for the greater improvement for women has been the reduction in the number of deaths in childbirth.

At the foundation of the State, about 0.6 per cent of all births resulted in the death of the mother; with women having an average of about five children, mothers had a significant chance of dying in childbirth.

However, over the course of the last 80 years, the maternal death rate has fallen dramatically, as shown in figure 1. The maternal death rate was lower in the Republic than in Northern Ireland in 1922, but the rate fell more rapidly in the North in the late 1940s and the 1950s, coinciding with the establishment of the National Health Service in Britain.

While the death rate also fell in the Republic, it was not till the late 1970s that it reached the UK level. Today, in spite of recent tragedies that have received significant media attention, the maternal death rate is very low, at about three per 100,000 births, marginally lower than that in Northern Ireland, England and Wales.

Another major factor in rising life expectancy has been the reduction in the number of babies dying in the first year of their lives. In the latter years of the 19th century, about 10 per cent of all babies died in their first year, although the death rate was generally lower than in England and Wales.

However, from 1900 on, there was a fairly steady fall in infant mortality, as shown in figure 2. As with the maternal death rate, progress was more rapid in Britain in the 1940s and the 1950s, but Ireland caught up in the 1970s and the 1980s, so that the infant mortality rate today is slightly lower than in the UK.

The latest Vital Statistics for Ireland, published by the CSO, covers 2012 and has a wealth of information on births, deaths and marriages. The style and many of the tables changed little over the 150 years since the first issue for 1864.

The authors of this volume almost always abstained from any social comment, concentrating on describing in objective terms the data in the many tables. However, in the newly formed State, statisticians began to record and comment on the very high death rates they observed for babies born to unmarried mothers.

The 1923 edition of Vital Statistics included for the first time a table showing that more than a third of children born to unmarried mothers died in their first year, most of them in institutions across the country, compared with a 6 per cent infant mortality rate for the babies of married mothers.

The authors were moved to write “these rates must be regarded as excessive”, highlighting the fact that the comparable death rate for England was dramatically lower. While we would today use much stronger language, this statement stands out in 150 years of the publication as an exceptional case of social comment by the authors.

In spite of the fact that this “excessive” death rate was highlighted in the report, no action appears to have been taken to deal with the problem.

The Vital Statistics reports continued to focus on the death rate for these children until the early 1940s, when more than 20 per cent were still dying in their first year. It was only in the subsequent 15 years that the infant mortality rate for these children was dramatically reduced.

Ninety years after the ongoing tragedy that was first highlighted in the Vital Statistics volume, Judge Yvonne Murphy has been appointed to head the Government's commission of investigation into mother and baby homes.

The data shows that the exceptionally high death rate among children of unmarried mothers was not confined to any one home or any one location in Ireland and that it persisted till the 1940s. * http://iti.ms/1wsseRR Figure 1: Maternal Death Rate, Deaths per 100,000 births. Figure 2: Infant Mortality, Deaths per 1000 births