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The Ghost of Christmas Past: health effects of poverty in London in 1896 and 1991

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1547

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  1. Danny Dorling, professor of quantitative human geography (D.Dorling{at},
  2. Richard Mitchell, research fellowa,
  3. Mary Shaw, research fellowb,
  4. Scott Orford, lecturer in geographic information systems and spatial analysisc,
  5. George Davey Smith, professor of clinical epidemiologyd
  1. a. School of Geography, University of Leeds, Leeds LS2 9JT
  2. b. School of Geographical Sciences, University of Bristol, Bristol BS8 1SS
  3. c. Department of City and Regional Planning, Cardiff University, Cardiff CF10 3WA
  4. d. Department of Social Medicine, University of Bristol, Bristol BS8 2PR


Objectives: To compare the extent to which late 20th century patterns of mortality in London are predicted by contemporary patterns of poverty and by late 19th century patterns of poverty. To test the hypothesis that the pattern of mortality from causes known to be related to deprivation in early life can be better predicted by the distribution of poverty in the late 19th century than by that in the late 20th century.

Design: Data from Charles Booth's survey of inner London in 1896 were digitised and matched to contemporary local government wards. Ward level indices of relative poverty were derived from Booth's survey and the 1991 UK census of population. All deaths which took place within the surveyed area between 1991 and 1995 were identified and assigned to contemporary local government wards. Standardised mortality ratios for various causes of death were calculated for each ward for all ages, under age 65, and over age 65. Simple correlation and partial correlation analysis were used to estimate the contribution of the indices of poverty from 1896 and 1991 in predicting ward level mortality ratios in the early 1990s.

Setting: Inner London.

Results: For many causes of death in London, measures of deprivation made around 1896 and 1991 both contributed strongly to predicting the current spatial distribution. Contemporary mortality from diseases which are known to be related to deprivation in early life (stomach cancer, stroke, lung cancer) is predicted more strongly by the distribution of poverty in 1896 than that in 1991. In addition, all cause mortality among people aged over 65 was slightly more strongly related to the geography of poverty in the late 19th century than to its contemporary distribution.

Conclusions: Contemporary patterns of some diseases have their roots in the past. The fundamental relation between spatial patterns of social deprivation and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.


  • Funding The study was supported by ESRC Health Variations Programme grants L128251009, L128251007, and L128251037; ESRC fellowship R000271045; and Joseph Rowntree Foundation project Inequalities in Life and Death.

  • Competing interests None declared.

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