North-south divide in health persists in EnglandBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7572.774 (Published 12 October 2006) Cite this as: BMJ 2006;333:774
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The news item mentions the Fat people of Boston. Does the Chief Medical Officer of England have any theories about the cause of the obesity? Is it potatoes? Lincolnshire was noted for growing potatoes before Egypt, Cyprus, Israel muscled in.
Secondly, has there been, concomitantly, an increase in the height of the population? I should like to see a comparison of the height and weight graphs of true born Bostonians still living in Boston and the cockney bantams (the native ones descended from the Thames Lightermen and the like). Has there been a temporal increase in both height and girth in both populations? Merely a personal observation: when in the 1960s I worked in Nottingham, the Bostonians visiting the hospital for specialised treatment were well-covered AND tall. Or, at least they were my height. The East Enders were shorter than me and equally lean. The East Enders did have mixed genes from London as well as Scotland and Eire, besides a sprinkling from abroad. Today's population there is probably very largely derived from Bangladesh. Hence the plea for comparing like with like.
Can the Directors of Public Health for Newham and for Boston perhaps help?
Next and with reference to Mr Gandhi's response, I suggest that it is possible that the fittest went south to seek their fortunes. Those left up north went on suffering.
As long the political capital of the UK remains on the banks of Father Thames, the fit, the rich, the powerful will keep moving South. Simple solution to the health problem. Move the political capital to the North. And do not build HS 2.
If this suggestion is adopted (probably it will not be), we will achieve a reversal of the North-South Divide.
I live in the East Midlands. No clash of interests.
Competing interests: No competing interests
The north-south divide in Britain has always yielded much for discussion. Over recent years, the disparity has become noticeable with regard to health parameters and life expectancy. America finds itself in a similar position with its own north-south divide, which is also crossed by an east-west chasm. Surveying the literature, one finds that north-south discrepancies have been studied by a train of British writers. From the assemblage, the names which engage most with the mainstream are Charles Dickens, and Eric Blair writing pseudonymously as “George Orwell.”
The finding that the north-south divide features in Dickens is not surprising for industrialisation was the background to his lifetime from 1812 to 1870. Of all the novels, the slenderest volume was named “Hard Times,” an opus concerned with conditions in the machineried North of England. A trip by stagecoach to Manchester had shown Dickens the penance being imposed on the masses by the Industrial Revolution. Acclaimed across continents, the most statured writer of his day had in his childhood worked in a factory tacking labels to bottles. He had earned for a family in which his father was continually feckless because of drink and debts. Traumatised forever by childhood labour, Dickens knew the wounds that could be inflicted by a rapacious industrialisation. His emphasis on the social canvas of his time found kinship in a writer who would be born some thirty years after his death.
Tendrils of connection between the Victorian Dickens and the Edwardian Orwell are found growing within the work of the successor. Orwell could have chosen from a profusion of Victorian forebears or a stock of capable contemporaries when choosing his point of reference. He was certainly aware of his stablemate, J B Priestley, the Yorkshireman from Bradford, whose “English Journey” was a soliloquy on conditions in the depression of the 1930s. He knew that the hefty intellectual, Aldous Huxley, was enraptured by the state of the miners from Nottinghamshire. But for Orwell the propinquity was strongest between him and Charles Dickens, as evinced by the long ribbon of an essay he wrote on the Victorian whose shadow fell heavily on subsequent phases of literature.
Orwell, an Indian-born Englishman from the south, embarked on peregrinations which resulted in one of the most accessible documentaries on the Great Depression. “The Road to Wigan Pier” (1937) is parcelled in an abstemious prose which one associates with the turnip-eating Orwell, garbed unashamedly in moth-eaten tweed despite his upper-class origins. His own life a rich compost of eccentricities, Orwell has made some of the best contributions to the understanding of modern life before the era had fully blossomed. His prose derives from the style which was developed by Somerset Maugham, to whose unostentatious writings Orwell credited the nature of his own literary development. Maugham, in his own summing-up, rated himself as being in “the front row of the second-raters” in terms of the eventual benefits of his contribution to English literature.
Orwell’s northbound adventure took him through the spine of England. He meandered through Wolverhampton, Birmingham, Leeds, Manchester and Liverpool – metropolises which, when amalgamated, were once the engine room of the manufacturing world. One of the most valuable non-fiction books from Britain came from this wintry journey. It was commissioned by the same publisher who printed J B Priestley’s “An English Journey” (1934) on a quality of paper which was allowable by the austerity measures of the Depression. Although “The Road to Wigan Pier” (1937) is the most renowned work on social conditions from the last century there has been, throughout its post-publication history, much resentment pitched against the well-placed praise. The bourgeoisie of the south read the book on their chaise longues and cared for the insights on an area of the country which was entirely alien to them. Northern working classes, meanwhile, chided Orwell for portraying their plight in monodimensionally bleak tones. They complained that he had ignored heartening aspects such as the camaraderie of northern football clubs. Orwell, nonetheless, had managed to etch out a veracity in prose which the cine camera could not convey with the same precision.
For a southerner, the jumble of mills on heath and moorland were sudden environmental uglifications rising from the landscape. Orwell’s sketches of miners are unrivalled in the English language. Inside the visual narratives are the asides which exhibit his greatly developed faculties for empathy. He mentions the miners ekeing out imperilled livelihoods, each bringing up a shard of coal only so that it may be thoughtlessly cast on a fire blazing away in a gambling room.
Coal mines and heavy industry were the hives of northern England during the 1930s, a phase which has been referenced when viewing the last few recessional years in Britain. Life expectancy in Orwellian times was constrained by the rigours of heavy occupation. Miners, especially, form a distinct part of British medical history and only over the last decade have ravages such as “miner’s lung” become a rarity in hospitals. The brutality of raw industrialisation may have gone but the north-divide with regard to health indices has not followed suit. Unemployment, depression, climate, smoking, drugs and alcohol are some of the elements behind the shortest lifespans seen in northern areas such as coastal Lancashire and Glasgow. These factors are entwined because unemployment, depression, faulty eating, indoor living, weight gain, diabetes and circulatory disease form a linear sequence of pathology. Chronic socioeconomic ailments which affect certain areas, and which are influenced by a weave of factors, cannot be cured easily. Gains can nonetheless be made, for instance, by asking fast-food chains to make their edibles healthier and by bolstering anti-smoking programmes inside the aim of improving the health of as many citizens as possible.
Modern medicine in developed nations means an allowance of years past the age of seventy ------now an antiquated idea of a reasonable lifespan. As the honeycomb of space becomes increasingly stocked with older persons, the question is not one of longevity any more, but rather that which asks how much of a lifespan can be spent in good health. There is also the question of resources. In the lifetime of one person, the Orwellian 1937 to the current year of 2013, a collection of almost eighty years, life expectancy has risen spectacularly across the United Kingdom. Although there remains a north-south divide of sizeable proportions, there also continues for now a National Health Service, the only one of its kind in the world, which narrows the breadth of this gap.
Competing interests: No competing interests