In July, Public Health England, the public health oversight body, distributed a report that revealed that about 23,400 more elderly people died between June 2012 and June 2013, than over the same period a year before.
In addition, week on week, more people were reported to have died in 2012 than at the same time in 2011. And so far in 2013, the excess death rates are reported to be higher than in any of the previous five years. The death rates were higher for women than men, especially in the most deprived areas of England. The causes were not immediately obvious – something the report itself admitted.
However, in a letter attached to a report on a related topic released a month later, John Newton, chief knowledge officer of PHE, provided some explanation. The July report, he wrote, had been written by an analyst who used a novel statistical approach that was consequently found to have potential methodological weaknesses.
There had been excess deaths in 2012-13, Newton continued, but they could be explained by higher-than-expected circulation of influenza and a bout of cold weather. Also, the rise in death rates did not look exceptional, he wrote, when compared with the past 12 years rather than with data from more recent years.
Newton observed that many of the deaths were preventable and that the data showed the need to work harder to protect the vulnerable from both flu and extreme weather. Nevertheless, questions have been raised over a possible link between the rising mortality rates and a drop in the UK’s overall wealth, as measured by its gross domestic product.
About 20 years ago, Amartya Sen, the Nobel Prize-winning economist, wrote an article in the journal Scientific American about the importance of mortality data. Death statistics can be an important supplement to traditional economic indicators, he wrote, as they reveal very clearly what is actually happening in society, namely, if people are dying prematurely. Equally importantly, Sen argued that mortality data also show the efficacy of social institutions. In contrast, the most commonly used indicator of how well a society is doing is often the size of its economy or GDP, as the popular argument among economists and social scientists holds that wealth leads to wellbeing and, therefore, the wealthier the country the better off are its people.
Sen’s advocacy for the importance of mortality data is part of his broader work spanning decades on moving economics beyond just wealth, and measuring social progress beyond traditional economic indicators such as GDP.
Rather than focus on the means, he would see us focus on the quality of people’s daily lives.
Sen’s arguments have influenced development economics greatly and aided wellbeing indices such as the Human Development Index. During economic booms such as in the years preceding the economic crisis of 2008, there was growing interest among wealthy nations in moving beyond using GDP data or simply focusing on wealth as an indicator of people’s lives.
In early 2008, the then French President Nicolas Sarkozy set up the Commission on Economic Performance and Social Progress with Sen as one of its three chairmen.
In late 2010, UK Prime Minister David Cameron instructed the Office of National Statistics to begin measuring national wellbeing using a broader set of measures than just GDP.
Since the recession, however, GDP has come back firmly to centre stage. Changes in the latest set of data make headlines, and the justification for any policy is often linked to its effect on the underlying rate of growth. The re-entrenchment of GDP as an indicator might lead us to conclude that wealth is in fact the most important basis of how people live their lives.
But while many people around the world are indeed concerned about GDP data, particularly on how it affects their personal wealth, they are starting to recognise that other factors are just as important. Healthcare, for example, is on the political agenda of many countries.
England is not alone in reporting rising excess mortality rates among the elderly. In April 2012, a group of researchers published a study in the journal Eurosurveillance that detailed increases in excess mortality rates of the elderly across 12 European countries. And in the US, the Centers for Disease Control and Prevention reported a sharp increase of excess mortality due to influenza during the winter of 2012-13. Yet death from influenza or a harsher winter is not inevitable.
What role should the state play in preventing these early deaths – and, further, is the harsh economic climate taking its toll?
People’s health and mortality rates are due to a combination of factors – biological, behavioural and environmental. Economic growth is undoubtedly important for maintaining and improving people’s health and life expectancy. But it is unclear what the link between the two actually is. The range of life expectancies across countries with the largest economies, as well as health inequalities within countries, show that there is no automatic connection between health and wealth.
Morbid though they may be, Sen was right to argue that mortality rates are an important social indicator of the state of people’s lives and the efficacy of social institutions.
Looking deeper into the causes of deaths, or their inequalities within different social groups could reveal much not only about healthcare but also about a country’s social and economic development.
With the number of preventable deaths of the elderly in many industrialised countries on the rise, now is surely the time for the relationship between health and wealth to come under greater scrutiny.