Changes in infant mortality

For the past twenty years I have been researching child mortality both in our country and overseas. One of the most encouraging aspects of this has been the steady decrease in child deaths over this period and for many decades before throughout the world. There have been some particularly positive achievements in this, with deaths from cancer, external causes and violent deaths in children all falling by more than 50% in England and Wales since the 1970s, while Sudden Infant Death Syndrome (SIDS) fell by over 80% (Sidebotham, Fraser, Fleming, Ward-Platt, & Hain, 2014). Globally, under five mortality rates have fallen by more than 50% since 1990 (Unicef, 2019).

Sadly, though, those huge achievements have not been maintained, and a recent paper in the British Medical Journal has shown that, for those in the most deprived areas of our country, infant mortality has actually been rising since 2013 (Taylor-Robinson et al., 2019). The gap between the most wealthy and the most deprived, having been reducing for many years, has now started to increase. While there are some limitations in their research, the overall pattern seems very clear. In this graph from that paper, infant mortality in the most deprived local authorities is in pink at the top of the graph, with the least deprived in brown at the bottom.

Politics, Poverty and Austerity

In the run up to a general election, with all the political posturing going on, it is hard not to conclude that this reversal in infant mortality is linked to a combination of poverty and austerity, with increasing wealth inequalities, reductions in welfare benefits for families with children, and real-terms cuts to the NHS, local authority children’s services, social care and public health budgets. It is notable that throughout the Labour administration from 1997 to 2010, infant mortality fell, particularly in the most deprived areas of the country. The reversal in this trend seemed to kick in just a few years after the change of government.

It seems to me that we need a clear change in policy (and not just electioneering promises) if we are going to see a reversal of this recent trend and a change in the life-chances of those who are most disadvantaged in our society. Perhaps we should be judging our political parties, not so much on what they promise to do, but on their actual track record in tackling poverty and inequalities, ill-health and child mortality.

In the context of increasing health inequalities in England, policies that reduce poverty and social  inequalities and investing in child health and social care are likely to reduce the occurrence of infant  mortality and that of many other adverse child health outcomes.  – Taylor-Robinson et al., 2019

Sidebotham, P., Fraser, J., Fleming, P., Ward-Platt, M., & Hain, R. (2014). Patterns of child death in England and Wales. Lancet, 384(9946), 904-914. doi:10.1016/S0140-6736(13)61090-9

Taylor-Robinson, D., Lai, E. T. C., Wickham, S., Rose, T., Norman, P., Bambra, C., . . . Barr, B. (2019). Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000-2017: time trend analysis. BMJ Open, 9(10), e029424. doi:10.1136/bmjopen-2019-029424