Reflections on retirement 3: Longing for a world where children don’t die

Last week I received an email from one of our administrative team at the medical school, reminding me that I have just over two months to fully clear my office – to shred or archive all old research papers and data, get rid of the mountain of books and files, empty my filing cabinet, clear my hard drive, and hand back all my IT and other equipment.

Once I’d got over my initial shock and the reactive ‘I can’t possibly do that, there’s far too much, and what about all that academic stuff I want to keep on?’ I realised that perhaps it wasn’t such a bad thing after all. I do need to wake up to the fact that, come October, I will no longer be a paid employee of the University with all the benefits (and responsibilities and frustrations) that brings. It is also high time I had a good clear out of all the accretions of 13 years as an academic.

When was the last time I opened that file of research interviews I did back in the late 1990s?

So, taking the bull by the horns, I started work on one of my filing cabinet drawers. After filtering through each file, I think I ended up with just two or three papers worth keeping.

This particular drawer held all my case notes from the South West Infant Sleep Scene study I did with Peter Fleming in the early 2000s. As I started shredding the interviews from those early home visits to bereaved families, I reflected on the blessing it has been to meet with, and hopefully offer some support to, so many amazing families.

Longing for a world where children don’t die

The dramatic drop in SIDS rates in the 1990s has been one of the most impressive successes of epidemiological research this century. I have been immensely privileged to meet and work with many of the leading researchers from around the world who contributed to this work, and in my small way, to contribute to ongoing research, teaching and practice that has seen SIDS death rates continue to fall to this day.

At times it has been truly heart-breaking to meet with families in the horrendous trauma of their child’s death. But it has also been encouraging to know that the work we did in Bristol and elsewhere has contributed to more compassionate and thorough responses to unexpected child deaths. I have, over the years, had many expressions of thanks from bereaved families who have appreciated the care and support they have received from my colleagues in health, police, and social services.

And, even more encouragingly, over the course of my career, I have seen the numbers of children’s deaths decrease.

When I started my medical training in 1982, nearly 8,000 children in England and Wales died before their fifth birthday. By the time I started work as a consultant, that figure had fallen to less than 4,500. Now, as I retire, the figure is just over 3,000. Just looking at the past two decades, that suggests there are 15,000 children and young people alive today who might not have been if our mortality rates had stayed at the 1997 level.

Has my work contributed to that fall?

Perhaps I will never know, but I like to think that, in some small way, my research and teaching and the little steps I have taken to engage with individual parents and children might have made a difference to some. And perhaps, with so many others making their small contributions, we may just be moving towards a world where children don’t die.

August 8, 2016

Time to call for a maximum wage?

A report from the High Pay Centre this morning told us that the bosses of Britain’s biggest companies take home an average of £5.5 million, having seen their incomes rise by 10% during 2015.

This is a travesty that should have us all shouting for justice every bit as much as the travesty of people sleeping on our streets, queuing at food banks or struggling to live on a minimum wage that doesn’t even cover the basics of life.

The median pay of the chief executives of London’s FTSE index 100 firms rose to £4 million, 144 times the median wage of the average British worker (£27,600).

It is obscene, and as George Monbiot put it, ‘high pay is both counterproductive and unnecessary.’[1] To be earning 7 figure salaries cannot count as anything other than greed.

‘The successful bank robber no longer covers his face and leaps over the counter with a sawn-off shotgun. He arrives in a chauffeur-driven car, glides into the lift then saunters into an office at the top of the building. No one stops him.’ – George Monbiot, Guardian 23.1.12

But does it really matter?

The answer to this has to be a resounding yes.

Last week I reviewed a paper for a journal which, once again, pointed out the links between income inequality and child mortality. This is not just an issue for developing countries – it is a reality in our own, Western bloc.

The impact of income inequality (as measured by the GINI coefficient) on infant mortality in high income countries, has been highlighted in many scientific papers, and is neatly summarised in this figure from The spirit level[2]: those Western countries with the highest income inequality (USA, Portugal, UK, New Zealand) have the highest infant mortality rates, while the Nordic countries and Japan, with far more egalitarian societies have the lowest infant mortality rates. The only exception to this rule seems to be Singapore.

‘a 43 per cent increase in income inequality, which was observed in the UK over the period 1975–2006, would correspond to a 10.6 per cent increase in child mortality for boys and a 12.6 per cent increase for girls.’[3]

And the effects are not just in life expectancy. Income inequalities have been shown to be correlated with measures of child wellbeing, mental illness, drug use, obesity, teenage pregnancy, and much more.

So perhaps the time has come to speak out and make it clear that we don’t want to live in this kind of society. The idea of a maximum wage is not new, but perhaps it is starting to gain momentum and to be seen as a credible policy that could, perhaps, do as much for restoring justice as the minimum and living wages.

[1] https://www.theguardian.com/commentisfree/2012/jan/23/george-monbiot-executive-pay-robbery

[2] Wilkinson R, Pickett K. The spirit level. London: Allen Lane; 2009.

[3] Roberta Torre & Mikko Myrskylä (2014) Income inequality and population health: An analysis of panel data for 21 developed countries, 1975–2006, Population Studies,68:1, 1-13, DOI: 10.1080/00324728.2013.856457

[4] http://www.theatlantic.com/business/archive/2015/11/bernie-sanders-used-to-think-there-should-be-a-maximum-wage/416790/

May 6, 2015

On the eve of the general election

On the eve of the general election I find myself increasingly exercised by the issues of justice that are at stake here. This election isn’t just about who we would like to govern our country, it is about how we, as a country, and the people who govern us, treat our fellow-citizens, particularly the most vulnerable in our society: children, the elderly, disabled people, immigrants and asylum seekers, those living in poverty, those with mental health problems… the list could go on.

Over the past three weeks I have spent a lot of time preparing and delivering lectures on child mortality, both in the UK and overseas. While there has been incredible progress over the past 25 years in reducing child mortality, we live in a country in which over 5,000 children and young people die each year, and in a world where over 6 million children die each year before their fifth birthday. One aspect stands out above all others:

there is a consistent inverse relationship between child mortality and socioeconomic status.

The more wealthy you are, the less likely your child is to die. This finding is persistent across time, and geography, and holds true regardless of whether you measure socioeconomic status at an individual or societal level.

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