Feature

Counting the loss of young lives

Don’t underestimate the impact of accidents and violence, say the Radical Statistics Health Group

What are the most important preventable causes of death? If you paid attention to the health education literature and its reflections in the media you would find that an easy question to answer: heart disease and some types of cancer. Logical consequence: we must all stop smoking, eat less fat, take more exercise and (perhaps) drink less alcohol.

Heart disease and cancer are the causes of higher numbers of deaths each year than any other, true. But many people who die of these diseases are in the later years of the normal lifespan. An alternative measure to the usual death rates which takes more account of the amount of life lost gives a different picture.

One such measure is known as the years of potential life lost (YPLL), and can be used to examine the importance and trends in deaths from different causes, and the influence of social and material deprivation.

Certain points from the graphs stand out. Figure 1 shows that the causes of death which have been grouped together under the heading of ‘accidents and violence’ are of comparable importance in terms of years of potential life lost to coronary heart disease and malignant cancers. In women in 1981 they were more important than heart disease — rather strikingly supporting the claim that women are neglected by health education.

Figure 2 shows that the class differences for men have widened between 1971 and 1981. Because of changes in the age grouping of women’s deaths, we can not directly compare these years, but we can compare the gap between more and less privileged groups of women — and this has also widened.

The wider differences shown by the use of YPLL than those shown by the conventional mortality measure — the standardised mortality ratio (SMR) — result from the way in which deaths at younger ages add more to the total of years lost. Like the SMR, the YPLL reflects the higher mortality rates of the working class, but it also registers the extent to which death occurs prematurely — something the SMR can’t detect.

Years of potential life lost due to heart disease have fallen in white-collar workers, but not in blue-collar workers, over the period 1971 to 1981. When we look at death due to accident or violence, we see that no class experienced an improvement, and that manual groups suffered an increase.

The importance of accidental and violent death has been known for many years, and several pieces of effective preventive legislation have been enacted. But despite these measures, accidents and violence have increased in importance as a proportion of total years of potential life lost in all social classes. For social class I they account for 22% of YPLL in 1971 and 30% in 1981; for social class V the figures are 28% and 34%.

The social class gradient is steeper for deaths due to accidents and violence than for the other major causes — so although heart disease is still the most important cause of YPLL for white-collar men, accidents and violence are now the most important cause for the combined classes IV and V.

Health education messages, as well as being biased towards men, are also biased in favour of the middle class. Whenever the Department of Health is reminded of health inequalities, they point to the ‘Look after your heart’ campaign as a contribution to reducing social class differences in health. These figures show that it will not.