Poverty as a Cause of Ill-Health

One from the TARA Vaults at TCD - A study by Dr. James Deeny (with collaboration from Roy Geary).

POVERTY AS A CAUSE OF ILL-HEALTH
By JAMES DEENY, M.D., M.Sc., D.P.H., M.R.C.P.I.
(With Discussion.)
(Read on Friday, 31 si May, 1940.)

The paper begins with some overview remarks on the importance of considering broader aspects of health. These are certainly not hollow reflections as Deeny was centrally involved in the major health transitions in Ireland in the mid 20th century. Much of his research work involved the statistical advice of Roy Geary, after whom this Institute is named. 

Anyone engaged in general medical practice soon appreciates the influence of environment on health. It also becomes clear that so long as social and industrial conditions are allowed to remain as they are, medicine is merely a routine matter of treating disease as it occurs. A better attempt should be made to deal with the real factors responsible for ill-health—the social and economic causes

This study is one of a series of studies conducted by Deeney in the 1930s and 1940s. In this study, he examines socioeconomic variations in the health of 205 women working in the linen trade in Lurgan. Income is calculated using a simple household equivalence method and the health of different income groups is analysed using a wide variety of anthropometric and biological markers of health. The paper documents positive correlations of health with income across a wide range of variables, but with generally low health even among the upper income groups. Deeny particularly notes income gradients in posture, hair quality, number of teeth, respitory conditions, cardiac abnormalities and enlarged thyroid. He leans towards the view that low income reduces nutritional intake and that this is the direct causal effect at play:

It is apparent that unemployment is largely responsible and that the amount received as unemployment pay is insufficient to provide for their needs. Among the poorer women the amounts spent on milk, meat and eggs considered in association with the symptoms of vitamin deficiency displayed, makes it plain that their diets do not contain sufficient protective foodstuffs. This leads to an increased incidence of sickness. Deficiency of iron in the diet and the loss of blood at frequent confinements is probably responsible for the anaemia. The most serious clinical condition found was the marked anaemia of the poorer woman. The greater prevalence of many conditions definitely due to malnutrition in the poorer groups and their improvement with increased income shows plainly that malnutrition caused by poverty is the cause of their ill health.

Ruth Barrington, in her introduction to "End of an Epidemic" a collection of Deeny's papers, argues that the results of the study were influential in the trade union movement's insistence on better health conditions for workers and in the development of nutrition communication in Northern Ireland.

Those of us interested in measuring income and expenditure will be interested in one of the comments from Deeney in his wrapping up:

If it had been possible to continue the work, he had intended to do a series of family budget estimations. They were difficult to do properly, and there were many pitfalls to be avoided. In a survey such as this, the account-book method, in which housewives entered their purchases, was best. He favoured the investigation of a small number of households, say, between thirty and forty, and the books should be kept for at least one month.