Most of us with an interest in equality issues have been familiar with the contours of inequality in Irish society: the huge disparity in wealth between the top 10 per cent as against the bottom 10 per cent, the inequalities in income, in education, in opportunity.
We have also been vaguely aware of inequalities in health, especially in healthcare; the differences in the services available to those on private schemes and those reliant on public health services.
I suspect that none of us even suspected the degree of systematic inequity that a new report reveals in shocking detail. Inequalities in Mortality 1989-1998: A Report on All Ireland Mortality Data is published by the Institute of Public Health in Ireland. It reveals the raw data on death rates for the major diseases that shows inequalities previously unimagined between the rich and the poor.
An average of 46,841 people a year died in the 10 years from 1989 to 1998. By far the most prevalent cause of death was diseases of the circulatory system (the heart), which accounted for 45 per cent of all deaths.
One would have thought that the incidence of heart disease would have been fairly uniform across the social spectrum or perhaps even slightly more pronounced among the better-off. The situation is quite the reverse. In both jurisdictions, the mortality rate for the lowest occupational class for all heart diseases was 120 per cent higher than in the highest occupational class. Indeed, the figures show a progressive worsening of the mortality rate for heart disease as one goes down the social ladder. Of course, lifestyle must be a factor, but access to services must be also.
An average of 4,600 people died of strokes (cerebrovascular disease) during the period, almost all over 50 years of age. The mortality rate here was 2 1/2 times higher (150 per cent) for the lowest occupational class, compared with the highest occupational class.
Nearly a quarter of all deaths in the period were caused by cancers (23.7 per cent, 11,102 on average per year). For cancer of the oesophagus, the mortality rate for the lowest occupational group was nearly 3 1/2 times (250 per cent) that of the highest occupational group; for stomach cancers it was over twice (110 per cent); for pancreas, 60 per cent more. On average, 2,400 people died each year from cancer of the larynx and trachea/bronchus/lung. The mortality rate for the lowest occupational group was nearly four times higher (280 per cent) than for the highest. The data in this category also suggest that deaths from this form of cancer is primarily an urban phenomenon, with high incidences in Dublin, Belfast, Waterford, Cork and Limerick cities.
Clearly more than lifestyle problems and problems associated with access to services are at work, most likely pollution. The figures in this and other categories show graduated worsening of mortality rates as one moves down the occupational class. There are relatively high incidences for the middle occupational classes as well. This indicates that the problem is not just one of poverty but of inequality.
The report is unrelenting in its emphasis on the inequalities at work in health. Mortality rates for infectious and parasitic diseases for the lowest occupational class are nearly five times those of the highest occupational class (poor people still die of tuberculosis: on average, 70 die each year); for endocrine, nutritional and metabolic diseases the mortality rate is nearly 3 1/2 times higher; the mortality rate for mental and behavioural disorders was more than 4 1/2 times; for alcohol abuse nearly four times; for drug abuse almost seven times; for pneumonia it was more than three times higher; for chronic lower respiratory disease it was nearly 4 1/2 times; for diseases of the diges tive system nearly three times; and for the genito-urinary system, nearly five times higher.
On average 300 people a year died from congenital malformations; chromosomal abnormalities and the mortality rate in this category for the lowest occupational group was nearly 10 times higher (930 per cent) than for the highest class.
On average 2,100 people died each year from injury or poisoning, the mortality rate for the lowest class being 2 1/2 times that of the highest. Six hundred people died on the roads each year on average, almost three times as many men as women. Again, the mortality rate for the lowest occupational class was 40 per cent above that of the highest.
The figures for suicide show that, on average, 500 people died each year by suicide, nearly four times more men than women. The phenomenon is more rural than urban and the mortality rate is almost three times higher in the lowest class than in the highest.
These mortality figures reveal not just the facts of death but the facts of life. They provide an insight into the deep levels of inequality that exist throughout lifetimes that give rise to these startling differences in mortality rates. Inequality is not just about unequal incomes and unequal wealth or unequal power or unequal opportunities. It is also about unequal lives, not just of years of life, but of quality of life and of health throughout lives.
Pity the Dail has gone off for almost three months (yeah, yeah, we know about the committees and the constituency work and all that caper.) It might have found time to address this report and the shocking inequalities it reveals had the demands of the holidays not been so pressing.
vbrowne@irish-times.ie