What evidence does Public Health England possess which demonstrates beyond any reasonable doubt a causal link between lower socio-economic status and higher infant mortality rates?

Public Health England did not have the information requested.

Dear Public Health England,

I should be grateful if you'd provide factual evidence (ie not opinion) that lower socio-economic status causes higher infant mortality.

There's a widespread belief that lower socio-economic status is to blame for higher infant mortality, as seen from the following extract from the decision letter by John Woolcock in respect of his decision to overturn the refusal of planning permission for Veolia's incinerator at Harlescott, Shrewsbury:

John Woolcock, the Inspector at the 2011 public inquiry into Veolia’s appeal, wrote the following on pages 26 & 27 of his decision document in Jan 2012:

“Mr Ryan submitted a number of maps documenting mortality rates upwind and downwind of incinerators, and health statistics for localities near incinerators and power stations. However, no reliable inference can be drawn from this data. A whole host of possible confounding factors exist. These are other causes of the adverse health effect of interest, and they preclude any reasonable conclusions about likely cause and effect in the evidence adduced by Mr Ryan. Chief amongst these is socioeconomic status, for which there is much evidence as to its importance as a predictor of state of health. This is a very complex area which would require detailed epidemiological studies to provide any meaningful analysis of the Office of National Statistics data and other statistics submitted by Mr Ryan.”
(Appeal Decision APP/L3245/A/11/2146219)

Mr Woolcock opined that socioeconomic status is an important predictor of state of health and yet Kensington & Chelsea, one of the wealthiest London Boroughs, had the highest 1965-67 infant mortality rate of all 32 London Boroughs at 23 per 1,000 live births, whilst less wealthy Boroughs had very low rates with Harrow and Hillingdon having the joint-lowest rate at 13 per 1,000 live births.

The 1965-67 infant mortality rates for London Boroughs listed below is relevant to my question as the five Boroughs with the highest rates all form a single group, which would have been heavily exposed to emissions from Battersea Power Station, whilst the Boroughs with lowest rates are around the Boundary of Greater London, where there would have been less exposure to emissions from Battersea Power Station.

London boroughs 1965-67

Infant deaths per 1,000 live births
(ONS data)

Kensington and Chelsea 23
Lambeth 22.3
Wandsworth 21.3
Camden 20.7
Westminster, City of 20.7
Hackney 20.3
Greenwich 20
Lewisham 20
Brent 19.7
Islington 19.7
Ealing 19.3
Newham 19.3
Southwark 19
Hammersmith 18.7
Waltham Forest 18.7
Haringey 18.3
Tower Hamlets 18
Barking 17.3
Merton 17
Hounslow 16.7
Croydon 16.3
Redbridge 16.3
Richmond upon Thames 16.3
Enfield 16
Bromley 15.3
Havering 15.3
Sutton 15.3
Kingston upon Thames 15
Bexley 14.7
Barnet 14
Harrow 13
Hillingdon 13

Your June 2015 report lists the 2010-2012 infant mortality rates for all London Boroughs in descending order on page 5 as follows:

Harrow 5.9
Enfield 5.8
Lambeth 5.5
Waltham Forest 5.5
Hackney 5.4
Tower Hamlets 5.3
Lewisham 4.7
Brent 4.7
Newham 4.7
Havering 4.7
Merton 4.5
Hounslow 4.4
Camden 4.2
Greenwich 4.2
Southwark 4.2
Barking 4
Hillingdon 4
Haringey 3.9
Croydon 3.9
Wandsworth 3.8
Westminster, City of 3.8
Hammersmith 3.8
Redbridge 3.8
Kingston upon Thames 3.6
Ealing 3.5
Kensington and Chelsea 3.1
Barnet 3
Richmond upon Thames 2.7
Bexley 2.6
Sutton 2.3
Islington 2.2
Bromley 1.9

https://www.gov.uk/government/uploads/sy...

Page 4 of the above report has a graph with the title "Infant mortality shows a socioeconomic gradient", which suggests a belief that low socioeconomic status is causing higher infant mortality and yet that theory obviously couldnt have applied in London during 1965-67 when exposure to air pollution from Battersea Power Station couldn't be dissociated from having a causal effect and neither was it applicable in London with the 2010-2012 infant mortality rates when Boroughs exposed to emissions from incinerators, such as Harrow, Enfield, Waltham Forest etc. had high rates.

The above report also has the following on page 20:

"Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services."

Professor Frederica Perera is a world-renowned expert on air pollution and was awared 250,000 dollars by the Heinz Foundation last year. The following extract is from the Pittsburg Post-Gazette of 18 May 2015:

"Dr. Perera’s research tracked the pre- and post-natal health of 720 mother-child pairs in New York City.
She found that in addition to causing infant mortality, low birth weight, allergies, asthma, slower brain development and respiratory illnesses, there is also a correlation between exposure to air pollutants and childhood obesity.
“Exposure to endocrine disruptors in the air can alter the normal hormonal signalling and affect growth and development, so there is a tendency for some children to become more obese,” said Dr. Perera who reviewed the findings of that study, first reported in 2013, at one of four public presentations by Heinz Award winners on Wednesday in Pittsburgh."

http://www.post-gazette.com/news/environ...

Yours faithfully,

Michael Ryan

FOI, Public Health England

1 Attachment

Please find attached PHE's response to your request for information

Regards

FOI Team

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Dear Public Health England,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of Public Health England's handling of my FOI request 'What evidence does Public Health England possess which demonstrates beyond any reasonable doubt a causal link between lower socio-economic status and higher infant mortality rates?'.

Your reply avoids admitting no evidence and fails to provide evidence and therefore doesn’t form an adequate response.

Your reply of 28 January 2014 (Your ref: 04/01/lv/473) contains the following which shows that some effort must have been made before admitting an inability to establish “clear causality between economic status and infant mortality”:

“It is difficult to establish clear causality between socio-economic status and infant mortality; however, many of the factors known to influence foetal development and health are also linked with socio-economic status.”

The association between infant mortality and socio-economic status began with Dr William Farr (1807-1882), who was Superintendent of the Statistics Department at the Registrar General’s Office.

Dr Rosemary Geller wrote the following about Dr Farr:

“He described the close relationship between socio-economic status and infant mortality and used statistics of health to help define social class in England and Wales. The five social classes he defined have become the major criteria for research on the need for social intervention…..”
(Making the Connections: Annual Report of the Directot of Public Health for Shropshire, 2001)

Dr Farr didn’t consider the impact of air pollution on mortality rates, nor on the fact that “the poor” have little choice where they live or work, but he and his colleagues should have realised the importance of air pollution on mortality from the following in the 1858 report by the Registrar-General Scotland:

“In Glasgow there died 13.08 children out of every 100 living under five years of age; in Aberdeen the mortality was only 4.83 out of 100 children. From whatever cause or causes it may arise, infantile mortality is nearly three times greater in Glasgow than in Aberdeen, and consequently Glasgow is a much more unhealthy town than Aberdeen; for it has been proved that, as a general rule, “the less the proportion of deaths among children under five years, the greater is the healthiness of a town or locality.” The report, in stating the causes of death, shows that the deaths from consumption were much greater in the towns than in the country districts, and that among the towns the lowest proportion was in the more exposed, and, therefore, better ventilated towns, such as Edinburgh and Aberdeen.”

(The Vital Statistics Of Scottish Towns. The Times, 28 February 1859)

A full history of my FOI request and all correspondence is available on the Internet at this address: https://www.whatdotheyknow.com/request/w...

Yours faithfully,

Michael Ryan

FOI, Public Health England

Public Health England acknowledges your request.

FOI team

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Dear FOI,

I draw your attention to the following two sentences by Debbie Abrahams MP:

“We know from national statistics that there is a fivefold difference in the infant mortality rates between the lowest and highest socioeconomic groups. There is not a law of nature that says that children from poor families have to die at five times the rate of children from rich families.”

(Debbie Abraham MP, Hansard, 23 February 2016, Volume 606, Col 202)

https://hansard.digiminster.com/Commons/...

Yours sincerely,

Michael Ryan

FOI, Public Health England

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Dear Mr Ryan

Please find attached Public Health England's response to your request for information.

Kind regards

Freedom of Information Officer

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