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Health inequality in Britain before 1750

Kendall, Ellen J.; Brown, Alex T.; Doran, Tim; Gowland, Rebecca; Cookson, Richard

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Tim Doran

Richard Cookson


Background This study examines the claim that social inequality in health in European populations was absent prior to 1750. This claim is primarily based on comparisons of life expectancy at birth in England between general and ducal (elite aristocrat) social classes from the 1550s to the 1870s. Methods We examined historic childhood mortality trends among the English ducal class and the general population, based on previously published data. We compared mid-childhood to adolescent mortality (age 5–14) and early-childhood mortality (age 0–4) between the ducal class and the general population from the 17th to 19th centuries. Results Prior to 1750, ducal early-childhood mortality was higher than the general population. However, mid-childhood to adolescent mortality was lower among the ducal class than the general population in all observed periods for boys, and almost all periods for girls. Among the ducal class, but not the general population, there was a sharp decline in early-childhood mortality around the 1750s which may partly explain the divergent trends in overall life expectancy at birth. Conclusion Health inequality between the ducal class and general population was present in England from the 16th to mid-18th centuries, with disadvantages in mortality for ducal children in infancy and early childhood, but survival advantages in mid-childhood and adolescence. These opposing effects are obscured in life expectancy at birth data. Relatively high early-childhood mortality among ducal families before 1750 likely resulted from short birth intervals and harmful infant feeding practices during this time.


Kendall, E. J., Brown, A. T., Doran, T., Gowland, R., & Cookson, R. (2021). Health inequality in Britain before 1750. SSM - Population Health, 16, Article 100957.

Journal Article Type Article
Acceptance Date Nov 3, 2021
Online Publication Date Nov 16, 2021
Publication Date 2021-12
Deposit Date Jan 26, 2022
Publicly Available Date Jan 28, 2022
Journal SSM - Population Health
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 16
Article Number 100957
Public URL


Published Journal Article (3.4 Mb)

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Copyright Statement
This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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