A Survey of the Mortality in Dr Farr's 63 Healthy Districts of England and Wales During the Period 1851–1925

Extract

1. Farr's 63 healthy districts are, as a whole, representative of the stationary districts of England and Wales, i.e. those districts in which growth or decline of industry has, on the whole, been absent and in which mortality rates are consequently free from the influence of industrialisation, though not necessarily unaffected by urbanisation.

2. These healthy districts maintained, until 1901–10, the advantage they held over England and Wales as regards their relative death rates in 1851–60.

3. From 1851–60 to 1901–10 the death rate of the healthy districts remained roughly constant at 76 per cent, of the death rate of England and Wales. Both improved their total death rate to the extent of 30 per cent, of what it was in 1851–60, the rates for this decennium being—England and Wales 21·17, healthy districts 16·13 per 1000.

4. The population of the healthy districts has been unfavourably constituted for a low death rate throughout the period.

5. That the periods during which the most improvement was made in lowering the death rate—not only in the healthy districts, but in England and Wales as a whole—were 1881—90 and 1901–25.

6. By 1921–5 the position of the healthy districts had become a little less favourable, their death rate having risen from 76 to 86 per cent, of that of England and Wales. It is quite possible, however, that this is due, not so much to a falling-off in the rate of improvement in the healthy districts, as to an exceptional increased improvement in backward, very unhealthy districts.

7. For the following diseases, the healthy districts show improvement at faster rates, of varying degrees, than England and Wales as a whole, during the period 1851–1925. Measles, scarlet fever, whooping cough, diphtheria, pulmonary tuberculosis, and respiratory diseases.

On the other hand, the data relating to diarrhoea seems to indicate less improvement, though inherent deficiencies in the data make this a matter open to doubt.

The death rate from cancer, which has increased considerably in the whole country during the last forty years, appears to have increased at a slightly faster rate in the healthy districts.

But, as discussed in the report, the untrustworthiness of the data, relating to comparisons of individual disease death rates over long periods of time, make it essential to regard the points enumerated in conclusion 7 rather in the manner of interesting possibilities than as proven facts.

8. When the 141 administrative areas, which in 1920–5 corresponded to Dr Farr's original healthy districts, were classified as to whether the majority of their occupied persons worked in other districts or in their own district, the standardised death rates found were as follows:

I. Districts in which 50 per cent, of occupied persons work in other districts. Death rate = 10·55 per 1000.

II. Districts in which more than 50 per cent, of occupied persons work within the district. Death rate = 9·90 per 1000.

When the second of these classes is sub-divided according to whether 50–75 per cent, or over 75 per cent, of occupied persons work within the district, the death rates are:

(a) 50–75 per cent, of occupied persons working within the district. Death rate = 9·69 per 1000.

(b) 75–100 per cent, of occupied persons working within the district. Death rate = 10·14 per 1000.

When the same class is sub-divided according to whether the majority of workers are engaged in non-agricultural or agricultural pursuits, the death rates in each sub-class are:

(a) Mainly non-agricultural. Death rate = 9·85 per 1000.

(b) Mainly agricultural. Death rate = 9·98 per 1000.