Poverty's lifelong damage

December 2, 2016

In the early 1970s, about 30 percent of American women and more than 40 percent of British women smoked, even when pregnant. My Lamaze childbirth instructor, a heavy smoker, often held her nursing baby with one hand and her cigarette with the other. And why not? As Helen Pearson points out, “The leading scientific journal Nature said [in 1973] that cigarettes had the double bonus of helping expectant mothers calm their nerves and not gain excessive weight. For this reason, any pressure to stop them smoking was misguided and could backfire by worsening their health.”

Nowadays only 9 to 11 percent of American and British women smoke while pregnant, and most of them feel guilty. Part of the change is due to a series of cohort studies done in Britain. Even before the Nature article blew smoke, a writer in the British Medical Journal had used one of those studies to infer a clear causal link between smoking and infant mortality. A popular tabloid newspaper took notice. “Mums’ cigs killed 1,500 babies,” screamed a front-page headline in the Sun, and the campaign to discourage pregnant women from smoking was on.

Pearson’s book tells the story of five amazingly successful British cohort studies that, over the last 70 years, have tracked some 70,000 people. These studies have generated a massive collection of data that has changed the world’s understanding of infant mortality, breastfeeding, early childhood development, chronic diseases, and—above all—the deep, ineradicable scars of growing up poor.

Pearson, whose prose is both entertaining and clear, carefully defines her terms. A cohort is “a group of people with something in common,” such as their date of birth. The U.K.’s first major cohort study looked at a group of the very earliest Baby Boomers—children born in the first week of March 1946. It began as a survey, which, like a snapshot, is “a picture of a crowd as if it were frozen at that instant in time.” It later turned into a longitudinal study, which looks at the cohort repeatedly over time.

The first longitudinal cohort study was led by James Douglas, an Oxford-trained physician who spent several months delivering babies in London’s squalid East End (think Call the Midwife, but 20 years earlier, when conditions were even worse). “By helping to reduce infant mortality,” Pearson writes, Douglas hoped to prevent the ill-health and tragedy he had seen “and perhaps to smooth out some of the gaps between rich and poor.”

What Douglas found, Pearson says, was “a country divided by class.” In his 1948 report, Maternity in Great Britain, Douglas noted: “The babies in the lowest class were 70 percent more likely to be born dead than those in the most prosperous.”

But those 17,000 Douglas babies, as the first cohort came to be known, arrived at a propitious time. The National Health Service, inaugurated when they were two years old, provided them with free medical care. The 1944 Education Act offered free schooling from preschool through university. The expanding welfare state supplied free school lunches.

How would these reforms affect their lives? Five cohort studies—in 1946, 1958, 1970, 1991, and 2000–2002—aimed to find out. A bevy of workaholic re­searchers investigated families’ income, occupations, living conditions, and diet. They inquired about children’s height, use of time, reading habits, and bedtimes. They looked at air pollution, schools, single parents, and dental care. They collected and preserved 9,000 placentas and 1.5 million biological samples for future study. And they confirmed Douglas’s original intuition, that underlying nearly all negative findings—high infant mortality, slow growth, low school performance, chronic illness, poor social and emotional development—is one persistent factor: poverty.

Scholarly discoveries, alas, do not necessarily appeal to politicians, as a researcher learned when asked to pre­sent her results to the Department of Health and Social Security.

“OK, so we’ve read your findings,” [the senior civil servant] said. “Now what do you think is the most important policy message?”

“Well, quite clearly,” [the re­searcher] replied, “the main area for policy re­form is poverty.”

[The senior civil servant’s] eyes glazed over. “Oh, well, yes of course we know all that,” he said. “But, given that’s not going to happen, what would you recommend?”

Studies that cost lots of money—no matter how beneficial their results—do not necessarily appeal to politicians either. “Ever since their inception,” Pearson writes, “these valuable studies have always teetered on the brink of extinction—either through lack of money, or through the shifting winds of scientific fashion and political support.” Prime Minister Margaret Thatcher, for example, viewed the social sciences “as a hotbed of left-wing ideals to which she was politically opposed.” Her secretary of state for industry told a meeting of scientists, “I’ll start funding your research when you start telling me things I want to hear.”

Despite the government’s frequent indifference, the researchers persisted, working long days and often nights to accumulate a body of data that no other nation has been able to equal. (The U.S. Congress authorized a cohort study in 2000, but it was aborted 14 years and $1.3 billion later.) Thanks to the British cohort studies, we now know beyond a shadow of a doubt that poverty and inequality have dire lifelong consequences persisting from one generation to the next. And yet, in both the U.K. and the United States, the gap between rich and poor continues to widen.

Over a century ago, Pearson writes, the British historian R. H. Tawney made this observation: “The continuance of social evils is not due to the fact that we do not know what is right, but that we prefer to continue doing what is wrong. Those who have the power to remove them do not have the will, and those who have the will have not, as yet, the power.” Apparently the will and the power are still lacking.