The spirits of Christmases past have a strong influence on our health today

December 20, 2000

Using maps of poverty, made over 100 years ago, researchers in this week's Christmas issue of the BMJ, show that there has been little change in the distribution of poverty in inner London between the 19th and 20th centuries. They suggest that the key message of Dickens's A Christmas Carol -- that redistribution of wealth reduces inequalities in health - is as relevant today as when it was written over 150 years ago.

Data from a comprehensive survey of inner London in the years leading up to 1896 were digitised and matched to contemporary local government wards to compare patterns of social deprivation and mortality. On the whole, affluent places have remained affluent and poor places have remained relatively poor, say the authors, and the longer people spend both in poverty and in poor places, the earlier they tend to die. The maps also show that, despite overall improvements, 100 years of policy initiatives have had almost no impact on the patterns of inequality in inner London and on the relationship between people's socioeconomic position and their relative chances of dying.

Dickens advocated redistribution of wealth at the end of his tale, say the authors. More recently it has been suggested that greater income equality is beneficial for the health of the whole population -- including the relatively affluent -- not just for those who are badly off. They conclude that inequalities in health are likely to persist without as fundamental change in social attitudes as that which Scrooge experienced at the end of A Christmas Carol.

"A merrier Christmas, Bob, my good fellow, than I have given you for many a year -- I'll raise your salary, and endeavour to assist your struggling family ... Scrooge was better than his word. He did it all, and infinitely more; and to Tiny Tim, who did NOT die, he was a second father. His own heart laughed: and that was quite enough for him."
Contacts: Danny Dorling, Professor of Quantitative Human Geography, School of Geography, University of Leeds, UK Tel: +44 (0)113 233 3347 Fax: +44 (0)113 233 3308 Mobile: 0370 766 450 Email:

Richard Mitchell, Research Fellow, School of Geography, University of Leeds, UK Mobile 07976 814 833 Email:

Mary Shaw, Research Fellow, School of Geographical Sciences, University of Bristol, UK Tel: +44 (0)117 928 9000 ext. 3843 Mobile: 0771 436 4901 Email:

(The Ghost of Christmas Past: health effects of poverty in London in 1896 and 1991) BMJ Volume 321, pp 1547-1551

This release is reproduced verbatim and with permission from the British Medical Association as a service to reporters interested in health and behavioral change. Please contact Public Affairs Division for the text of the paper, and the authors direct for further comment. For further information about The British Medical Journal or to obtain a copy of the article, please contact Public Affairs Division, British Medical Association, BMA House, Tavistock Square, London WC1H 9JP, Tel: 020 7383 6254 or email: After 6 p.m. and on weekends telephone: +44 (0)208 241 6386 / +44 (0)208 997 3653/+44 (0)208 674 6294 / +44 (0)1525 379792 / +44 (0)208 651 5130.

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