Healthy districts

Edward Higgs

In the nineteenth century the General Register Office (GRO) was at the forefront of the public health movement. The GRO was responsible for administering the system in England and Wales for the civil registration of births, marriages and deaths, the latter including cause of death. The GRO received duplicate death certificates from the local registrars of births, marriages and deaths, on the basis of which it published statistics on mortality for defined administrative areas in the Annual report of the Registrar General (Higgs, 1–89). The most important statistic was perhaps the 'death rate', the number of deaths in an area in a year per thousand population. The death rate allowed mortality in differing places to be compared, so that Victorians could see which were unhealthy places (mainly in the cities), and which were relatively healthy (mainly in the countryside). This would then provide ammunition for local public health reformers to push for improvement in sanitation and housing standards (Szreter).

But if this information was to be used for propaganda purposes the question inevitably arose as to what was the desirable level of mortality, anything above which could be regarded as preventable, and thus unnecessary. Under the 1848 Public Health Act, local authorities could be compelled to establish health boards to implement local sanitary reform if their annual mortality rate was over 23 per thousand, the national average as measured by the GRO. But William Farr (1807-1883), the GRO's medical statistician from 1839 to 1879, pushed this further in the 1850s by developing the concept of the mortality of 'Healthy Districts', which responsible local authorities should try to match. This was based on a set of 63 registration districts, mostly rural, which made up 10 percent of the national population, and had a crude death rate below 17 per thousand (Eyler, 71–2; Szreter, 439).

Farr took the Healthy District rate to be the 'standard' mortality, and castigated places where the mortality rate was in excess of 17 per thousand. Thus, in his 'Letter to the Registrar General' appended to the Annual report for 1857, Farr claimed that:

On average, 57,582 persons died in London annually during the five years 1849–53, whereas the deaths should not, at rates of mortality then prevailing in certain [healthy] districts of England, have exceeded 36,179; consequently 21,403 unnatural deaths took place every year in London. It will be the office of the Boards of Works to reduce this dreadful sacrifice of life to the lowest point, and thus to deserve well of their country' (Twentieth annual report of the registrar-general, 175).

Farr calculated 'degrees of insalubrity' for town districts, each degree representing 1 death per 1,000 above the healthy district rate, and later produced life tables showing the 'excess' mortality in certain districts by age (Supplement to the Registrar General's twenty-fifth annual report, xvi-xvii).

John Tatham, the GRO's superintendent of statistics from 1893 to 1909, developed Farr's work. In the Decennial supplement to the annual reports of the Registrar General, covering the decade 1881 to 1890, Tatham pointed out that mortality rates had so improved since Farr's time that 25 percent of the population now lived in districts in which the crude death rate was below 17.5 per thousand, and 4.5 percent lived in districts in which the death rate did not reach 15 per thousand. He calculated a life table based on a new healthy districts rate of 15 per thousand derived from the mortality experience of 263 districts with a mean aggregate population of 4,606,503 persons, or about one sixth of the whole population. This then became the 'standard' against which mortality in specific districts was compared (Supplement to Registrar General's fifty-fifth annual report. Pt.II, ciii).

REFERENCES

John M. Eyler, Victorian Social Medicine. The Ideas and Methods of William Farr (London, 1979).

Edward Higgs, Life, death and statistics: civil registration, censuses and the work of the General Register Office, 1837–1952 (Hatfield, 2004).

Simon Szreter, 'The GRO and the public health movement in Britain 1837–1914', Social History of Medicine, 4 (1991), 435–64.

Supplement to Registrar General's fifty-fifth annual report. Pt.II, BPP 1897 XXI (C.8503) [View this document: Supplement to registrar-general's fifty-fifth annual report. Pt.II]

Supplement to the Registrar General's twenty-fifth annual report, BPP 1865 XIII (3542). [View this document: Supplement to registrar-general's twenty-fifth annual report]

Twentieth annual report of the Registrar General (1857), BPP 1859 Session 2 XII (2559). [View this document: Twentieth annual report of the registrar-general ]