Socio-economic differentials in health: the role of nutrition.

Mortality differentials according to socioeconomic group have long been recognized in the UK. Engels (1845) reproduced such data, using both area-based and individual indicators of socioeconomic status (Table 1). Engels (1845) went on to quote from the Report on the Sanitary Conditions of the Working Class: 'In Liverpool in 1840 the average lifespan of the upper classes, gentry, professional men, etc, was thirty-five years; that of the business men and better-placed handicraftsmen, twenty-two years; and that of the operatives, day-labourers, and serviceable class in general, but fifteen years'. To Engels (1 845) it was obvious that deficiencies in nutrition contributed to the poor health of the labouring classes. The dependence of dietary adequacy on financial wherewithal was clear. 'The better paid workers, especially those in whose families every member is able to earn something, have good food as long as this state of things lasts; meat daily and bacon and cheese for supper. Where wages are less, meat is used only two or three times a week, and the proportion of bread and potatoes increases. Descending gradually, we find the animal food reduced to a small piece of bacon cut up with the potatoes; lower still, even this disappears, and there remain only bread, cheese, porridge, and potatoes, until on the lowest rung of the ladder, among the Irish, potatoes form the sole food'. Engels (1845) recognized that the financial disadvantages of the poor were compounded by other social factors in determining their poor diet. The payment of wages on Saturday evening meant that workers could only buy their food after the middle class had had first choice during Saturday morning. When the workers reached the market, 'the best has vanished, and, if it was still there, they would probably not be able to buy it. The potatoes which the workers buy are usually poor, the vegetables wilted, the cheese old and of poor quality, the bacon rancid, the meat lean, tough, taken from old, often diseased, cattle, or such as have died a natural death, and not fresh even then, often half decayed'. The working classes were also more liable to be sold adulterated food, because while the rich developed sensitive palates through habitual good eating and could detect adulteration, the poor had little opportunity to cultivate their taste and were unable to detect adulteration. They also had to deal with small retailers who could not sell 'even the …