Progress and the Lack of Progress in Addressing Infant Health and Infant Health Inequalities in Ireland during the 20th Century

By McGovern, Mark E. | Journal of the Statistical and Social Inquiry Society of Ireland, Annual 2016 | Go to article overview

Progress and the Lack of Progress in Addressing Infant Health and Infant Health Inequalities in Ireland during the 20th Century


McGovern, Mark E., Journal of the Statistical and Social Inquiry Society of Ireland


Abstract There is a growing literature which documents the importance of early life environment for outcomes across the life cycle. Research, including studies based on Irish data, demonstrates that those who experience better childhood conditions go on to be wealthier and healthier adults. Therefore, inequalities at birth and in childhood shape inequality in wellbeing in later life, and the historical evolution of the mortality and morbidity of children born in Ireland is important for understanding the current status of the Irish population. In this paper, I describe these patterns by reviewing the existing literature on infant health in Ireland over the course of the 20th century. Up to the 1950s, infant mortality in Ireland (both North and South) was substantially higher than in other developed countries, with a large penalty for those born in urban areas. The subsequent reduction in this penalty, and the sustained decline in infant death rates, occurred later than would be expected from the experience in other contexts. Using records from the Rotunda Lying-in Hospital in Dublin, I discuss sources of disparities in stillbirth in the early 1900s. Despite impressive improvements in death rates since that time, a comparison with those born at the end of the century reveals that Irish children continue to be born unequal. Evidence from studies which track people across the life course, for example research on the returns to birthweight, suggests that the economic cost of this early life inequality is substantial.

Keywords: Infant Mortality, Early Life Conditions, Inequality

JEL Classification: I10, J10

1. INTRODUCTION

The lives of a country's children are a national asset (Millin, 1917). The welfare of young people is not only an indicator of a country's achievements, but also a marker for the future. A measure such as infant mortality is an important policy outcome because minimising the amount of lives lost is not only a goal in its own right, but also a reflection of other characteristics of a successful state, such as economic development, nutritional intake, access to education and healthcare, and the status of women. However, infant mortality is also an input because it reflects the underlying conditions that each cohort is exposed to as they grow up. Surviving children who are allowed to reach their full potential are best placed to make the most contribution to society in the future (Heckman and Masterov, 2007). Exposure to adverse conditions in early life, particularly excess mortality, reflects poorly on the organisation and management of a country, but can also harm future progress by impacting on both human and physical capital accumulation. Macro-level economic and social development depends on the productivity and labour force participation of future cohorts. Therefore, knowledge of the historical evolution of the mortality and morbidity of children can inform our understanding of past successes and failures, but also provide an insight into the current distribution of wellbeing in a population. The environment experienced at birth among those who grew up in the first half of the last century in Ireland likely has a continuing influence on those individuals and the country as a whole.

Motivated by these observations, the goal of this paper is to provide a survey of the health of children and infants born in Ireland during the 20th century. This country is a particularly interesting case study because of the historical patterns it experienced in early life conditions. I focus mainly on measures of mortality because they are the most readily available health statistics in historical data, and have been widely used as a more general proxy for the environment faced in early life, facilitating comparisons with other countries. These comparisons allow us to benchmark Irish performance, and in fact Ireland preformed favourably during the latter part of the 19th and early 20th centuries, with a lower rate of infant deaths than many of our neighbours, including England. …

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