Wednesday, 2 December 2009


Recently, there has been more media interest in mortality rates in UK NHS hospitals. The reasons may not be obvious to everyone. We know that dead people do not pay taxes. Government lives of taxes but it also has to make sure that NHS performs. Government has seen a dramatic fall in taxes due to many reasons some of which are due to unemployment.

Statistical arguments are flying around about the mortality rates in some NHS hospitals. A little about the history:

Babylonians, Egyptians and the Chinese were the first ones to use statistics to determine the taxes. Romans and Greeks also conducted censuses.

In Christian times clergy took on the role of counting people. In Florence beans were used: black for boys, white for girls.

However, as we know sooner or later we all run out of beans.

Estimates have been used at times to predict the population in England eg by Gregory King in England in 1695. This was necessary in order to estimate the forthcoming taxes.

Thomas Cromwell, Lord Chancellor to King Henry VIII (1491-1547) ordered clergy in every English parish to record baptism, weddings and funerals. The result was predictable: some people disappeared from the register. Faith is one thing and purse another. Having such discriminatory powers has been life saving for some people to present day.

John Graunt (1620-1674), a merchant , used parish records to write "Natural and Political Observations upon the London Bills of Mortality". His friend was one called William Petty who invented the expression : "political arithmetick" to describe the work. Graunt used mercantile bookkeeping method and Francis Bacon's Natural History to derive his method.

The Life Table or Table of Vitality was constructed at the suggestion of John Graunt in 1693 by Edmond Halley (1656-1742) who is, of course, famous for his comet.

When the country is at war the coffers are emptied quickly as generally speaking people are not too keen to go into the battlefields and die but can be lured by cash. When king has to borrow the money to fight wars it is important to know what money from taxes will be coming in. Thus estimates based on population size and mortality rates can become very important. It is like like getting an overdraft from a banker because one knows what would be coming in. The banker likes the security.

Mortality rates have been complicated by other factors such as manipulation of data. Florence Nightingales observed that some hospitals discharged terminally ill people to other hospitals and it gave worse mortality rates to the second hospital where patients died within days. Patients can be discharged to die at home or in hospice. All of these methods can improve hospital mortality rates.

Poor people also have worse medical treatment for a number of different reasons. One is that they have limited resources to fight injustice. They do not have the choice to find the best doctors and keep them. The system does not allow it.

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