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The Life Project:
The Extraordinary Story of Our Ordinary Lives
by Helen Pearson
Seventy years ago, we had no idea that smoking in pregnancy stunts a baby's growth, that diabetes starts developing in the body years before the illness is evident, that warm, involved parenting can be a significant compensation for being born into disadvantaged homes, or that summer-born children are more likely to be bullied, dislike school and fall behind in class than their autumn-born peers.
That we now know these facts, and myriad other intriguing correlations and causations that illuminate our lives, is due to a series of half-a-dozen little-known studies - the oldest of them the longest-running study of human development in the world - that have been quietly tracking the lives of batches of Britons since just after the Second World War. These surveys have, as the science journalist Helen Pearson shows in this intriguing book, 'changed the way we are born, schooled, parent and die, and irrevocably altered our understanding of inequality and health'.
The studies didn't start out with these ambitions. The first, collecting facts about every baby born in England, Scotland and Wales in a single week in 1946, was intended simply as a maternity survey. British scientists were worried about Britain's falling birth rate, and set out to discover whether it was the pain, the cost or the difficulty of child-rearing that was putting mothers off. Every eligible mother was seen by a health visitor and asked if she worked, whether she had any servants, her husband's occupation, the number of rooms in her home, the number and ages of children living and dead, and every cost associated with the baby's birth. Some 91% (13,687 women) took part.
It took two years for the man running the survey, a doctor called James Douglas, to process the data and publish it. By the time he did, falling fertility was no longer an issue. The late 1940s saw the start of the postwar baby boom. Douglas's evidence highlighted something different and equally worrying: the extent to which Britain was divided by class.
Babies in the lowest class were 70% more likely to be born dead than those at the top. Working-class mothers, in those pre-NHS days, had much less medical attention than richer ones and suffered more at birth because they were less likely to be offered pain relief. Well-off women tended to spend two weeks in hospital: poor ones to give birth in the (free) family bed, and be doing housework again two days later. The total costs were much higher than anyone had realised - richer mothers spent almost £50 on medical fees and layettes; farm labourers' wives half that. Each amounted to some six weeks of the family income; way more than the government's £2 maternity grant.
Just as the survey came out, so did an apparent solution. The new welfare state was expected to mend many of Britain’s social divisions. Douglas and his colleagues had a brainwave; if they could track the 1946 children, following everything from their diets and their home lives to their education, they would learn how far political reforms could transform lives.
By the mid-1950s it was grimly clear: class was still destiny for this generation. The poor were shorter and smaller, more likely to get ill and more likely to die. Might the children of 1958, born long after the world wars and rationing, be different? That was the start of a sequence of studies; national surveys of children born in 1958, 1970, 1991 and the millennium, and a local study in Bristol from 1982. As Pearson finds, each struggled to find and keep funding, they all ran on a shoestring, and all produced immensely valuable discoveries no one could have predicted when they started.
It is the cohort studies that have shown the lasting impact of divorce: the children of break-ups are more likely to become adults who are ill, unemployed, mentally troubled, poorer and in unstable relationships themselves. But there are important nuances. Wealth protects. And because the scientists had been tracking these people all their lives, they were able to see that behaviour was affected long before the divorce itself; it might be the conflict and not the separation that matters.
Health has been a revelation. Breast-feeding and eating fish in pregnancy boost IQ years later. Babies who are small at birth tend to develop high blood pressure in middle age, not because of lifestyle, but possibly because a foetus deprived of nutrition 'ends up building its heart on the cheap'. Bigger babies are liable to have better cognition and muscle strength as adults, even accounting for social class. Children who are late to stand or walk have a higher chance of schizophrenia.
More recently, as the 1946 cohort reaches 70, three simple tests taken at 53 have turned out to be remarkable predictors of an early death. Members were measured on how strong their hand grip was, how quickly they could stand up from a chair 10 times in a row and whether they could balance on one leg with their eyes closed for 30 seconds. Those who did poorly died younger than the rest, even when factors such as an unhealthy lifestyle were taken out. Those who could complete none of the tests had a mortality rate 12 times higher than the top performers.
Obesity has been another surprise. The members of the first three cohorts all saw their rates of overweight and obesity start to climb abruptly in the mid-1980s, whether they were teenagers or fortysomethings. Something in the British lifestyle at that time - car ownership, greater wealth or changing diets - produced a radical and unwelcome change.
Class has remained a barrier. The cohort studies demonstrated that poor, clever children have been overtaken by rich, dim children by the age of three, and that, despite all the efforts to overcome it, the social-class gulfs in achievement evident at five are wider at 16. And so far the children of 1958 have been more socially mobile than those of 1970.
Pearson's fine, detailed book makes an eloquent case for the continued creation and proper funding of cohort studies. Nothing else can so effectively explain the experience of a generation or expose the worth of policy. Yet the existing studies live in constant fear of being wound up, and are always a grant application away from closure. And the latest one, due to start in 2015, has stalled, possibly fatally. The problem wasn't money (the government had given generously), but public will. Each successive cohort has found its participants less and less willing to take part in something of no clear benefit to themselves. The 1946 group had a strong sense of duty, and few have dropped out. The 2015 study hoped to recruit 16,000 mothers in the first 18 months, but only 249 signed up. The disappointed organisers are now trying to think again. I hope for all our sakes that they succeed.
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