Morbidity, Mortality, and Marginalization: An Intersectional Investigation of Respiratory Stress and Differential Frailty in Industrial-Era England

Respiratory disease affects more than one billion people today, particularly in urbanizing areas of low- and middle-income countries due to overcrowding, air pollution, poor sanitation, and differential access to life-sustaining resources. We can look to the past to understand the social, economic, and environmental factors that influence respiratory disease burden among urban dwellers because conditions in the urbanizing areas of antiquity mimic those observed in lower- and middle-income countries today. This study explored the impact of classism, sexism, and regional inequalities on respiratory disease burden among urban dwellers with differing levels of social and economic marginalization in England during the Industrial Revolution (AD 1700-1857). Individuals over 18 years at death from four skeletal samples (Coach Lane, New Bunhill Fields, St. Bride’s Fleet Street, and St. Peter’s Church) were examined for skeletal evidence of chronic maxillary sinusitis (CMS) and pleural disease (rib PNB). Skeletal data were combined with historic mortality records to estimate (1) the probability of presenting CMS and rib PNB and (2) age-at-death among those with these lesions using hierarchical Bayesian modeling. Estimates were compared between intersectional groups defined simultaneously by biological sex, social class, and region of burial. I hypothesized that respiratory disease burden would be highest for individuals with multiple marginalizations (lower/middle-class northern females) and lowest for those with multiple privileges (middle/upper-class southern males).

The results of this study provide evidence of intersectionality in respiratory disease burden among urban dwellers in industrializing England. Everyone exhibited similar CMS morbidity except middle/upper-class Londoners whose environmental privileges (well-ventilated homes, countryside vacations, and at-home medical care) buffered them against respiratory disease. Additionally, lower/middle-class female Londoners with rib PNB were more likely to die at a younger age than anyone else. These findings suggest that the devaluation of women’s work combined with the squalid conditions in London created health inequalities that were amplified by respiratory disease, resulting in premature death among working-class women. While neither hypothesis was fully supported, this study was able to lend insight into the living and working conditions of marginalized communities in the urbanizing areas of industrial-era England, particularly working-class women from London.