Accidents of Birth

Do you play the lottery? Are you bothered by it? Well, we all play a lottery, just not one that relies on coloured balls falling out of a machine and being picked up by a white-gloved attendant. Does the National Lottery even do that any more?

This one, however, is the lottery of birth. The early 21st century is the best time to be alive, given that we are at the pinnacle of nutrition and sanitation, immunisation, education and health care, and greater legal protection for women and children. We have never had it so good.

And yet many people have never experienced the good life; they have never had all these opportunities, because of where they are born. Being disabled, female, black, or gay, for example, will dramatically affect your life chances depending on whether you were born in the UK or Uganda, Australia or Azerbijan, Germany or Ghana.

Armed conflict, disparities of income and wealth, abuse of all kinds, and discrimination still damage the lives of countless numbers of human beings.

I was born in a first world country – England – and I have access to clean drinking water, cheap food, heating, a roof over my friend, a family who care for me, and access to job opportunities and hobbies. I am writing this section in a hotel room as my son sleeps in the next bed, on a laptop at 5am. All of this means I’ve scored pretty high in the lottery of birth; my asthma isn’t a big deal because I have access to socialised health services that keep it in check, and I can get my eyes tested whenever I need to increase my prescription. Life is good, and – for the most part – my sexuality is irrelevant, my disability status isn’t significant, and I can raise my son in safety and security.

All of that makes life sound pretty perfect, doesn’t it? The UK isn’t perfect, of course – no country is, and successive governments here have made as many bad decisions as good ones – but had I been born in a different country where services and liberal attitudes weren’t as advanced, would my life be quite so comfortable? Would I be as content? Quite probably not.

It will be a surprise to practically no-one that the world is an unequal place for its inhabitants; life expectancy, health, income, and education are the biggest indicators of inequality.

Asia has had an economic boon since the beginning of the 21st century, especially the powerhouses of China and India. This has taken millions out of absolute poverty, but the divides between the “haves” and “have nots” are still very striking.

Inequality constantly attracts attention because of the visibility of both the extremely rich and the extremely poor; we see homeless people sitting outside expensive shops in central London, and expensive cars driving through deprived towns where every second shop is closed.

A couple of researchers – Wilkerson and Pickett – have studied these lotteries of birth, and have come to a strong conclusion; that economic growth will soon stop being able to influence wellbeing, and that people are now looking to different things for their wellbeing, either through choice or necessity.

They’ve gathered evidence to suggest that the majority of social problems, including ill health, violence, drug abuse, obesity, mental illness, and large prison populations are more likely to appear in less equal societies (such as in the UK). They believe that inequality should be the main focus of social and economic policies. They have constructed a powerful argument stating that we are more affected by differences in income than by our wealth.

Approximately eight hundred women die from otherwise preventable causes that are related to pregnancy and childbirth; ninety-nine percent of these deaths happen in developing countries, rural areas, and the poorest communities. Most importantly, efforts in reducing the numbers of deaths have resulted in a 50% drop between 1990 and 2013.

The USA, surprisingly for a first world nation, has a high number of children dying on the first day of their life; an estimated 11,300 newborn babies. This is fifty percent more than all other industrialised countries combined – 7,500 first-day deaths each year.

Two main reasons are that many babies in the United States are born too early, and complications of preterm birth are the direct cause of 35 percent of all newborn deaths in the US; and the country has the highest adolescent birth rate of any industrialised country. Teenage mothers in the US tend to be poorer, less educated, and receive less prenatal care than older mothers. Because of these challenges, babies born to teen mothers are more likely to be low-birthweight and be born prematurely and to die in their first month. They are also more likely to suffer chronic medical conditions, do poorly in school, and give birth during their teen years (continuing the cycle of teen pregnancy).

The access you have to all the services I’ve mentioned – health, education, social care, and so on – dramatically influence your ability to realise your full potential. We don’t know if the next Einstein was born and died in poverty-stricken Africa, or if the next da Vinci has already been and gone because he was stuck in the slums of India. A vision of a world where the lottery has been abolished is just that; a vision. One day … who knows, but – sadly – it is a long way off.

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