Appleby’s recent paper in the BMJ  shows steadily worsening health across social care bands, with no particular step change at the lower end of the distribution. However, there are some particularly vulnerable small populations in most countries. In the UK the homeless form such a group, with an average age of death of 47 years, some 30 years less than the general population. We thought it would be interesting to compare the life expectancy of particular high-risk populations with those of the host community across a range of middle- and high-risk countries. The results are shown in Table 1. The sharpest gradient applies to residents of the largest informal settlement in Kenya, who have a terrible life expectancy of about half the national mean.  The Inuit population of Canada have a life expectancy that is 84% of the national mean, while the Aboriginal and Torres Strait people of Australia have a life expectancy that is 88% of the Australian average. The indigenous peoples of the Yunnan province in China, the Alaska Natives of the USA, the Māori people of New Zealand, and the Pacific Islanders of the USA  all fare relatively better. Table 2 shows that excess mortality across at least one of these groups is attributed to a wide range of medical conditions. As to the mechanism linking social conditions to these diseases, we would be interested in your views. In the meantime, we note that none of the above groups, save the children of Kibera slum, have an outcome as bad as that of the homeless in the UK.
Table 1. Life expectancy of indigenous populations compared to that of the country/state as a whole.
NB. All life expectancies, except for Native Hawaiians & other Pacific Islanders, are an average of the male and female life expectancies.
Table 2. Causes of excess mortality among Aboriginal and Torres Strait Islanders in Australia (2004-2008).
* Standardised Mortality Ratio – observed deaths as a proportion of deaths expected based on age, gender and cause-specific rates for non-Indigenous population.
† Excess deaths (observed deaths minus expected deaths), as a percentage of total excess deaths for all causes.
— Richard Lilford, CLAHRC WM Director
— Peter Chilton, Research Associate
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