'Victorian-Era' Diseases on the Rise in the UK, but Why?

Hospital visits for so-called “Victorian-era” diseases are on the rise in the United Kingdom, and experts there believe public health budget cuts may be behind the upswing.

According to UK National Health Service data analyzed by the opposition Labour party, hospital visits for scarlet fever, gout, whooping cough, and malnutrition rose by 3000 admissions since 2010-11, a 52% increase.

Admissions for a primary diagnosis of scarlet fever spiked more than 200% (429 hospital admissions in 2010-11 to 1321 in 2017-18), gout admissions rose 38% (4935 in 2010-11 to 6824 in 2017-18), whooping cough admissions rose 59%, and malnutrition admissions rose 54%.

“It’s very concerning that these conditions, associated with a bygone era, seem to be on the resurgence,” Helen Donovan, professional lead for public health at the Royal College of Nursing, said in a statement to Contagion^®. “Nurses are central to educating people about what they can do to better look after their own health, however the very nurses that deliver public health interventions around diet, [behavior], and lifestyle have seen their numbers plummet—last year, the number of health visitors fell by 22 percent. As a result, people at risk of diseases we thought were a thing of the past will continue slip through the cracks.”

But why are these diseases, more commonly seen in the mid-nineteenth century, on the rise again?

In 2017, when the UK experienced its biggest increase of scarlet fever cases in several decades, investigators from Public Health England sought to determine the root cause. Published in The Lancet Infectious Diseases, their study found that rates of the illness in England tripled to more than 27 cases per 100,000 individuals from 2013 to 2014, with 87% of those cases occurring in children under the age of 10. In 2015, the rate of infection rose to more than 30 cases per 100,000 and in 2016 rose again to more than 33 cases per 100,000.

After studying epidemiological patterns and performing whole-genome sequencing of clinical isolates, the investigators failed to find a cause of the epidemic.

“Comparison with historical UK data showed that the magnitude of the recent upsurge in scarlet fever was unique, suggesting the current phenomenon is not explained by the usual cyclical patterns in disease incidence,” the investigators wrote in their paper.

The spike in pertussis cases is also alarming, as the highly contagious respiratory disease was nearly eradicated in England after a nationwide vaccination push in the 1950s.

Labour party officials blame austerity, or public health spending cuts, for the rise in these “Dickensian” diseases.

"Dickensian diseases on the rise in Tory Britain today," Jonathan Ashworth, member of Parliament and Labour’s shadow health and social care secretary, said in a statement. "The damning truth is austerity is making our society sicker. It means the poor die younger… We are facing a national emergency as widening health inequalities blight the land. Not only have advances in life expectancy begun to stall for the first time in a hundred years, it’s even going backwards amongst some of the poorest communities.”

Donovan, of the Royal College of Nursing, also pointed toward government cuts as reasoning for the uptick in nineteenth-century diseases.

“There are many reasons behind this but one thing that cannot be ignored is the effect of sustained cuts to local authority public health budgets which have caused the services that screen, prevent, and protect against illness, and promote good hygiene to be scaled back,” she said in a statement. “Across the country the stark differences in life expectancy paint a worrying picture about the availability and access to health care and the variability of these services.”