It may be affirmed, without great risk of exaggeration, that it is possible to reduce the annual deaths in England and Wales by 30,000, and to increase the vigour (may I not add the industry and wealth?) of the population in an equal proportion; for diseases are the iron index of misery, which recedes before strength, health and happiness, as the mortality declines.
William Farr in 1839—letter in first Registrar General's Report (1)
This quotation is from the first of that long series of letters addressed to the Registrar General on the Causes of Death in England. Dr Farr was in 1839 appointed ‘Compiler of Abstracts’ in the newly created General Register Office. The saving of 30,000 deaths a year represented about 10% of the current number of deaths. It took some forty years to make that reduction in the death rate, which coincided with Dr Farr's career with the General Register Office.
In the twenty-year period 1936–38 to 1956–58 the Standardized Mortality Ratio for England and Wales fell by 21 % for males and 31 % for females. Measured from a much lower rate of mortality, the rate of improvement has been from four to six times greater than in Farr's day. What of the future?