Britain has become less equal in death, warns JRF report

Although the overall death rates among men and women under 65 have been falling steadily, the research finds that since 1981 there has been greater improvement in some parts of the country than others - creating a widening north-south divide.

People living in the tenth of areas with the highest death rates are now almost twice as likely to die prematurely as those who live in the tenth of areas where mortality rates are lowest. This represents the greatest degree of inequality since local records were first collated in 1951.

And while there have been substantial improvements in infant and child mortality across the country as a whole, the research identifies a number of areas where death rates have actually risen during the past 15 years.

The analysis of official statistics by Dr Daniel Dorling of the University of Bristol's Department of Geography suggests that between 1990 and 1992 there were 77,000 'excess' deaths above the average rate for men and women under 65. The highest death rates were generally recorded in northern and urban areas. For example:

• Glasgow residents were 66 per cent more likely to die prematurely in recent years than people living in rural Dorset - and 31 per cent more likely than people living in Bristol;
• The three areas with the highest death rates in the 1990s - Oldham, Salford and Greenock - had mortality ratios nearly a third higher than the national average, compared with only a fifth higher in the 1950s.

Infant mortality
Despite a dramatic and continuing decline in death rates among babies under 12 months since the 1950s, there are widening variations between areas:

• A baby girl born in Leeds is more than twice as likely to die in the first year of life than a girl infant growing up in a Dorset town. In Paisley, there has been a recent increase in infant mortality rates for girls;
• Mortality rates for baby boys born in Blackburn, Halifax and Preston have risen against the national trend since 1981 to reach nearly double the average level.

Children and adolescents The proportion of children aged 1 to 14 who die is very small. Differences between certain areas can, nevertheless, be dramatic:

• Proportionately eight times as many boys aged 1 to 4 died in Manchester between 1990 and 1992 as died in rural Gloucestershire;
• Early childhood mortality rates for boys in Dewsbury, Bethnal Green, Manchester and St. Helens have doubled since 1981 and are approaching the level recorded in the 1950s;
• Increases in the death rates among pre-school girls have been recorded in Birkenhead, Manchester and on the Isle of Wight;
• Mortality rates for boys and girls aged 5 to 14 increased during the 1980s in Salford, rural Carmarthenshire, St. Helens, Nottingham and Bethnal Green. There has been a more recent rise in mortality rates for girls in Barrow-in-Furness.

Adults
Mortality rates among adults relate to many more deaths per year than those for children. National death rates among men aged 15 to 44 fell sharply between 1950 and 1981, but have since remained static. For older men and women, aged 45 to 64, there has been a sustained improvement in rates, especially since the 1970s. However, the variations between different parts of the country have increased:

• Men aged 15 to 44 are twice as likely to die in Hammersmith, Port Glasgow and Southwark as the national average for their age group;
• Death rates for 15 to 44 year old women have risen in recent years in several locations, including parts of Scotland;
• In the 1960s, 6.9 per cent of deaths among men aged 45 to 64 and 5.4 per cent of deaths among women would have been avoided if there had been nowhere in the country with over-average mortality. By the early 1990s, the proportion of these 'excess' deaths had risen to 9.6 per cent among men and 8.9 per cent for women of these ages.

Death rates and social disadvantage
The study finds that the worst tenth of areas of Britain in terms of premature mortality also showed up among the most socially disadvantaged areas using Census indicators of poverty. The number of people living in areas of high relative mortality is higher than at any time since the early 1950s. One in 12 of the population now live in areas where the standardised premature death rates are more than 15 per cent above the national average.

The report concludes that these mortality differences make it extremely unlikely that Britain will be able to meet its commitment to a 25 per cent reduction in health inequalities by the year 2000, as a signatory to the Targets for Health set out by the World Health Organisation in 1985.

Dr Dorling said: "We are becoming less equal in death. Where people live in the 1990s has become a more reliable guide to their chances of dying before they reach retirement age than at any time since the Second World War."

He added: "This study does not seek to speculate on the reasons why divisions between different parts of the country have become so pronounced. However, it does seem that the trend has occurred too quickly - and involves too many deaths - to be explained simply by a changing distribution of wealth, changing causes of death or as a reflection of past health inequalities. These patterns of varying life chances need to be investigated - and that is likely to prove a harder task than describing them."