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Pre-pandemic trends in mortality inequalities in Europe and North America

Observation

A special Issue of Fiscal Studies published today by Wiley on behalf of the Institute for Fiscal Studies (IFS) provides new analysis of the evolution of mortality levels and socio-economic inequalities in 11 OECD countries, including England, over the last 20-30 years. As well as documenting and comparing trends using a new methodology, it provides historical context within which to consider the disproportionate effects of the COVID pandemic on disadvantaged areas.

Trends in mortality levels

  • As in the other European countries included in the analysis, and unlike the much-publicised trend in the US, there were significant improvements in mortality levels in England across all age-groups in the first part of this century. These were more substantial for men than women, reducing mortality gender inequalities, and were accompanied by reductions in differences between those living in poorer and better off local authorities, especially among 0-4 year olds.
  • However, there has been a marked slow-down in improvements over the last decade in England. While between 2003 and 2010 adult mortality rates declined by 13% - 33% (depending on gender and age-group), between 2010 and 2016 reductions were below 5% for most groups.

Trends in mortality inequalities

  • Some countries, including Norway and Finland, have seen mortality inequalities across areas fall or disappear for most age-groups. In England significant inequalities remain. The largest reductions in inequality have been achieved among 0-4 year olds: a boy in this age-group living in the poorest 5% of local authorities was twice as likely to die than one living in the richest 5% in 2003. By 2016 this difference in likelihood had fallen to 1.7. Much less progress has been made among older groups, and inequalities have grown when analysed across small geographical areas.
  • Inequality in mortality has evolved very differently across the 11 OECD countries, suggesting that country-specific policy choices may play a critical role. For example, while Spain and Portugal were both hard hit by the recession following the financial crisis of 2008, Spain continued to see declining mortality and declining inequality in mortality, while in Portugal inequality in mortality increased. Income and health inequality do not have to move in lock-step.

How policy intervention in England could improve mortality levels and inequality

  • Deaths considered to be most responsive to policy intervention continue to make up a higher fraction of all deaths in the UK than in many Nordic, Northern and Southern European countries. Since 2003, only a small proportion (just over a fifth) of the overall mortality improvement for the 50–79 age group in England arose as the result of a decrease in these types of deaths.
  • Deaths from the leading causes at older ages (cancers, respiratory and heart disease) occur later in life in rich areas than poorer areas. To reduce mortality inequalities at older ages policy interventions should aim to delay the onset and deterioration of these conditions among those living in poorer areas.
  • In contrast, at ages under 50, ‘deaths of despair’ (deaths from drug-overdoses, alcohol and suicide) are less likely to occur in rich areas than they are in poor areas. Hence policies aimed at reducing mortality inequalities at younger ages would need to focus on prevention of such deaths in poorer areas.

The UK Government “levelling-up” agenda should not overlook within area inequalities. There is more inequality within local authority areas than there is between them, suggesting that that there are important pockets of disadvantage within LA’s. This is not unique to England: for example, in Norway, infant mortality gap between rich and poor families based on individual-level socio-economic status measures persisted for several decades longer than the gap between rich and poor municipalities.