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British Medical Journal

Clinical Articles, Lead Article

Early death rates 20% higher in North vs. South

Chances of death at an early age (<75 years) are a fifth higher in Northern than Southern England, the gap now at its widest in 40 years, according to a comparative observational study into mortality trends from 1965 to 2008 published recently on

Researchers at the University of Manchester and Manchester City Council analysed all-cause mortality and population data from the five northernmost and four southernmost English regions, finding that overall rates of premature death have been 14% higher in the north over that period. This inequality was larger for men (15%) than for women (13%).

This north-south divide decreased significantly but temporarily for both sexes from the early 80s to the late 90s, followed by a steep rise from 2000 to 2008, despite government initiatives to reduce health inequalities over this period. 

Trends also varied with age – the 20 to 34 age group saw a sharp rise (22%) in northern excess deaths from 1996 to 2008.

Authors Professor Iain Buchan from the University of Manchester School of Community Based Medicine and Mr John Hacking from Manchester City Council’s Joint Health Unit said: “The main implication of our findings is that they point towards a severe, long term, and recently worsening structural health problem in the geography of England, which may not have received the attention it requires from government policy and which has been resistant to specific policies to reduce inequalities in health or to regenerate local communities”.

The large north-south divide has persisted despite the fact that overall mortality in England has greatly reduced since 1965 – by about 50% for men and about 40% for women with north and south both experiencing similar reductions.

 The authors continue: “More research is needed into why policies to reduce such inequalities have failed, how the wider determinants of health may be unbalanced between north and south, and the size and drivers of selective migration”.

In an accompanying editorial2 Margaret Whitehead, Professor of Public Health at the University of Liverpool, and Tim Doran, Clinical Research Fellow at the University of Manchester, argue that deprived northern communities have “borne the brunt” of the current recession and that government spending cuts “will also hit hardest in the north.” 

They believe that the NHS must do more than pick up the pieces and call for “a national overview” of access to NHS services for different sections of the population living in different parts of the country. “Otherwise, the result could be chaos and an even wider health divide” 


1. Hacking JM, Muller S, Buchan IE. Trends in mortality from 1965 to 2008 across the English north-south divide: comparative observational study. BMJ 2011;342:d508.
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Published on: March 3, 2011

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