People living in the north of England are 20 percent more likely to die before age 75 years than those living in the south, according to a study spanning four decades. And this figure changed little between 1965-2008, the study said.

Researchers analyzed deaths and population data for all residents from the five northernmost and four southernmost English regions each year from 1965-2008. Results show that overall rates of premature death have been 14 percent higher in the north over the four decades. This inequality was larger for men (15 percent) than for women (13 percent).

This north-south divide decreased significantly but temporarily for both sexes from the early 1980s to the late 1990s, followed by a steep rise from 2000-2008, despite government initiatives to reduce health inequalities over this period.

Time trends also varied with age—most striking among the 20-34 age group, which saw a sharp rise (22 percent) in northern excess deaths from 1996-2008.

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

The north-south health divide in England is well documented and has posed a public health challenge—as well as a political and economic challenge—to successive governments. From 2003-2010, the UK government had performance targets for reducing geographical inequalities in health, but there has been little research of time trends in this divide.

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 what role selective migration plays, according to the study.

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. (open access)