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BMJ No 7105 Volume 315 News Saturday 16 August 1997
Britain has become less equal in deathIf you live in Glasgow you are 66% more likely to die prematurely than if you live in rural Dorset and 31% more likely than if you live in Bristol. Where you live in Britain is a better guide to your chance of an early death now than at any time in almost half a century, according to a report from the Joseph Rowntree Foundation.Although absolute mortality for all groups in society has fallen steadily since the 1950s, the gap between people living in different areas has widened, particularly since the 1980s. 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 the rates are lowest. The analysis of the statistics, by Dr Daniel Dorling of the University of Bristol's department of geography, shows that those living in the worst tenth of areas in terms of mortality are in those areas where indicators of poverty are also the greatest. One in 12 of the population of Britain now live in areas where the standardised premature death rates are more than 15% above the national average. The study found that despite a dramatic and continuing decline in death rates among babies under 12 months since the 1950s, variations between areas are increasing. A girl born in Leeds, for example, is more than twice as likely to die within the first year of life than a girl born in a Dorset town. Mortality in the first year of life for boys born in Blackburn, Halifax, and Preston has risen against the national trend since 1981 and is now nearly double the average level. And although the number of children who die between ages 1 year and 14 years is very small, differences between areas can still be dramatic. For example, proportionally eight times as many boys aged 1 year to 4 years died in Manchester between 1990 and 1992 as died in rural Gloucestershire. Dr Dorling said he did not know why the differences 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." The report concludes that it is unlikely that Britain will be able to meet its commitment to a 25% reduction in health inequalities by the year 2000. The British government says that it is committed to reducing inequalities in health, with proposals due out in the autumn. Commenting on the report, the health secretary, Frank Dobson, said: "Inequality in health is the worst inequality of all. There is no more serious inequality than knowing that you will die sooner because you are badly off."
Jacqui Wise,
Death in Britain: How Local Mortality Rates have Changed: 1950s to 1990s can be obtained from York Publishing Services, 64 Hallfield Road, Layerthorpe, York YO3 7XQ, price £13.45. A summary can be found on the Joseph Rowntree Foundation's web site (http://www.jrf.org.uk).
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