Inequality of healthBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6954.612 (Published 03 September 1994) Cite this as: BMJ 1994;309:612
EDITOR, - Peter Phillimore and colleagues described at widening gap in the mortality ratios between the most and least deprived electoral wards in the Northern region.1 Both groups of wards showed a fall in mortality from 1981 to 1991, but the fall was greater in the richer wards. Dermot O'Reilly gives good evidence that similar “gaps” between the councils of Northern Ireland are related to healthy people leaving a council and increasing the role of unhealthy people.2 I suggest that younger adults should be substituted for healthy people and older adults for unhealthy people. It is a natural trend for young people to move and also basic housing policy.
The table shows the mortality (not mortality ratio) per 1000 adults in each age group in England and Wales and the Northern Region; postneonatal mortality is included for comparison. The number of deaths by age group in one of the poorest districts in the Northern region (Gateshead) is also included. The regional and national figures show a gradual rise from 45- 54 years, but this becomes pronounced only from 55-64 years. Regional figures are higher than national figures. The figures for Gateshead show that 65% of the deaths under age 65 occurred in people aged 55-64 and that 86% of the deaths under age 75 occurred in people aged over 55. So mortality in adults now relates strongly to elderly people.
To study mortality properly we must look at causes, not just risk factors. In people aged 15-44 the chief cause of death for years has been accidents and other forms of violence, especially in males, but the proportion of the total remains small. From age 45 the main causes of death are malignant neoplasms and the results of arterial obstruction in various organs resulting from hypertension. For coronary heart disease (deaths from which are now rapidly falling in the United States and Britain), smoking and obesity are powerful precursors. Both are mainly related to personal behaviour.
Most premature deaths of adults are now due to malignancy or degenerative vascular disease. Social deprivation still exists but leads more to misery than to death