Intended for healthcare professionals


“I'm all right, John”: voting patterns and mortality in England and Wales, 1981–92

BMJ 1996; 313 doi: (Published 21 December 1996) Cite this as: BMJ 1996;313:1573
  1. George Davey Smith, professor of clinical epidemiologya,
  2. Daniel Dorling, lecturer in geographyb
  1. a Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. b Department of Geography, University of Bristol, Bristol BS8 1SS
  1. Correspondence to: Professor Davey Smith.


    Objective: To investigate the association between voting patterns, deprivation, and mortality across England and Wales.

    Design: Ecological study.

    Setting: All the electoral constituencies of England and Wales.

    Main outcome measures: Combined and sex specific standardised mortality ratios.

    Results: For the years surrounding the three elections of 1983, 1987, and 1992 overall standardised mortality ratios showed substantial negative correlations of −0.74 to −0.76 with Conservative voting and substantial positive correlations of 0.73 to 0.77 with Labour voting (all P<0.0001). Correlations were higher for male than female mortality. Conservative voting was strongly negatively correlated (r = −0.84) with the Townsend deprivation score, while Labour voting was positively correlated (r = 0.74) with this. Labour and Conservative voting explained more of the variance in mortality than did the Townsend score. In multiple regression analyses for the 1992 election Labour voting (P<0.0001), Conservative voting (P<0.0001), the Townsend score (P = 0.016), and abstentions (P = 0.032) were all associated with mortality. Labour and Conservative voting explained 61% of the variance in mortality between constituencies; when Townsend score and abstentions were added this increased to 63%.

    Conclusions: Conservative and Labour voting are at least as strongly associated with mortality as is a standard deprivation index. Voting patterns may add information above that provided by indicators of material deprivation. People living in better circumstances and who have better health, who are least likely to require unemployment benefit and free school meals or to rely on a state pension in old age, and who are most able to opt out of state subsidised provision of transport, education, and the NHS, vote for the party that is most likely to dismantle the welfare state.

    Key messages

    • The places where people are most likely to die young are also the places where people are most difficult to count when alive

    • The places where people are most likely to die young are also the places where people are least likely to choose or to be registered to vote

    • This study provides further evidence of the strength of self interest in voting in Britain

    • There are wide ranging social, economic, and political implications from the polarisation of health and voting in Britain


    • Funding None.

    • Conflict of interest None.

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