Intended for healthcare professionals

CCBY Open access

Investigating the impact of the English health inequalities strategy: time trend analysis

BMJ 2017; 358 doi: (Published 26 July 2017) Cite this as: BMJ 2017;358:j3310
  1. Ben Barr, senior clinical lecturer in applied public health research,
  2. James Higgerson, research fellow,
  3. Margaret Whitehead, WH Duncan professor of public health
  1. Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB, UK
  1. Correspondence to: B Barr benbarr{at}
  • Accepted 5 July 2017


Objective To investigate whether the English health inequalities strategy was associated with a decline in geographical health inequalities, compared with trends before and after the strategy.

Design Time trend analysis.

Setting Two groups of lower tier local authorities in England. The most deprived, bottom fifth and the rest of England.

Intervention The English health inequalities strategy—a cross government strategy implemented between 1997 and 2010 to reduce health inequalities in England. Trends in geographical health inequalities were assessed before (1983-2003), during (2004-12), and after (2013-15) the strategy using segmented linear regression.

Main outcome measure Geographical health inequalities measured as the relative and absolute differences in male and female life expectancy at birth between the most deprived local authorities in England and the rest of the country.

Results Before the strategy the gap in male and female life expectancy between the most deprived local authorities in England and the rest of the country increased at a rate of 0.57 months each year (95% confidence interval 0.40 to 0.74 months) and 0.30 months each year (0.12 to 0.48 months). During the strategy period this trend reversed and the gap in life expectancy for men reduced by 0.91 months each year (0.54 to 1.27 months) and for women by 0.50 months each year (0.15 to 0.86 months). Since the end of the strategy period the inequality gap has increased again at a rate of 0.68 months each year (−0.20 to 1.56 months) for men and 0.31 months each year (−0.26 to 0.88) for women. By 2012 the gap in male life expectancy was 1.2 years smaller (95% confidence interval 0.8 to 1.5 years smaller) and the gap in female life expectancy was 0.6 years smaller (0.3 to 1.0 years smaller) than it would have been if the trends in inequalities before the strategy had continued.

Conclusion The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience. The concerns are that current policies are reversing the achievements of the strategy.


  • We thank Tom Hennell for his support and advice on initial drafts of this paper and Rebecca Holley from the Office for National Statistics for her help with accessing the mortality data.

  • Contributors: BB is lead author and guarantor. He planned the study. BB and JH conducted the analysis and led the drafting and revising of the manuscript. BB, JH, and MMW contributed to interpretation of the data, drafting of the manuscript, and revisions. All authors agreed the submitted version of the manuscript.

  • Funding: MMW and JH were supported by the DEMETRIQ project, which was funded from the Commission of the European Communities seventh framework programme under grant agreement No 278511. The study does not necessarily reflect the commission’s views and in no way anticipates the commission’s future policy in this area. BB is supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Health Research and Care (CLAHRC NWC). The NIHR had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This report is independent research arising from research supported by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: Statistical code and data are available from the corresponding author.

  • Transparency: The lead author (BB) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text