New research has revealed widening inequality between death rates in the northern and southern England. Here Professor Iain Buchan explains the significance of his research and calls on policymakers to take action and introduce northern weighting in industrial growth funds to address the North-South health divide.

• There has been an alarming rise since the mid-90s in the numbers of young adults and middle-aged people dying in the North
• All premature deaths (under age 75) recorded over the past five decades have been a fifth higher in the North
• Efforts from 1997 to 2010 to reduce differences in life expectancy made a small difference over all England, which has now reversed, but no difference to the North-South divide
• Tackling health inequalities from the NHS and public health services is important, but arguably futile without accompanying economic policies that create the lasting conditions for better health
• The forthcoming Industrial Strategy should apply a ‘northern weighting’ reflecting the 20% difference in premature mortality

This week in the Journal of Epidemiology and Community Health we report the profound and persistent inequality in early deaths between northern and southern England, with an alarming rise, since the mid-90s, in the numbers of young adults and middle-aged people dying in the North.

Government policies over the past five decades have failed to close this divide. It is time to act – beyond the reach of the NHS and public health services – to tackle this major structural inequality at its source: introducing a northern-weighting to incentives, such as the forthcoming Industrial Strategy, which can create the wealth and social capital that feeds public health.

Examining data on all deaths in England since 1965 to 2015 we found:

• Persistence of a 20% higher risk of dying under age 75 in northern compared with southern England, amounting to 1.2 million northern excess premature deaths over five decades.
• An emergence of a profound inequality in younger deaths since the mid-90s, with a northern excess risk by 2015 of 49% among 35-44-year olds and 29% among 25-34-year olds.
• Stalling of long-term improvements in premature mortality across the whole of England from 2010, with rising mortality among younger people in the North.
• Periods of recession had little apparent impact on these North-South divides in mortality.

England’s health as a tale of two nations

A line drawn between the River Severn and the Wash divides England into approximately two halves of 25 million population. The history of prosperity and better health below this line can be traced back to 1066, with the ancient houses of England holding the balance of power and resources in the South. After his tenure as Prime Minister (1874-1880), Disraeli wrote of a tale of two nations in the novel Sybil, with English social and economic divides resistant to political norms.

Since the 1980s, there have been numerous reports designed to inform UK Government policies for tackling inequalities in health. The specific efforts from 1997 to 2010 to reduce differences in life expectancy began to close the health gap between the wealthiest and most deprived areas of the country. However, this trend has now reversed, and the policy did not close the North-South divide in premature deaths.

Closing the divide

NHS investments are important for dealing with the consequences more so than the causes, especially in primary care. But even here, the spending on primary care is lower not higher in the North, after allowing for population burdens of illness.

Tackling health inequalities from the NHS and public health services is important, but arguably futile without accompanying economic policies that create the lasting conditions for better health. In recent years there have been policies to “rebalance the economy” across England; investments in global growth areas such as digital health via the Health North Connected Health Cities pilots of the Northern Health Science Alliance have been welcome. But a £20m investment is tiny in proportion to the size of the inequality, and the opportunity.

Another cruel paradox is pointed out by IPPR North in their recent report showing the much higher levels of public spending on health research in southern compared with northern England, despite greater needs in the North. In addition, where industry invests in clinical trials in the North, patients are more likely to participate in large numbers (e.g. Salford Lung Study) – leading to the real-world evidence that benefits the NHS, the UK economy and global biomedical knowledge.

It is time to turn policy attention to the opportunity for the whole UK in addressing this inequality at scale and at pace. A healthy, productive workforce, maximising the human resource of the whole country is a path to optimal UK prosperity. The forthcoming Industrial Strategy, for example, might apply a ‘northern weighting’ reflecting the 20% difference in premature mortality.