England’s fraying health: laying bare the latest findings

This is the first in a series of blogs on our latest mortality trends research. Here, Jo Bibby explores the data and its implications for policymakers in England. 

In 2020, Labour leadership hopeful Keir Starmer pledged to set a national wellbeing goal ‘to make health as important as GDP’. If the prime minister saw our latest briefing on international mortality trends, he may want to recommit to this pledge. 

Our briefing showed a relative worsening of mortality rates across all four UK nations compared with 21 high-income countries. England, while faring better than other UK nations, is by no means exempt, with a higher mortality rate than the median of peer nations studied.

Unpicking England’s data quickly lays bare the extent of inequalities between different parts of the country. Mortality rates were 20% higher in the North of England than in the South West in 2021. And while mortality rates across England worsened compared with the median of peer countries between 1990 and 2021, there were some stark differences between regions (Figure 1):

• In the North East, female and male mortality rates increased from 19% and 14% higher, respectively, in 1990 to 30% and 17% higher in 2021.
• In the South West, female and male mortality rates changed, from 4% and 7% lower, respectively, than the median in 1990 to 5% higher and 3% lower in 2021.

Findings for people aged 25–49 years – a significant proportion of our working-age population – are even more concerning. In the North East of England, the mortality rate for men aged 25–49 years went from 7% lower than the median of peer countries in 1990 to 113% higher in 2021. In comparison, the mortality rate for men aged 25–49 years in London – which is the closest of all England regions to the median – rose from 7% higher than the median in 1990 to 11% higher in 2021.

While mortality rates for those aged 25–49 years in England are lower than for other age groups, these rates have been rising and are now much higher than peers in other high-income countries. Notably, the drug-related mortality rate in England was almost 3 times higher than the median of peer countries in 2019. And in the North East, drug-related mortality rates were 3.5 times higher for males and almost 4 times higher for females than in London (Figure 2).

This picture of deterioration is not inevitable. Many of the countries we compare ourselves with have managed to improve health outcomes through the 2010s. We, on the other hand, have slipped backwards. But why, and what can we do to reverse the course? 

What might explain these findings? 

Over the past two decades, the UK has experienced a period of economic stagnation and falling living standards. Between 2007 and 2019, median working-age incomes rose by just 6%, placing the UK among the slowest growing nations. There are also persistent gaps between regions – between 2004 and 2019, average incomes in London rose by 7% but fell by 2% in the Yorkshire and Humber. 

Falling living standards, deepening inequalities and socioeconomic deprivation are all major factors that shape health, with economic deprivation strongly associated with drug-related harm. Our research shows that drug-related deaths are a key contributor to the divergence in mortality rates for people aged 25–49 years. 

Investment in prevention in England – both within the NHS and in wider public services – also suffered cuts in the 2010s. And the proportion of the NHS budget spent on prevention, primary care and community health declined over the past decade. Moreover, the public health grant provided to local governments – used to provide vital preventative services – fell by 26% per person between 2015/16 and 2025/26, the effects of which are compounded by overall spending power being 9% lower in 2025/2026 compared with 2010/11. The result has been a shift towards maintaining statutory services at the expense of non-statutory spending that can improve neighbourhood health and wellbeing. A well-cited example is the Sure Start programme, where funding was cut despite evidence of significant positive outcomes for young people and their families.

Specialist drug treatment services have also faced cuts despite evidence they can be an effective preventative approach, highlighted by Dame Carol Black’s 2021 independent review of drugs. Additional funding for drug and alcohol treatment and recovery services was recently extended to 2025/26, but certainty of multi-year funding is needed for local authorities to plan over the long term. 

What action can be taken? 

Addressing the nation’s health cannot be achieved by any single government department or policy alone. As the now prime minister recognised 5 years ago, we need a shift towards prevention-led services. This requires commitment across government for each department to contribute to creating a healthier UK.

Our latest briefing explored various policy opportunities and solutions. But government needs an overarching health inequalities strategy that orientates its whole policy agenda towards health improvement – from welfare reform to the industrial strategy, the 10-Year Health Plan and a commitment to build 1.5 million new homes.  

The stark trends in drug-related deaths and the regional inequalities laid out in our briefing will only be addressed through sustained action to boost local economies, which have experienced long-term decline. Also needed are:

• a renewed commitment to continue supplementary drug treatment funding for councils
• the implementations of policies to address the illegal supply of drugs, as set out in Dame Carol Black’s independent review, and
• investment in key preventative services for drug-related harm, including community mental health support, youth clubs and other services that provide early intervention.

A new way forward

Before the current government came into power, Labour set out their mission-based approach, which included some positive aspirations – real-world impact, accountability and, vitally, the need for a long-term preventative approach to health. Our latest briefing on the trends in mortality rates shows that now is not the moment to hang up the hat on this way of working, even if pressing political priorities such as reducing NHS waiting lists are more tangible short-term goals. 

If we want everyone to live well for longer, we need to reset the way we think about health. The conversation, rhetoric and policy must go beyond the NHS to focus on rebuilding the fabric of our society. It's about putting in place all the building blocks of health, from opportunities for young people and those currently out of work to safer neighbourhoods. By stitching together these and other policies as part of a broader prevention and health inequalities strategy, we could finally start to address the longstanding issues laid bare in our briefing. 

This will require the government to build public backing for a mandate that spans parliaments. There are already signs the public supports the changes needed to improve health. The government must now seize the opportunities it has to deliver health and wealth.