Death rates among adults aged 25-49 were 42% higher in the North than in the South of England in 2024, compared with 13% higher in 1981, according to research published today in The Lancet Public Health.
The relative North-South gap in this age group has therefore more than tripled over four decades. These comparisons take account of differences in age and sex between the populations.
In the 1980s, northern women in their late twenties and thirties had no excess mortality compared with the South; today every five-year band of women aged 25-49 shows a 35-60% excess, and the gap for women has grown 3.5-fold overall, from around 12% to 41%.
In this study, "northern excess mortality" means how much higher death rates are in the North than in the South of England in the same year.
The study, led by researchers from the University of Liverpool, the University of Manchester and Health Equity North, analysed national death registrations and population estimates from 1981 to 2024. It examined how the divide varied by age and sex, and whether trends changed during and after the COVID-19 pandemic.
Mortality rates fell overall during the four decades studied, although improvements were interrupted by the pandemic. The North-South gap persisted, and the widening among adults aged 25-49 began well before COVID-19.
During 2010-19, the relative North-South mortality gap among 25-49-year-olds widened for both women and men, with a faster increase among women.
There was no evidence of a narrowing of the gap during 2020-24 in any of the age or sex groups studied. Across all people under 75, death rates were 26% higher in the North than in the South in 2024, after adjustment for age and sex.
The study examined deaths from all causes combined, rather than the specific causes of the divide. The researchers plan further analyses to investigate which causes of death are contributing to the differences.
The authors describe the persistence of the North-South health divide and its widening among working-age adults and women in early to mid-life as "major challenges for government".
They call for sustained, coordinated action by central government and strategic regional authorities to tackle the social and economic drivers of excess mortality in the North. This includes:
- Giving regional strategic authorities sufficient powers to address the social and economic determinants of health.
- Targeting funding at areas of high deprivation to narrow health gaps.
Professor Iain Buchan, W.H. Duncan Professor of Public Health Systems and Associate Pro Vice Chancellor for Innovation at the University of Liverpool, and Director of Civic Health Innovation Labs (CHIL), said: "These findings are deeply concerning for England's health, social fabric and economy. The more than tripling of the relative North-South mortality gap between 1981 and 2024 among 25-49-year-olds is the tip of the iceberg of rising regional inequalities in the health of working-age adults, which risk compounding economic divides and reinforcing a vicious circle of disadvantage in the North compared with the South of England.
"Policymakers need to consider radical steps to improve health, work and opportunity in the North of England, not only for public health but for the whole UK economy."
Professor Evangelos Kontopantelis, Professor in Data Science and Health Services Research, University of Manchester, said: "By bringing previous analyses of the North-South mortality divide up to date, the study paints a picture of persistent regional inequalities and exposes a concerning trajectory for the North.
"It also provides robust evidence for the need for sustained policy action in the North that extends beyond healthcare and tackles the wider factors that shape health outcomes, such as deprivation, multimorbidity, poor housing and adverse employment conditions."
Hannah Davies, Chief Executive of the Northern Health Science Alliance and Executive Director of Health Equity North (HEN), said: "This paper adds to the evidence on health inequalities in the North. HEN's separate research has also examined the economic consequences of poor health and the circumstances in which people leave work.
"Targeted action is needed in the hardest-hit communities, informed by robust research and combining prevention and healthcare with action on the wider social and economic determinants of health."
The paper, 'The north-south divide in English mortality, 1981-2024: a longitudinal population study', was published in The Lancet Public Health.
