May 23, 2024

Divided by despair – exploring deaths from drugs, alcohol, and suicide across England

By Christine Camacho, PhD Fellow ARC-GM at the University of Manchester and Dr Luke Munford, Senior Lecturer in Health Economics at the University of Manchester


In the wake of the ‘Deaths of Despair’ (DoD) phenomenon observed in the United States in 2015, Christine Camacho and Dr Luke Munford explore regional disparities in these deaths within England. With an estimated 46,200 lives lost to Deaths of Despair between 2019 and 2021, they uncover stark geographical inequalities, emphasising that these deaths are not inevitable outcomes but rather consequences of unfair allocation of resources.

Deaths of Despair encompass alcohol-specific deaths, drug-related fatalities, and suicide. These incidents, rooted in long-term economic hardship and societal disintegration, disproportionately affect certain segments of the population. Socioeconomic factors like labour market policies, income inequality, and housing instability are linked to the rates of DoD, highlighting the interconnectedness of social and health disparities.

The United Kingdom has high levels of regional economic disparities. The North of England bears the brunt of these inequalities, with lower economic productivity as well as lower life expectancy. Persistent economic and health inequalities have led to the emergence of ‘left behind‘ communities, where individuals face higher rates of chronic health issues and socioeconomic challenges.

Analysing data from 2019 to 2021, they found 46,200 deaths attributed to DoD in England, equivalent to 42 each day. The leading cause of DoD varied across age groups, with suicide prevalent among the under-30s, drug misuse among those aged 30-44, and alcohol-related deaths among individuals over 45. Notably, alcohol-specific deaths accounted for 44% of all DoD.

While the average DoD rate for England stood at 34 per 100,000 people, significant regional variations were evident. The North East experienced the highest burden, with an average of 55 deaths per 100,000 people, whereas London reported the lowest rate at around 25 per 100,000. Coastal regions had higher rates of DoD before adjusting for other factors. At the local authority level, Blackpool, in the North West, had the highest rate of DoD (84 per 100,000), whereas Barnet, in North London, had the lowest rate (15 per 100,000).

Elevated risk of DoD was associated with several area-level factors, including unemployment rates, higher proportions of White British ethnicity, living alone, higher rates of economic inactivity, employment in elementary occupations, and urbanicity.

Addressing regional disparities requires geographically tailored interventions. Initiatives like devolution offer promising avenues for local decision-making and resource allocation. However, the national policy context is also important. Prioritising equitable access to economic opportunities, the labour market, and housing is paramount, requiring cross-party collaboration and a sustained commitment to levelling up.

This research underscores the urgent need for decisive action to tackle the systemic factors driving Deaths of Despair. By shining a light on the areas bearing the brunt of these tragedies, it calls for a holistic approach to address root causes and reshape the landscape of despair in England.

Read more from Policy@Manchester, including local authority data.


This article is featured in our 22 May newsletter.

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