Changing the Map: Health in Britain 1951–91

It is accepted that within Britain there are persistent and growing inequalities in mortality between groups of people as defined by their social class. This paper shows that similar persistent and growing inequalities prevail between groups of people defined by district of residence. Although there is some confusion between these two ways of grouping people – there is a slight tendency for people of the same class to live in the same district. This paper reviews the geographical literature which may shed light on why inequalities in mortality are widening between districts in Britain. We present new data for a set of 293 unchanging districts by amalgamating published reports from the 1950s, 60s and 70s with individual postcoded mortality records from the 1980s and 90s, aggregated to the 293 districts using a Geographic Information System and Census data from 1971, 1981 and 1991 (including estimates of the residence of the ‘missing million’). We find that a growing proportion of premature deaths in Britain can be attributed to some aspect of rising spatial inequalities. Changing geographical inequalities in health are not simply a passive reflection of social inequalities. To begin to investigate them, however, we first need to measure them properly.