Moralisation, stigmatisation, and downstream interventions: How symbolic violence sustains geographic inequalities in deaths of despair in England

This paper examines how symbolic violence contributes to the persistence of geographic inequalities in deaths of despair (DoD), those from drug, suicide, and alcohol-specific mortality, in two deindustrialised towns in North East England. Although there is evidence that DoD are driven by structural determinants, such as economic policies, inadequate social safety nets, and poverty, less is known about how these determinants are ideologically obscured. Drawing on qualitative data collected from 30 residents of Middlesbrough and South Tyneside, two towns with above average rates of DoD, the analysis explores how symbolic violence, in the form of moralisation, stigma, and downstream interventions, frames behaviours as individual failings, downplays structural determinants, and sustains inaction while maintaining the appearance of intervention. By diverting attention away from the root causes of DoD, symbolic violence functions as a mechanism through which these inequalities are reproduced. By highlighting the cultural and ideological processes that allow structural determinants to go unaddressed, this study deepens our understanding of how inequalities in these deaths are sustained and legitimised in marginalised places. The findings point to the need for future interventions to not only improve material conditions but also critically engage with the symbolic forces that reinforce geographic disparities in DoD.