Key points:

• This briefing compares trends in mortality within the UK and with 21 high-income countries, based on new research by the London School of Hygiene and Tropical Medicine. The findings are stark, underlining deep inequalities in health between different parts of the UK and a worrying decline in UK health compared with international peers.
• Improvements in UK mortality rates slowed significantly in the 2010s, more than in most of the other countries studied. By 2023, the UK female mortality rate was 14% higher than the median of peer countries and the UK male mortality rate was 9% higher. For both, the gap to the median widened significantly after 2011, and the UK’s ranking relative to peer countries has now worsened.
• Improvements in mortality rates slowed across all UK nations and regions in the 2010s – but there are significant geographic inequalities. Scotland, Wales and Northern Ireland all have higher mortality rates than England. Scotland is performing particularly poorly – of the countries studied, in 2021 only the US had a worse mortality rate. In 2021, mortality rates were 20% higher in the North East and North West of England than in the South West.
• People aged 25–49 have seen a particularly pronounced relative worsening of mortality rates. In 2023, UK female mortality rates for this age group were 46% higher than the median of peer countries, while male rates were 31% higher. Of the other countries studied, only Canada and the US experienced a similar worsening of mortality rates among this age group over the 2010s. This worsening of mortality rates is a sign of ill health in the working-age population, acting as a drag on economic growth.
• Of the main three causes of death for people aged 25–49, mortality rates for cancers and circulatory diseases improved between 2001 and 2019, but rates worsened for deaths from external causes. Deaths from external causes explain between 70% and 80% of the divergence in UK mortality rates compared with the median of peer countries over this period.
• While in the 2010s alcohol-related mortality rates for people aged 25–49 plateaued or declined and mortality rates for suicide (and undetermined intent) slightly increased, the rate of drug-related deaths rose sharply. In contrast, rates of drug-related deaths continued to decline for peer countries. As a result, the drug-related mortality rate in the UK was more than three times higher in 2019 than the median of peer countries.
• Geographic inequalities in drug-related deaths are stark among people aged 25–49. In 2019, the drug-related mortality rate in Scotland was around 4 times higher than in England. Within England, the drug-related mortality rate in the North East was 3.5 times higher for men and almost 4 times higher for women than in London.
• With the UK comparing poorly with many other high-income countries, improvement is both possible and urgently needed. This will require long-term action for economic recovery in areas of long run industrial decline; a strong focus on prevention; investment in public health services and action to address risk factors such as smoking, alcohol and poor diet; and a concerted effort to tackle drug-related deaths.
• These actions should be brought together in a clear strategy for tackling health inequalities. The UK government’s health mission promised just such an approach, but progress so far has been slow. This needs to change or the UK’s health will fall further behind its international peers.