The Great Leap: explaining the steepest part of the socio-spatial gradient in life expectancy in England

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Abstract
Background: Socio-spatial health inequalities are increasing in England, as in many other high-income countries. While most research focuses on inequalities between the extreme ends of the deprivation continuum, a less recognised but critical pattern is that the largest gap within the socio-spatial gradient occurs at its lower end - between the two most deprived fifths. Our aim was to understand the drivers of this gap. Methods: Using aggregate-level data from official national statistics for a period 2015–2022 and Blinder–Oaxaca decomposition, we provide the first empirical examination of the contributors to the life expectancy gap between the most and second most deprived fifths of local authorities in England and compare these findings with the more conventional comparison between the most and least deprived areas. We assess the relative contributions of material, behavioural, psychosocial, and political economy factors. Results: We find that household income accounts for around a third of the life expectancy gap between the two most deprived fifths of local authorities for both men and women (30% and 35%, respectively). It contributes more to inequality at the bottom end of the socio-spatial distribution than between the most and least deprived local authorities. Welfare benefit losses are the next greatest contributor. Conclusion: Household income and welfare benefit losses were the strongest contributors to life expectancy inequalities between the two most deprived fifths of local authorities, highlighting the importance of income and wider political economy determinants of health inequalities.
Funding Information
  • National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (n/a)
  • Wellcome Trust (221266/Z/20/Z)

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