Health inequalities are avoidable, unfair and systematic differences in health between different groups of people. There are many kinds of health inequality, and many ways in which the term is used. That\u2019s why, when we talk about \u2018health inequality\u2019, it\u2019s useful to be clear about which measure is unequally distributed and between which people.<\/p>\n<\/div><\/div><\/div>
Note:\u00a0<\/strong>This explainer was updated on 3 September 2025. It was previously updated on 17 June 2022 and originally published in February 2020.<\/p>\n<\/div><\/div><\/div><\/div><\/div> Health inequalities are ultimately about differences in the status of people\u2019s health. But the term is also used to refer to differences in the care that people receive and the opportunities that they have to lead healthy lives \u2013 both of which can contribute to their health status. Health inequalities can therefore involve differences in:<\/p>\n Differences in health status, and the things that determine it, can be experienced by people grouped by a range of factors. In England, health inequalities are often analysed and addressed by policy across four types of factors:<\/p>\n People experience different combinations of these factors, which has implications for the health inequalities they are likely to experience. This means that people grouped according to one factor, such as disabled people or people from a particular\u00a0ethnic background<\/a>, will not be homogeneous \u2013 there will be variation in health profiles and risks within any given population group. The way these factors combine and interact with each other also influences the health inequalities people experience. This is often referred to as \u2018intersectionality<\/a>\u2019 \u2013 for example, women experiencing homelessness have\u00a0distinct health risks and needs<\/a>\u00a0compared with men experiencing homelessness.<\/p>\n This explainer provides an overview of how health inequalities are shaped and experienced in England\u2019s population. Where possible, we use the most recent data available, primarily data from 2021\u20132023.<\/p>\n<\/div> Life expectancy<\/a>\u00a0is a key measure of a population\u2019s health status. Inequality in life expectancy is therefore one of the foremost measures of health inequality.<\/p>\n Life expectancy is closely related to people\u2019s socio-economic circumstances. The most common summary measure of these circumstances across a population is deprivation. The\u00a0index of multiple deprivation<\/a>\u00a0is a way of summarising how deprived people are within an area based on a set of factors that includes their levels of income, employment and education as well as local levels of crime.<\/p>\n In England, there is a systematic relationship between deprivation and life expectancy, sometimes known as the\u00a0social gradient in health<\/a>. The most recent data available of this type shows that at a national level in 2020\u20132022, women living in the least deprived 10% of areas could, at birth, expect to live to 86.1 years old, whereas women in the most-deprived 10% of areas could expect to live to 77.7 years \u2013\u00a0a gap in life expectancy of 8.4 years<\/a>. For men, this gap was even wider, with a difference of 10.4 years between the life expectancy for those in the least deprived 10% of areas (83.0 years) and the most deprived 10% of areas (72.6 years). In recent years, inequalities in life expectancy by deprivation have\u00a0widened<\/a>.<\/p>\n This social gradient relationship holds true across the whole population \u2013 health inequalities are experienced by everyone, not just between those at the very bottom and top. Figure 1 shows how during 2021\u20132023 in England local deprivation was linked to life expectancy.<\/p>\n Figure 1: Inequalities in life expectancy by local deprivation level<\/strong> There are also geographical inequalities in life expectancy. In 2021\u20132023, the North East of England experienced\u00a0the lowest life expectancy at birth for both men and women across England\u2019s regions<\/a>, followed by the North West. In the four most southerly English regions , life expectancy was higher than the England average, whereas in all other regions, life expectancy was lower than the England average.<\/p>\n The north of England has a higher concentration of deprived neighbourhoods than the south of England, and therefore a greater proportion of communities where life expectancy is likely to be lower based on their levels of deprivation. But in addition to this, for any given level of deprivation,\u00a0life expectancy in the north of England is lower than in the south of England<\/a>.<\/p>\n The differences in life expectancy at birth in 2021\u20132023 by local authority areas: For women, the gap between the area with the lowest life expectancy (Blackpool, at 78.9 years) and the area with the highest (Kensington, at 86.5 years) is 7.5 years. For men, the gap is 10.3 years, between Blackpool (73.1 years) and Hart, Hampshire (83.4 years).<\/p>\n Some population groups have significantly shorter life expectancy than the general population. For example, as of 2022, the median age at death for\u00a0people with learning disabilities was 63 years<\/a>, which is more than 20 years younger than the general population.<\/p>\n Inequalities in life expectancy exist between ethnic minority and white British groups, as well as between different ethnic minority groups. The picture of health inequalities by ethnicity in general is both\u00a0complex and limited by imperfect data<\/a>. Since 2021, the Office for National Statistics (ONS) has linked death records to other data sources, for example census and hospital records, to provide the best available national data on mortality by ethnicity.\u00a0ONS statistics\u00a0<\/a>suggest that in 2021\u201323, mortality rates from all causes of death were lower for ethnic minorities than white British. This may be due in part to the \u2018healthy migrant effect<\/a>\u2019, whereby people who migrate tend to be in good health, as well as lower rates of\u00a0smoking\u00a0<\/a>and\u00a0alcohol consumption<\/a>\u00a0in ethnic minority groups compared with white groups.<\/p>\n Another key measure of health inequality is how much time people spend in good health over the course of their lives, given how crucial good health is to quality of life and people\u2019s ability to do the things that they value.<\/p>\n A widely used measure for this is healthy life expectancy. This estimates time spent in \u2018good\u2019 or \u2018very good\u2019 health based on how people perceive and report on their general health.<\/p>\n The gap in healthy life expectancy at birth by deprivation is stark. The most recent data available of this type shows that nationally in 2020\u20132022, people living in the least deprived areas could expect to live almost\u00a0two decades longer in good health<\/a>\u00a0than those in the most deprived areas. People in the most deprived areas spend around a third of their lives in poor health, nearly twice the proportion spent by those in the least deprived areas. This means that, on average, people in more deprived areas spend a greater part of their already far shorter lives in poor health.<\/p>\n Again, geographical inequalities exist in this measure. In 2021\u201323,\u00a0healthy life expectancy at birth for women<\/a>\u00a0in the North East of England was 57.5 years, compared with 64.4 years for women in the South East, a gap of 6.9 years. For\u00a0men<\/a>, this gap was 6.6 years.<\/p>\n Deaths are considered\u00a0avoidable<\/a>\u00a0if they could have been averted or delayed through timely, effective health care (known as \u2018treatable mortality\u2019) or wider public health and preventive interventions (known as \u2018amenable mortality\u2019). In 2023, more than\u00a0117,000 deaths<\/a>\u00a0in England (roughly 1 in 5) were considered avoidable.<\/p>\n Differences in rates of avoidable mortality between population groups reflect differences in people getting the help they need to address life-threatening health risks and illnesses. In England, in 2023, women in the most deprived areas were\u00a03.5 times more likely to die from an avoidable cause<\/a>\u00a0than those in the least deprived areas. Men in the most deprived areas were 3.9 times more likely to die from an avoidable cause than those in the least deprived areas.<\/p>\n Blackpool had the highest rate at 454.4 deaths per 100,000, almost three times higher than the lowest area, which was Hart at 1118.1 per 100,000.<\/p>\n Long-term conditions are a major cause of\u00a0poor quality of life<\/a>\u00a0in England. People on the lowest incomes or living in areas of high deprivation\u00a0are\u00a0more likely to acquire more multiple long-term conditions<\/a>, and at a younger age, than people on the highest incomes or those living in areas of low deprivation. On average, people in the most deprived decile of the population develop multiple long-term conditions\u00a0seven years earlier<\/a>\u00a0than those in the least deprived decile.<\/p>\n People identifying as white Gypsy and Irish Traveller\u00a0report the poorest<\/a>\u00a0health and are most likely to report limiting long-term illness.<\/p>\n Assessing differences in the prevalence of mental illness between social groups is challenging and complex, because rates of recognition, reporting and diagnosis are likely to vary between groups. Existing evidence is\u00a0patchy and inconsistent<\/a>, but data from a variety of sources highlights a range of differences in how mental illness and treatment for mental illness is experienced.<\/p>\n First,\u00a0data suggests<\/a> that demand for mental health services is higher among more deprived communities. Figure 2 shows that in England in 2019\/20, both the rate of attended contacts with community and outpatient mental health services and the rate of inpatient stays in secondary mental health services were higher among more deprived populations.<\/p>\n Figure 2: Use of mental health services is higher in more deprived areas<\/strong> Second, existing evidence suggests that inequalities in various types of mental ill-health exist across a range of protected characteristics, including sexual orientation, disability, sex and ethnicity.<\/p>\n Several socially excluded groups have been shown to experience higher rates of mental ill-health than the general population. For example,\u00a0more than 80% of people experiencing homelessness report having a mental health difficulty<\/a>, and in 2021 people in this group were\u00a013 times<\/a>\u00a0more likely than those in the general population to die by suicide.\u00a0Asylum seekers and refugees<\/a>\u00a0are also at increased risk of experiencing depression, post-traumatic stress disorder and other anxiety disorders.<\/p>\n There is also substantial evidence of\u00a0ethnic differences in pathways into psychiatric care<\/a>\u00a0across England. For example, in 2023\/24 use of the Mental Health Act among the Black or Black British group were\u00a0three and a half times higher<\/a>\u00a0than the white group. In addition, access to mental health services through general practice has been found to be less likely for people in the Black group compared with people in the white group. This has been\u00a0linked in part to\u00a0higher rates of serious mental illness<\/a>\u00a0in this group as well as to\u00a0racism and discrimination<\/a>\u00a0within services.<\/p>\n Access to health services refers to the availability of services that are timely, appropriate, easy to get to and use, and sensitive to user choice and need. Inequitable access can result in particular groups receiving less care relative to their needs, or more inappropriate or sub-optimal care, than others, which often leads to poorer experiences, outcomes and health status. Access to the full range of services that can have an impact on health includes access to preventive interventions and social services, as well as primary and secondary health care.<\/p>\n Inequitable access might mean that a group faces particular\u00a0barriers\u00a0<\/a>to getting the services they need, such as real or anticipated discrimination or challenges around language. It can mean that information is not communicated in an easily understandable or culturally sensitive way. These issues are often reported for\u00a0asylum seekers and refugees<\/a>\u00a0and\u00a0Gypsy, Roma and Traveller communities<\/a>, in particular.<\/p>\n Access can be measured in terms of service availability and uptake.\u00a0People living in poverty and more deprived areas<\/a>\u00a0tend to find it harder to access services. For example, more deprived areas tend to have\u00a0fewer GPs per head<\/a>\u00a0and\u00a0lower rates of admission to elective care<\/a>\u00a0than less deprived areas, despite having a higher disease prevalence.<\/p>\n Different social groups might also have systematically\u00a0different experiences<\/a>\u00a0within the services that they use, including in terms of the quality of care they receive and whether they are treated with dignity and respect. For example, a\u00a0recent review<\/a>\u00a0commissioned by the NHS Race and Health Observatory found evidence of women from ethnic minority backgrounds experiencing \u2018stereotyping, disrespect, discrimination and cultural insensitivity\u2019 when using maternal and neonatal health care services. To take another example, in a\u00a0study commissioned<\/a>\u00a0by Stonewall, 13% of LGBT respondents reported experiencing unequal treatment from health care staff because they were LGBT, with this number rising to 32% for people who are transgender and 19% for LGBT people from ethnic minority backgrounds. The differences between groups in this latter example demonstrate how using intersectional lenses gives us a more precise picture of health inequalities.<\/p>\n<\/div> The examples previous show systematic differences across various measures of health for different population groups in England. This section explores differences in the likelihood of engaging in healthy or unhealthy behaviours, and differences in the wider determinants of health. Both involve differences in the health risks that people are exposed to and in the opportunities they have to lead healthy lives.<\/p>\n People\u2019s behaviour is a major determinant of how healthy they are.\u00a0S<\/a>moking, poor diet, physical inactivity and harmful alcohol consumption<\/a>\u00a0are leading risk factors that drive preventable ill health and premature mortality in England. Behavioural risks to health are more common in some parts of the population than in others. The distribution is patterned by measures of deprivation, income, sex and ethnicity, and risks are concentrated in the most disadvantaged groups. For example, in England in 2022,\u00a0the proportion of adults who were smokers<\/a>\u00a0in the lowest income quintile was 21%, compared with 9% in the highest income quintile.<\/p>\n Higher-risk health behaviours also tend to\u00a0cluster<\/a>\u00a0together in certain population groups, with individuals in disadvantaged groups more likely to engage in more than one risky behaviour. The prevalence of\u00a0multiple higher-risk behaviours<\/a>\u00a0varies significantly by deprivation.<\/p>\n Health-related behaviours are shaped by cultural, social and material circumstances. For example,\u00a0recent analysis<\/a>\u00a0suggests that, after housing costs, the poorest fifth of UK households with children would need to spend 70% of their income on food in order to follow the government\u2019s official guidance on a\u00a0healthy diet<\/a>\u00a0\u2013 compared with only 12% of income for the richest fifth of households.<\/p>\n Furthermore,\u00a0evidence<\/a>\u00a0suggests that some people\u2019s circumstances make it harder for them to move away from unhealthy behaviours, particularly if they are worse off in terms of socio-economic factors such as debt or poverty. This is compounded by differences in the environments in which people live \u2013 for example, in 2024 the most deprived decile of area had twice as many\u00a0fast food outlets<\/a>\u00a0per person than the least deprived decile of areas. This indicates that interventions aimed at\u00a0changing behaviours<\/a>\u00a0need to be able to adapt to the reality of people\u2019s lives, addressing the contexts in which behaviours take place and recognising the challenges of achieving behavioural change under conditions of stress.<\/p>\n The wider determinants of health are the social, economic and environmental conditions in which people live that have an impact on health. They include income, education, access to green space and healthy food, the work people do and the homes they live in. It is\u00a0widely recognised<\/a>\u00a0that, taken together, these factors are the principal drivers of how healthy people are, and that inequalities in these factors are a fundamental cause of health inequalities.\u00a0Addressing these wider socio-economic inequalities<\/a>\u00a0is therefore a crucial part of reducing health inequalities.<\/p>\n Table 1 provides some examples of health impacts relating to a range of wider determinants. The examples focus on individual determinants, but these determinants are often experienced together and cumulatively over time. Particular groups can be disadvantaged across a number of factors, and these disadvantages can be mutually reinforcing.<\/p>\n Table 1:<\/strong><\/p>\n\nWhat are health inequalities?<\/h3><\/a><\/li>
Life expectancy inequalities<\/h3><\/a><\/li>
Pathways to health inequalities<\/h3><\/a><\/li>
Interactions between factors<\/h3><\/a><\/li>
The impact of Covid-19<\/h3><\/a><\/li>
Tackling health inequalities<\/h3><\/a><\/li><\/ul><\/div>
What are health inequalities?<\/h3><\/a><\/li><\/ul><\/div>
Inequalities of what?<\/h3>\n
\n
Inequalities between who?<\/h3>\n
\n
Life expectancy inequalities<\/h3><\/a><\/li><\/ul><\/div>
Inequalities in life expectancy<\/h3>\n
\nLife expectancy at birth (2021-2023) by local area indices of multiple deprivation (2019)<\/p>\n![](\"https:\/\/ourdorset.org.uk\/inequalities\/wp-content\/uploads\/sites\/3\/2026\/03\/figure-1-inequalities.png\")
<\/a><\/span><\/div><\/div>\nInequalities in healthy life expectancy<\/h3>\n
Inequalities in avoidable mortality<\/h3>\n
Inequalities in long-term health conditions<\/h3>\n
Inequalities in mental-ill health<\/h3>\n
\nRate per 100,000 people, 2019\/20<\/p>\n![](\"https:\/\/ourdorset.org.uk\/inequalities\/wp-content\/uploads\/sites\/3\/2026\/03\/figure-2-inequalities.png\")
<\/a><\/span><\/div><\/div>\n\n
Inequalities in access to and experience of health services<\/h3>\n
Pathways to health inequalities<\/h3><\/a><\/li><\/ul><\/div>
Behavioural risk factors<\/h3>\n
The wider determinants of health<\/h3>\n