Living in the North of England increases risk of death from alcohol, drugs and suicide

People living in the North of England and in coastal areas are more likely to die from ’death of despair’, according to new University of Manchester led research.

The new analysis shows that between 2019 and 2021, 46,200 people lost their lives due to Death of Despair in England - the equivalent of 42 people every day.

However, in the North East of England more than twice as many people lost their lives due to Deaths of Despair compared to London.

Deaths of Despair is a collective term for deaths from alcohol, drugs and suicide, which tend to occur much more frequently in socially deprived communities.

The study, led by academics from Health Equity North (HEN), the University of Manchester and the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) examined local authority data to identify geographical trends and risk factors that contribute to these kind of deaths.

The analysis found that northern regions and coastal areas of England are experiencing a much higher burden of mortality from these avoidable causes.

Out of the 20 local authority areas that experience the highest rates of Deaths of Despair, 16 are in the North, and all’of the top 10 areas are in the North.

Conversely, none of the 20 local authorities with the lowest rates of Deaths of Despair are in the North.

Time and time again, we see research exposing regional inequity with the North of England often being hit the hardest. Unsurprisingly, the findings of this study further highlight the persistent health inequalities in northern regions. This can’t be ignored - it is not acceptable that more than twice as many people in some deprived communities in the North are dying due to deaths of this nature
The analysis also looked at associated factors that predict the risk of these kinds of deaths; living in the North was the strongest predictor. Local authorities with higher proportions of unemployment, white British ethnicity, people living alone, economic inactivity, employment in elementary occupations, and people living in urban areas had higher rates of Deaths of Despair.

The study found that:
  • On average, 14.8 per 100,000 more people die from Deaths of Despair in the North compared to the rest of England
  • Even after accounting for multiple social and economic factors, living in the North of England was associated with a 5.8 per 100,000 increase in Deaths of Despair rate
  • More than twice as many people died from Deaths of Despair in the North East of England than they did in London (54.7 per 100,000 and 25.1 per 100,000 respectively)
  • The highest rate of Deaths of Despair in England (at local authority level) is in Blackpool - almost 2.5 times the national average
  • Three areas in England, all’in the North, experienced more than double the average Deaths of Despair - Blackpool (83.8 in 100,000 deaths), Middlesbrough (71.6 per 100,000 deaths) and Hartlepool (70.5 per 100,000 deaths)
  • Alcohol-specific deaths made up almost half of Deaths of Despair in England, accounting for 44.1% of all such deaths
  • Deaths of Despair accounted for 2.9% of all deaths in England
  • Deaths of Despair were highest among people aged 45-54 (55 per 100,000)
  • Deaths of Despair accounted for 2 in 5 deaths in people aged 25-29 (41.1% of all deaths)
  • Coastal local authorities had a significantly higher average Deaths of Despair rate than inland local authorities (41.6 per 100,000 compared to 31.5 per 100,000)


The study is believed to be the first of its kind to explore geographical patterning and contributing causes of deaths of despair in England.

The researchers are calling on government to prioritise preventative policies which address the longstanding inequalities across England, with fair funding allocation distributed according to need.

Christine Camacho, lead author and PhD Fellow NIHR ARC-GM, said: "Our study shows that some of the risk factors of deaths of despair have a more pronounced impact in the North of England, where inequalities in health and wealth are persistent and have widened during recent decades.

"As well as specific public health interventions to prevent deaths from drugs, alcohol and suicide, we need to move further and faster with Levelling Up in England to tackle the underlying inequalities which are leading people to die from despair."

Dr Luke Munford, Co-Academic Director at Health Equity North, and Senior Lecturer in Health Economics at the University of Manchester, said : "Time and time again, we see research exposing regional inequity with the North of England often being hit the hardest. Unsurprisingly, the findings of this study further highlight the persistent health inequalities in northern regions. This can’t be ignored - it is not acceptable that more than twice as many people in some deprived communities in the North are dying due to deaths of this nature.

"This research provides policymakers with a novel insight into the associated social factors of deaths of despair, which can help when developing comprehensive strategies that not only target specific risk factors but also consider the intricate relationships among these causes, contributing to more effective prevention and intervention efforts."

Read the full academic paper published in Social Science and Medicine Journal here - the paper includes a supplement with the Death of Despair rates for all local authorities in England.