A global overview of mortality inequalities between countries and by ranked socio-economic circumstances within...

Health inequalities are seen between populations, social groups in the same population and across populations ranked by social position. This paper focuses on trends in inequalities between countries and socio-economic inequalities in mortality within them. Mortality in most countries has improved since 1950 with some exceptions, notably: Younger adults in parts of Sub-Saharan Africa were associated with civil war, structural adjustment programmes and human immunodeficiency virus during the 1980s/1990s; the former USSR after the rapid adoption of neoliberal economic policies; European countries which implemented austerity in the 2010s; and globally in the shadow of COVID-19. Mortality differences between countries have narrowed, with the gap between the best and worst thirds of countries declining from 20.5 years for males and 22.6 years for females in 2000 to 15.6 years and 16.0 years, respectively, by 2021. Data for within-country inequalities are sparse and subject to measurement issues. Where trend data are available, they vary according to location and political context. For example, across many high-income countries, mortality inequalities improved in absolute terms between the 1990s and the early 2010s; however, relative inequalities widened. Inequalities in parts of Europe widened after 2012, reflecting austerity policies impacting the social and economic determinants of health, particularly for the poorest. Comparisons of between-country levels of inequality are problematic due to uncertainties of data recording and comparability; nonetheless, existing evidence demonstrates wider inequalities within particular 'neoliberal' political contexts. Future challenges include addressing such political determinants alongside the overlapping threats of climate change, social polarization, misinformation and erosion of democratic structures.