Health inequalities 2025
While Northern Ireland has largely returned to pre-pandemic health levels, the Department of Health’s latest analysis reveals that significant inequalities persist across a range of health outcomes.
The Health Inequalities Annual Report 2025, produced as part of the Health and Social Care Inequalities Monitoring System (HSCIMS), highlights that although some indicators have improved, the overall picture remains one of deep and enduring disparity between the most and least deprived communities.
Deprivation gaps in life expectancy have shown little movement since the 2017-19 period. Male life expectancy at birth in 2021-23 stood 7.3 years lower in the most deprived areas compared to the least deprived, while the gap for females was 5.2 years. Both male and female life expectancy declined during the pandemic years but have since returned broadly to pre-Covid levels.
The inequality gap for disability-free life expectancy (DFLE) narrowed slightly for both sexes due to improvements in the most deprived areas. However, the gap for healthy life expectancy (HLE) remained wide at 13.6 years for males and 14.0 years for females. This means that those living in the most deprived fifth of areas can expect to spend more than a decade longer in poor health than those in the least deprived fifth.
While there were modest improvements in self-reported general health across all areas, other indicators point to the ongoing burden of long-term conditions. The prevalence of limiting long-term illness remains significantly higher in deprived areas, and the overall gap has shown no notable change.
Premature mortality and major diseases
Large inequality gaps persist across all measures of premature mortality. Deaths that are considered treatable through timely healthcare interventions have fallen across all deprivation levels, but preventable mortality, defined as deaths that might be avoided through public-health action or behaviour change, has worsened regionally. Preventable mortality in the most deprived areas is now around three times that of the least deprived.
The rate of respiratory deaths among those under 75 in the most deprived areas remains one of the most striking disparities, at nearly three-and-a-half times that of the least deprived. While deaths from cancer and circulatory diseases have declined over time, the inequality gaps have shown little change.
On major diseases, the report finds that hospital admissions for circulatory and respiratory illnesses decreased in all areas over the past five years, reflecting both service disruption during the pandemic and longer-term health trends. Prescription rates for antihypertensive and statin medications have risen across all areas, with higher usage in deprived communities. Cancer incidence has decreased marginally, though inequality remains constant.
Mental health
The report underscores continuing inequalities in mental health outcomes. Prescription rates for mood and anxiety disorders have increased in all areas between 2019 and 2023, with the rate in the most deprived areas around two-thirds higher than in the least deprived. Suicide remains a critical challenge. In 2021-23, the mortality rate in the most deprived areas was almost three times that recorded in the least deprived, and the gap has widened.
Alongside these findings, new indicators from the Health Survey Northern Ireland shed light on self-reported wellbeing. High levels of anxiety and loneliness were both more prevalent in deprived communities, reinforcing the connection between deprivation and poor mental health outcomes.
Alcohol, smoking, and drugs
Alcohol- and drug-related harms continue to represent some of Northern Ireland’s most severe health inequalities. Drug misuse deaths show the largest deprivation gap of all monitored indicators, with mortality in the most deprived areas nearly six times that of the least deprived. This gap has widened further since the previous reporting period.
Alcohol-specific mortality and alcohol-related admissions remain over twice as high in the most deprived areas as in the least deprived, while smoking in pregnancy and teenage births continue to record some of the widest inequalities. In 2023, the rate of smoking in pregnancy in the most deprived areas was more than six times the rate in the least deprived, despite reductions across all groups.
Early years and obesity
Progress has been recorded in some early-years indicators, including continued declines in teenage birth rates and smoking during pregnancy. However, substantial inequality persists. Childhood obesity remains a major concern: in 2023/24, the proportion of year eight pupils classified as obese in the most deprived areas was more than double that in the least deprived.
Sub-regional variations
At sub-regional level, life expectancy and health outcomes vary markedly across trusts and local government districts (LGDs). The Belfast LGD recorded the lowest male and female life expectancies (76.5 and 80.6 years respectively).
Male life expectancy was highest in Lisburn and Castlereagh (80.9 years), and female life expectancy was highest in Ards and North Down and Mid Ulster (83.4 years).
Inequality within trust and LGD areas mirrors the regional pattern. Drug misuse mortality was the largest inequality gap in three of the five Health and Social Care trusts. In the Belfast and Western trusts, mortality rates in the most deprived areas were more than twice the Trust average. Similarly, in Mid and East Antrim, drug-related deaths in the most deprived areas were almost three times the LGD average.
Alcohol-related admissions and mortality also feature prominently among the largest local gaps. In several districts, including Derry City and Strabane and Lisburn and Castlereagh, rates in the most deprived areas were more than double the area average.
Analysis
The Department of Health’s report outlines longstanding health inequalities within the broader context of the Making Life Better public-health framework, highlighting the social and economic factors that shape health outcomes. The analysis outlines that while overall health indicators show gradual improvement, progress in narrowing the inequality gaps has been limited.
Many of the challenges, such as drug misuse, mental health challenges, and early years deprivation, align closely with wider socioeconomic disparities. The report stresses that addressing these will require cross-government collaboration and long-term investment beyond the health sector, encompassing housing, education, employment, and community development.
Speaking to agendaNi, Health Minister Mike Nesbitt MLA said that the latest stats on health inequalities “would suggest we have at least stemmed the tide”.
He adds: “It is a question of trying to reverse it, and it is an old Executive challenge because our research would suggest only 20 per cent health interventions deal with it. It is 40 per cent socioeconomic, 10 per cent environment, and the final 30 per cent would be behaviours such as smoking, alcohol, and substance use.
“We need the whole Executive to tackle that in the same way we need the Executive to tackle the other two big, sticky, long-lasting problems of educational underachievement and economic inactivity.”
