Why ‘deaths of despair’ are higher in former coal mining communities

Life expectancy in the UK has risen dramatically since the Industrial Revolution. For more than a century, people lived increasingly long and healthy lives. But around the turn of the millennium, that progress began to slow. In 2015, economists Anne Case and Angus Deaton published a landmark study showing something unexpected. From the late 1990s onwards, death rates among middle-aged white Americans without university degrees had started to rise. Three causes of death were driving the trend: suicide, drug overdoses and alcohol-related disease. Case and Deaton called these “deaths of despair” and they have been a topic of research in public health ever since. Although deaths of despair were originally thought to be a specifically American problem, researchers have been concerned that similar patterns exist elsewhere. New research from my colleague Eurwen Williams and myself suggests they do. And in England and Wales, they are particularly common in one type of place: former coal mining communities. Coal once powered the UK’s economy. At its peak in 1920, the industry employed more than 5% of the entire UK workforce. Mining shaped towns and villages across England, Wales and Scotland. Work was hard, but it provided stable employment and strong communities. That began to change in the late 20th century. Competition from imported coal, the shift to oil and gas, and political conflict between miners and government accelerated the industry’s decline. The confrontation reached its peak during the 1984 to 1985 miners’ strike against the government of Margaret Thatcher. Within a generation, most mines had closed. For many coalfield communities, the economic shock was profound. Jobs disappeared. Local economies struggled to recover. And many areas have never fully recovered. We wanted to understand whether this long economic transition has left a lasting mark on public health. For our study we examined whether deaths of despair are more common in former coal mining areas than elsewhere. To do this, we linked death registration data from the Office for National Statistics with historical records of coal mines and the dates they closed. This allowed us to compare mortality rates between areas with a history of coal mining and those without. We analysed deaths between 2015 and 2023 and looked specifically at three causes – suicide, alcohol-related deaths and drug poisoning. What we found was striking. Across England and Wales, deaths of despair were consistently higher in communities that once relied on coal mining. Alcohol-related deaths were particularly elevated. In some coalfield areas, they were between 27% and 52% higher than in places without a mining history. Drug poisoning deaths were also much more common, running 23% to 53% higher than elsewhere. While suicide rates were higher too, the difference was smaller, roughly 7% to 19% higher. Perhaps most striking was the fact that these patterns appeared even in places where coal mining ended more than 50 years ago. More than just poverty At first glance, it may seem obvious why this happens. Former coalfield areas tend to be poorer than other parts of the country. Poverty is closely linked to poorer health. But when we adjusted our analysis to account for differences in deprivation, something interesting happened. The gaps became smaller but they didn’t disappear. Former coal mining communities still had significantly higher rates of alcohol-related deaths and drug poisoning. Suicide rates also remained elevated in areas where mines closed more recently. In other words, poverty alone cannot explain the pattern. Something deeper appears to be at work. The legacy of industrial decline can shape communities in ways that standard economic measures struggle to capture. The loss of stable employment, the weakening of social institutions and long-term uncertainty about the future can all leave lasting effects. These pressures may contribute to the kinds of distress that lead to deaths of despair. A wider pattern of health inquality Our findings fit with a growing body of research on health in former coalfield communities. Previous studies have found higher rates of mental health problems in these areas. Others have identified other public health issues, including greater use of anabolic steroids and lower uptake of COVID-19 vaccines. Taken together, these studies suggest the effects of deindustrialisation can persist for decades. Coal may be gone, but the consequences remain. The decline of coal is one of the clearest examples in modern Britain of how economic transitions can reshape communities. It shows how the effects of industrial change can outlive the industries themselves. Many economists believe the world may be entering another major economic shift. Advances in artificial intelligence are already beginning to reshape parts of the labour market. History suggests these transitions need to be managed carefully. For decades, the UK has often relied on markets to absorb economic shocks, with limited industrial strategy to support the places most affected. But our findings highlight what can happen when communities face large economic changes without timely support. The story of Britain’s coalfields is not just about the past. It is a reminder that economic transitions leave deep marks on people and places. And if we want to avoid repeating those mistakes, we need to learn from them.

Christopher Saville has received funding from the British Academy, for work on coalfield health.