REGIONAL MORTALITY DIFFERENCES IN WESTERN EUROPE: A REVIEW OF THE SITUATION IN THE SEVENTIES* FRANS W. A. VAN POPPEL Netherlands Interuniversity Demographic Institute. Voorburg. The Netherlands Abstract-A comparison of data from nearly 260 regions in Western Europe during the period from 1969 to 1977 reveals regional differences of 11.0 years in life expectation at birth for males as well as females (from 73.6 to 62.6 years for males and from 79.2 to 68.5 years for females). The causes of these differences are still inadequately explored: however, it appears that male mortality is often relatively higher in the regions that are most highly urbanized and where mining and heavy industry or dockyards are concentrated. In contrast. the populations of predominantly agricultural regions appear to enjoy a . . higher life expectation. zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA INTRODUCTION While maintaining a system of private enterprise and parliamentary democracy, the governments of a large number of Western European countriest have tried to put an end to the worst forms of inequality by guar- anteeing every citizen a home, a minimum wage and access to health and educational facilities [l]. This pursuit of greater social and economic equality began quite recently in some European countries (for example Spain and Portugal), whereas in others (for example the Netherlands, England and Sweden), the process had already begun before the Second World War. We can reasonably expect that these policies, especially in the latter group of countries, would have brought to an end the most dramatic form of in- equality that we know, that of “the ability to survi- ve-duration of life itself’ [Z]. After all, a large number of government policies were directed towards those forms of social inequality that had a negative influence on the life expectancy of the least privileged groups. Recent research in Norway, England and France has shown however, that this policy of lowering the level of social and economic inequality did not mean the end of inequality in life chances between the least privileged and the most privileged groups (in terms of education, income and professional status) in society. Information on social inequality with respect to death is not available for all Western European countries. I would nonetheless like to attempt a rough answer to the question of whether social equality in the duration of life has been achieved in Western Europe as a whole. This answer will be based on data referring to regional differences in the mean duration of life in the countries of Western Europe. *This article is an enlarged and updated version of a paper. presented to a WHO/UN meeting on socioecon- omic determinants and consequences of mortality. held in Mexico City in June 1979. t For the purpose of this article. Western Europe com- prises the Common Market countries, Scandanavia. the Iberian peninsula. Austria and Switzerland Inequality in the expectation of life between regions in a country can be seen as an indication of the exist- ence of social inequality with respect to death. As such, we can assume that, if there is a difference in mortality between two regions, then the variables re- sponsible for the level of mortality (style of living, accessibility to and availability of various social, econ- omic and health facilities, motivations for using these facilities, etc.) will have different values in the one region than in the other. If considerable differences in regional mortality levels are found, then our conclu- sion can be that complete equality with respect to the social factors relevant to the mortality risks of the individual does not yet exist in Western European society. I deliberately stress social factors because in the Western European context, little real importance can be attached to genetic differences between popu- lation groups or differences in the physical geography of regions within countries. Furthermore, social factors not only include ihose circumstances beyond the control of the individual that negatively influence his or her probability of sur- vival by denying certain things essential to health status. It can also be argued that certain patterns of behaviour at an individual level, for which there is a certain amount of personal choice involved (smoking, drinking, driving manners, nutrition), are also social factors, because the frequency at which they occur differs from region to region. One must doubt how- ever, whether the influence of the causes of these dif- ferences can be fitted into the framework of a policy of greater equality. An exact answer to the question as to whether the pursuit of more social and economic equality has been successful or not is made even more difficult by the fact that where these policies have had a positive result, new forces may have been put into practice that have led to a reduction of the life chances of the formerly less privileged groups, for example a higher mortality resulting from the ability to buy a private car. Due to all these circumstances, the usefulness of our data remains limited. As a general indication of the social inequality with respect to death however. they remain. in my opinion, useful. 341