“The industry died… the towns went right down”: Structural Violence and Deaths of Despair in North East England

Abstract

The rise in mortality in high-income countries from drug, suicide, and alcohol-specific causes (DSA), referred to collectively as ‘deaths of despair’, has received growing interest from researchers since 2015. While this increase in mortality has been most pronounced within the United States (US), there is growing concern about deaths by these causes in the United Kingdom (UK). In both the US and the UK, mortality rates from deaths of despair are higher in deprived, deindustrialised communities and follow pre-existing patterns of geographic health and wealth inequality. In this qualitative study, I sought to learn how people living and working in areas with above-average prevalence of DSA mortality understand and explain the prevalence of deaths from these causes locally. Data were collected through in-depth, semi structured interviews with 54 professional stakeholders and community members in Middlesbrough and South Tyneside. Participants identified several individual, cultural, and structural level determinants that they believed drove DSA mortality in their communities. I make the argument that the existence and influence of these determinants are best understood through the theoretical lens of structural violence. The theoretical framing of the determinants of DSA mortality as a product of structural violence provides a novel perspective of how individual, cultural, and structural determinants influence DSA mortality. It also underscores the need for approaching the problems presented by ‘deaths of despair’ as issues rooted in social injustice. The findings from this study constitute a novel contribution to the literature surrounding ‘deaths of despair’ in the UK, which is currently dominated by research using quantitative methods. In this thesis, I demonstrate that ‘deaths of despair’ are a manifestation of broader social inequality; interventions seeking to prevent deaths from these causes must address the structural violence that has given rise to the conditions in which people initiate DSA behaviours.