All lives are existentially arbitrary. First by the chance of geography into which you are born and the wealth or poverty of the family you inherit – the ineffable coincidence of you being born you; then by the biological and genetic make-up predisposing you to long life or an early grave, and the lifestyle preferences, choices and accidents that will corral you along that path. Yet in each of these concentric spheres, the ostensible randomness of individual luck and choice masks the deeper systemic effect of political choices and societal arrangements – within countries and between them – shaping the material conditions and level of empowerment into which you are born and through which you grow, learn, earn, age and die.

Between 2015 and 2018, infant death in the United States was 2.3 times higher among Black Americans than White, and three times higher in poorer, rural communities. Risk of maternal mortality was 2.4 times higher for Black than for White American women – 120 per cent higher for mothers in the most-deprived areas (Singh et al, 2017; Singh, 2021). Inequality in life expectancy between rich and poor quintiles in the US has grown in the last three decades from five to 12 years for men, and 14 for women, an effect strongly correlated with race and ethnicity (NAS, 2015; Dwyer-Lindgren et al, 2017).

In the last decade, Washington, DC, Baltimore and Glasgow have seen a 20-year gap in male life expectancy between wealthy and poor neighbourhoods (Marmot, 2015; Matheson et al, 2020). Travelling from midtown Manhattan to the South Bronx in New York City, life expectancy declines by ten years – six months foregone for every minute on the subway (Berwick, 2020). Across Europe, increases in life expectancy have concentrated among the socially and economically better-off; in the UK, longevity in the most deprived areas has stalled and started to fall, widening the gap in life expectancy – a phenomenon not seen since the late 19th century (Leon, 2011; Bennett et al, 2018; Mackenbach, 2019; Marmot, 2020).

Across the world, people with lower social status live shorter, less healthy lives. Poor families experience higher levels of infant and child mortality than their rich neighbours (WHO, 2008; Suzuki et al, 2012). Although inequality in child mortality fell during the MDGs period, in 2015 the rate of child death in poor households was still 12.2 times higher than in wealthier families. Countries with the fastest rates of aggregate child survival improvement also saw inequality along socioeconomic and cultural lines widen (Cha and Jin, 2020).