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Progress in health during the second half of the 19th century and the early decades of the 20th century led to a monumental decline in mortality in industrialised economies, often referred to as the mortality transition. By the end of the transition, mortality disparities across areas that had differed in their socioeconomic conditions since the early 19th century had also narrowed, suggesting that, ultimately, progress in health reached the majority of the population. We study the dynamics of m

Progress in health during the second half of the 19th century and the early decades of the 20th century led to a monumental decline in mortality in industrialised economies, often referred to as the mortality transition. By the end of the transition, mortality disparities across areas that had differed in their socioeconomic conditions since the early 19^th century had also narrowed, suggesting that, ultimately, progress in health reached the majority of the population. We study the dynamics of mortality reductions and mortality inequalities between the 1860s and the 1940s. We compile a long time series of death rates for London and Glasgow and for their small constituent areas using administrative data from municipal archives and National Census Data. We find that mortality reductions follow sigmoid dynamics, with an initial period of slow reductions before faster reductions that, at the city level, start from around 1880, with an inflection point of trend mortality at around 1900. However, we also find that the timing at which fast reductions occur varies markedly – by decades – between areas of the cities. In particular, constructing area-specific distributional measures using National Census data and the Booth Report, we find that mortality fell first in areas with a higher proportion of affluent residents, reflected in earlier inflection points of trend mortality in these areas. We show that both findings can be explained using an economic model of the diffusion dynamics of health progress, according to which adoption depends on a cost-benefit evaluation of new health technology, with an underlying log-normal income distribution. Our results demonstrate that the mortality transition was not a period of monotonic convergence of inequalities, but that there was, instead, a prolonged increase in mortality inequality before the benefits reached lower income groups.