In 2019 the authors of this report published a paper in Lancet Public Health (https://pubmed.ncbi.nlm.nih.gov/31677776/) comparing life expectancy and mortality trends in England and Wales from 1970 to 2016 to a group of other high-income countries. In 2023 our group started a new project commissioned and funded by UK The Health Foundation that aimed to extend our analyses from our Lancet Public Health paper to consider mortality up to 2022 for the UK and all its constituent parts compared to a set of 21 peer countries. Moreover it aimed tp look at the contribution of specific causes of death to these overall trends. This report, written at the end of 2024, is the final output of this project for The Health Foundation. In summary, we found that over the past 50 years up to 2022, judged against the central tendency of our set of other high-income peer countries, the UK’s mortality record has been average for males and very poor for females. Of even more concern is the fact that over the past 30 years the relative international standing of the UK has deteriorated. This deterioration is seen in nearly all age groups and across a diverse range of causes of death. A key long-term influence is that for both sexes the UK was in the international vanguard of the smoking epidemic, which continues to affect the UK mortality disadvantage among women. At younger adult ages (25-49 years) a historical advantage in external cause mortality, with the UK having lower rates than many other peer countries, has progressively eroded since 2001 and was reversed by 2013. UK drug-related death rates stand out as having shown very steep increases in the period after 2010. However, this has not gone along with the same pattern of increases in alcohol-related deaths and suicide, casting some doubt on the relevance of the “deaths of despair” narrative. What is striking however is that despite the wide range of changes in mortality rates seen since 1990, a persistent north south geographic gradient persists, with only southern areas of the UK having a persistent mortality advantage compared to the peer country median, although even this has diminished over time.