Objective: To monitor geographical inequalities in health in New Zealand during the period 1980 to 2001, a time of rapid social and economic change in society. Methods: Age‐standardised mortality rates were calculated using mortality records aggregated to a consistent set of geographical areas (the 2001 District Health Boards) for the periods 1980‐82, 1985‐87, 1990‐92, 1995‐97 and 1999–2001. In addition, the Relative Index of Inequality (RII) was calculated for each period to provide a robust measure of mortality rates over time. Results: Although overall mortality rates have declined through the period 1980 to 2001, the reduction has not been consistent for all areas of New Zealand. Indeed for a small number of DHBs, mortality rates have increased slightly. There has been an increase in the geographical inequalities in health as measured by the RII between each time period except for between 1986 and 1991, where there was a small reduction. Conclusions: At the start of the 21st century, geographical inequalities in health in New Zealand have reached very high levels and continue to increase. The excess mortality for the worst areas in New Zealand increased from 15% in 1981 to 25% in 2000. If policy makers are committed to reducing health inequalities then more redistributive economic policies are required.