How much does where you’re born determine your health?

Healthy life expectancy — years lived without disability or chronic illness — varies by 18.4 years between England’s most and least deprived areas, up from a 16.2-year gap in 2001.^[1] A woman born in Blackpool’s most deprived neighbourhoods can expect just 52 years of good health; one born in Hart, Hampshire can expect 70.7.^[1] People in deprived areas are not just dying younger; they are suffering more for longer, spending a far higher proportion of shorter lives in poor health. The North-South divide reinforces this: men in the North East live 74.1 years against 81.8 in the South East — a 7.7-year gap that widened after the 2008 financial crisis as austerity disproportionately cut public services and welfare in already-deprived communities.^[1] The 2020 Marmot Review found that for the first time in over a century, life expectancy in England had stopped improving — and in the most deprived communities was actually declining.^[2]

The NHS can treat the consequences of inequality but cannot address its causes, which are material: income, housing quality, employment conditions, and early childhood environment. NHS England’s Core20PLUS5 framework targets the most deprived 20% across five clinical areas, but the health gap took decades to widen and will take decades to close even under optimistic scenarios. Public health spending fell 24% in real terms between 2015 and 2023, reducing the investment in prevention that could compress morbidity and narrow the gap.