Inequalities in health are a key concern for health policy in all five countries of the UK and Ireland.

The UK government, the national governments of its four countries, and the government of Ireland have all introduced a succession of commitments and initiatives to reduce health inequalities.

Although the four countries of the UK are becoming increasingly diverse in politics and policy, many of the actions aimed at reducing inequalities are similar in practice, as are the actions in the Republic of Ireland.

Area-based inequalities in mortality is the most commonly used measure of progress in reducing inequalities. The data is comparable, consistently available and relatively robust compared with data on other aspects of difference such as ethnicity or social class. Life expectancy at birth is a robust summary measure of an area's mortality, reflecting current mortality experience at different ages. It is not a prediction of how long a new-born might be expected to live.

It is well known that Scotland has the lowest life expectancy of the five countries, and England the highest. But looking at local authority level reveals an even greater challenge. The best local authorities in Scotland only match the average life expectancy in England.

Scottish problems

Scotland not only has specific challenges of very low life expectancy in its post-industrial western lowlands, especially for men, but faces a challenge of low life expectancy in almost every part of the country.

Inequalities between places seem to be persistent. The gap in life expectancy at birth between England and each of the other countries of the UK widened between 1991-93 and 2004-06 for both men and women.

Moreover, within each UK country, the spread of inequality between local authorities in 2004-06 was broadly similar to that in 1991-93. And, with only a few exceptions, the relative position of a local authority in 2004-06 was reflected its position in 1991-93.

Inequality in Britain and the Republic of Ireland is plain in the graphs below. Policy in all five countries is unequivocal that such inequality is unacceptable. However, a glance through the World Health Organisation's annual statistics reminds us that differences within the UK and the Irish Republic are small compared with the gap between the rich and poor countries of the world.