North-south divide in social inequalities in Great Britain: Health inequalities in Wirral: a living Black report?

EDITOR—Having read the paper by Doran et al on the north-south divide in social class inequalities in health in Great Britain, I am prompted to write about our local health divide.1 Wirral, across the Mersey from Liverpool, is demographically divided by the M53 motorway into two: a healthy, educated west sector and a less prosperous east. They show different rates of deprivation, smoking, childhood accidents, teenage pregnancy, and coronary heart disease. The healthier west sector, with a lower standardised mortality ratio for coronary heart disease, has a higher rate of referral for coronary angiography, coronary angioplasty, and bypass surgery—and vice versa.

Private referrals from the affluent sector do not explain this divide. I suspect that belief systems underpin some of it. Affluent patients are more likely to request referral for angiography while poorer patients present only in crisis. They accept their lot. They are shackled by powerful belief systems—for example, patients with angina being told by family or friends: “Don't take any exercise, you'll give yourself a heart attack.”

General practitioners also hear such questionable beliefs as β blockers are bad in heart failure,” etc. Such concepts have a crucial role in receiving or providing health care.

Attempts at redressing the balance led four years ago to the development of the Wallasey Heart Centre. This locally accessible service, led by general practitioners with a special interest, has brought improvements in coronary heart disease standardised mortality ratio, general practitioner prescribing, and knowledge of patients and carers.

Are services driven by general practitioners with a special interest across a primary care trust, the way to reduce UK health inequalities?