The north-south health divide

The north-south divide is one of England’s most powerful and enduring myths: one country geographically, politically, and culturally separated into beautiful south and grim north. On one side rolling fields, dazzling sunshine, conspicuous wealth, conservatism, and flat beer; on the other coal, cloud, desolation, socialism, and froth.

In the linked observational study (doi:10.1136/bmj.d508), Hacking and colleagues show that not only is the divide in premature mortality real, but that it has persisted and continued to widen over four decades and under five governments.1 Since 1965, the toll of excess deaths has surpassed 1.5 million—the north is being decimated at the rate of a major city every decade⇓.

Many explanations have been offered for this northern catastrophe. Hacking and colleagues discuss the contributions of genetics, lifestyle, and migration and find them modest. Explanations related to the differing social composition of the population in the north compared with the south also fall short, because southerners enjoy better health across the entire social spectrum.2 Any damage inflicted by climate and geology is likely to be indirect: the cotton industry developed where the weather was …