Is the past a foreign country?

By Eugene Milne

My card-carrying North London media brother, Ben, describes himself on his Twitter feed as a ‘recovering Northerner’.

In my case the disease is almost certainly incurable. Despite spending a good deal of last year in cosmopolitan London — beautiful, exciting and diverse as it is — I found myself on occasions near tears of joy as my feet hit the platform at King’s Cross.

“I need to know I can be at the coast or in miles of open countryside within 20 minutes,” I told Ben.

“I need to know I can get Vietnamese food at 3.00 a.m.,” he replied.

While mine is clearly the healthier individual craving, the gulf in population health outcomes between the North and South of England, or, perhaps more accurately, between the provinces and the capital and its South Eastern sprawl, remains as wide as ever.

On examining the distribution of age-standardised mortality for Nomenclature of Territorial Units for Statistics regions, the United Kingdom remains the most starkly unequal of European nations. This is illustrated in our new analyses of the North South divide in England, when compared with the experience of East and West Germany following the fall of the Berlin Wall. After that great political upheaval, notably for women, life expectancy in East Germany began to climb rapidly. Twenty years on, it is indistinguishable from that of the former West Germany.

In contrast, the gap between the North East of England and London, which in 1990 was similar to that between East and West Germany, remains just as wide in the most recent figures. Of course, life expectancy has risen markedly in both countries and their regions; modern North East English life expectancy is significantly higher than that which obtained in 1990 for West Germany. But the English failure to narrow its inequality gap despite overt national efforts signals that those efforts are simply too light-touch to be effective.

As Johan Mackenbach has commented, in reflecting on the English strategy from 1997-2010:

“it did not address the most relevant entry-points, did not use effective policies and was not delivered at a large enough scale for achieving population-wide impacts. Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the overall targets.”

Of course, fundamental to this problem is economics. The wealth of London and the South East in comparison to, well just about anywhere else in the UK, is now extraordinarily visible. London now feels more alien to my Northern sensibilities than much of Europe, and the reason is not people but cash.

The difference is illustrated rather well by the contrasting artistic expectations of the South Bank Centre — close by the Waterloo offices of Public Health England, for whom I worked last year — and the Culture budget of the City of Newcastle — for whom I now work as Director of Public Health.

On consecutive days in 2013, the Guardian and BBC reported the Southbank Centre’s unveiling of its £100m redevelopment plans (6 March), having made a successful first stage bid for £20m from the Arts Council, and Newcastle City Council was reported (7 March) as having cut its £2.5m culture budget by 50%. This comparison could equally be drawn in many other ways: for transport and infrastructure, investment in business, development of academic institutions (why did the Crick Institute need to be in King’s Cross?). And it all matters because, despite the cleaner air and wide open spaces, the English provinces and in particular the North, are losing out — on culture, mobility, urban environment, jobs, and crucially on health.

The English North has many charms, both for its natives and many who come upon its joys by accident (see this delightful, recent New York Times piece). For too many, however, it remains a place of shorter and poorer lives. The German experience suggests that it need not be so.

Prof. Eugene Milne became Director of Public Health for Newcastle upon Tyne earlier this year, after working nationally for Public Health England as Director for Adult Health and Wellbeing. He is an Honorary Professor in Medicine and Health at the University of Durham, and joint-editor, with his colleague Prof. Ted Schrecker, of the Journal of Public Health. He has research interests in health improvement, inequalities and ageing.

The Journal of Public Health invites submission of papers on any aspect of public health research and practice. We welcome papers on the theory and practice of the whole spectrum of public health across the domains of health improvement, health protection and service improvement, with a particular focus on the translation of science into action. Papers on the role of public health ethics and law are welcome.