The government's top medical officer has warned that health inequalities between socially disadvantaged and affluent sections of the population has widened

Professor Liam Donaldson, England's chief medical officer, warns in his annual report that more action needs to be taken cut inequalities in health and life expectancy.

The problem is a "deep seated and seemingly intractable problem which has been with us for at least a hundred years," says Donaldson.

Figures show that some communities in England have death rates equivalent to the national average in the 1950s.

While the report notes that England has seen increased prosperity and overall reductions in mortality during the last 20 years, it says the gap in health between those at the top and the bottom of the social scale has widened.

"Death rates of the most deprived sections of the population declined little in the 1990s, whereas death rates among the more advantaged declined substantially," says Donaldson.

An analysis of projected trends in life expectancy shows that the 20 per cent of health authorities with the lowest life expectancy are set to fall further behind the rest of the population.

The report says behaviour and lifestyle differences partly explain differences in health between advantaged and disadvantaged areas.

But it adds there is close relationship between life expectancy, measures of deprivation and other socio-economic indicators at health authority and smaller area levels.

Areas with high deprivation scores tend to have higher mortality than those with lower deprivation scores, the study finds.

The 20 per cent of health authorities with the lowest life expectancy are also among those with the largest proportion of their populations in manual social classes, in social housing and with the highest rates of unemployment.

Death rates for unskilled working men vary greatly between north and south, the figures show, indicating that being poor in the north is worse for your health than being poor in the south. Men in professional occupations seem to have better health whether they are in the north or the south of England.

Tackling the problem of health inequality will prove a more difficult task than just helping those in the most deprived areas, argues the report.

"Health effects of relative inequality apply right across the spectrum of advantage and disadvantage. Efforts to address these cannot be targeted only at the 20 per cent of most deprived areas or people. This is because there are more people affected by inequalities in the middle 60 per cent of deprivation than in the bottom 20 per cent," it says.

"For this reason, action targeted at the poorest section of society will improve those people's health but it will not alone reduce the inequalities gap. Action also needs to be targeted at the much larger numbers in the 'blue collar' (ie. manual workers) section of society where the numbers with potentially poor health are much greater."

Donaldson calls for health inequalities to be monitored and for a new cross-governmental action plan if the gap continues to widen. He also says that all government departments should make explicit their specific contributions to the achievement of the national health inequalities targets.

Regional Development Agencies should review their economic regeneration strategies to ensure maximum impact upon health inequality targets, and programmes aimed at providing opportunities for healthier lifestyles should be extended.

All new NHS initiatives should also tackle health inequalities as a key theme, recommends Donaldson.

Concern over alcohol abuse

The chief medical officer also warns that there is a "worrying" increase in deaths from liver cirrhosis, particularly in younger people.

Drinking patterns appear to be the key to this trend, he says.

Cirrhosis, the end result of long term liver damage, is the permanent scarring and damage of the liver and is irreversible.

In 2000, there were nearly 500 deaths in men almost 300 deaths in women aged 25 to 44 years.

These figures made it a bigger killer of men than Parkinson's disease and killed more women than cancer of the cervix.

Deaths caused by chronic liver disease and cirrhosis have also risen in most age groups.

In the 45 to 54-year-old age group there has been a four-fold increase amongst men dying of the disease since the early 1970s and a three-fold increase in women.

Among 35 to 44 year olds, there has been an eight-fold increase in the number of men and a near seven-fold increase in the number women dying from the illness.

Teenagers who drink alcohol are consuming larger quantities says the report.

In 1998 average consumption among 11 to 15-year-old drinkers was 9.9 units of alcohol a week, compared to 6.0 units a week in 1992.

The rising trend in deaths from cirrhosis in England are in contrast to the situation in other European Union countries, says the reports. In most EU states the trend is generally declining, although from levels higher than the current English rates.

Donaldson says that with alcohol misuse causing wider problems for society such as crime and disorder, problematic patterns of drinking need to be tackled.

Action will have to be taken on a wider level than just the NHS, the report argues.

The government, non-governmental organisations and the drinks industry should identify and help those with drinking problems, change attitudes so alcohol abuse is socially less acceptable and act to limit the social damage created by alcohol misuse.

The Health Development Agency should advise on intervention to protect young people from the harmful consequences of alcohol misuse, says the report. It also says a comprehensive strategy on the issue is planned.

Following publication of the report, Alcohol Concern called for a one per cent levy on the drink trade's £227 million annual advertising spend to add to the "miserly" £1 million a year currently spent on the prevention and treatment of alcohol misuse

"Clearly there is something about the British way of drinking that is resulting in people developing serious health problems younger than ever before," said Alcohol Concern director Eric Appleby.

"We need to think carefully about placing much greater emphasis on education and prevention if we are to get to grips with this damaging trend. This needs to go hand in hand with practical steps to look at the way alcohol advertising effectively promotes binge drinking - and it's only right that the drink trade should pay something towards this, given the miserly sums currently being spent."