The previous chapter provided an overview of public health and health divides in the 19th and early 20th century, and outlined the epidemiological shift from infectious to chronic disease. This chapter now examines what geographical inequalities in health are like today, providing an overview of the main contemporary causes of death and disease in wealthy countries. It demonstrates the consistent nature of health divides across the major causes of death and disease, that internationally, health is worse in the US; within the UK, that Scotland fares worse; regionally, that the North of England does worse than the South; and that deprived neighbourhoods in the major towns and cities of wealthy countries experience a health penalty. The starkness, proximity and universality of contemporary health divides are demonstrated.

Death and disease today

Since the ‘epidemiological transition’ the main causes of death in the UK, the US and other wealthy countries are chronic diseases such as cancer and CVD that now account for over 50% of deaths. Chronic diseases are characterised by slow development, long morbidity period and multiple causes. Table 3.1 shows the average proportion of deaths accounted for by communicable (infectious) diseases compared to non-communicable diseases (including CVD and cancer) for the World Health Organisation’s (WHO) wealthy countries in 2012. These data illustrate the scale of the epidemiological shift in wealthy countries as communicable diseases now account for less than 3% of all deaths, while in contrast, cancers account for 25% and CVD accounts for 38%. Likewise, the significant contemporary causes of ill health and disease (or morbidity) are largely chronic in nature such as diabetes, obesity, mental health or musculoskeletal problems. This section provides a general overview of the leading causes of death and disease in wealthy countries today to aid understanding of the spatial data that is presented later in the chapter.

CVD is the leading cause of death in the majority of wealthy countries, accounting for over 300,000 deaths every year in the UK, over a third of total deaths. CVD is a general term that describes a disease of the heart or blood vessels. The two most common types are coronary heart disease and stroke.