Today, Americans live three years less than their counterparts in France or Sweden. Scottish men live more than two years less than English men, and Northerners in England live two years less than Southerners. Londoners living in Canning Town at one end of the Jubilee tube line live seven years less than those living eight stops along in Westminster. There is a 25-year gap in life expectancy between residents of the Iberville and Naverre suburbs of the US city of New Orleans, although they are just 3 miles apart. This book examines these inequalities in life and death, showing that geographical health divides are longstanding and universal – present to a greater or lesser extent across both time and space.

Drawing on case studies of the US health disadvantage, the ‘Scottish health effect’, the North–South health divide in England and local health inequalities across the towns and cities of wealthy countries, this book explores the historical and contemporary nature of geographical inequalities in health. It looks at how they have evolved over time, what they are like today, and their social, environmental, economic and – ultimately – political causes. It examines what has and what could be done by governments to reduce these inequalities, and how health divides might develop in the future. The book presents a wealth of international, historical and contemporary data, to demonstrate how and why geography is a matter of life and death. This introductory chapter introduces the four case study health divides. It provides a general introduction to the themes of the book, outlining the scales of contemporary health divides internationally, nationally, regionally and locally. The chapter concludes by reflecting on the relationship between health and place.

On the health of nations

It is well known that health varies between countries. Most notably, there are considerable differences between the wealthy countries of Western Europe, North America, Australia and New Zealand and those in Africa and Asia. For example, average life expectancy for men and women in countries like Nigeria is as low as 50 years while in countries like the UK, the US, France or Sweden it is over 75. Populations in wealthy countries can more easily access adequate nutrition, medical care, safe drinking water and sanitation, and adequate incomes.