‘Poverty is as a strong a predictor of premature death today as it was a century ago’ reported a study on BMJ online this week. The study examined the geographical relationship between mortality and deprivation at the start of the 20th and 21st Century. Although there was a change in the number of deaths over this time, modern patterns of mortality and deprivation remain strongly linked to the patterns of a hundred years ago.

Their conclusion states ‘for all the medical and public health changes over this time, patterns of poverty and mortality and their relationship remain firmly entrenched.......... This relationship holds true for most major modern causes of death’.

If you bear with me for a few minutes I’ll explain why I think this occurs and the paradox that causes it.

Consider living in the most deprived areas of the country and survey one hundred 18 to 30 year-olds. Of these, 20 have long term health problems; for instance mental health problems. You decide over the next 10 years to invest considerably in health and for your investment you get a 20% reduction in chronic health problems, leaving you with 16 individuals still with chronic disease. However, 20 of the healthiest, educated and economically active individuals decide to become part of a common phenomenon: economic migration, whereby individuals emigrate from one area to another for the purposes of seeking employment or improved financial position. For the unhealthy this is normally not an option.

So what’s the paradox? Well when you resurvey you are left with 80 individuals of whom 16 have a chronic health problem. In effect 20% exactly the same figure we started with. Therefore, to me there seem only two solutions: one is to raise the average wealth of everyone, or second to take the economic activity to the areas which are the most deprived.