Is there a north-south divide in social class inequalities in health in Great Britain? Cross sectional study using data from the 2001 census

Objective To examine individual social class inequalities in self rated general health within and between the constituent countries of Great Britain and the regions of England. Design Cross sectional study using data from the 2001 national census. Setting Great Britain. Participants Adults aged between 25 and 64 in Great Britain and enumerated in the 2001 population census (n = 25.6 million). Main outcome measures European age standardised rates of self rated general health, for men and women classified by the government social class scheme. Results In each of the seven social classes, Wales and the North East and North West regions of England had high rates of poor health. There were large social class inequalities in self rated health, with rates of poor health generally increasing from class 1 (higher professional occupations) to class 7 (routine occupations). The size of the health divide varied between regions: the largest rate ratios for routine versus higher professional classes were for Scotland (2.9 for men; 2.8 for women) and London (2.9 for men; 2.4 for women). Women had higher rates of poor health compared to men in the same social class, except in class 6 (semi-routine occupations). Conclusions A northwest-southeast divide in social class inequalities existed in Great Britain at the start of the 21st century, with each of the seven social classes having higher rates of poor health in Wales, the North East and North West regions of England than elsewhere. The widest health gap between social classes, however, was in Scotland and London, adding another dimension to the policy debate on resource allocation and targets to tackle the health divide.