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By Eugene Milne

My card-carrying North London media brother, Ben, describes himself on his Twitter feed as a ‘recovering Northerner’.

In my case the disease is almost certainly incurable. Despite spending a good deal of last year in cosmopolitan London — beautiful, exciting and diverse as it is — I found myself on occasions near tears of joy as my feet hit the platform at King’s Cross.

“I need to know I can be at the coast or in miles of open countryside within 20 minutes,” I told Ben.

“I need to know I can get Vietnamese food at 3.00 a.m.,” he replied.

While mine is clearly the healthier individual craving, the gulf in population health outcomes between the North and South of England, or, perhaps more accurately, between the provinces and the capital and its South Eastern sprawl, remains as wide as ever.

On examining the distribution of age-standardised mortality for Nomenclature of Territorial Units for Statistics regions, the United Kingdom remains the most starkly unequal of European nations. This is starkly illustrated in our new analyses of the North South divide in England, when compared with the experience of East and West Germany following the fall of the Berlin Wall. After that great political upheaval, notably for women, life expectancy in East Germany began to climb rapidly. Twenty years on, it is indistinguishable from that of the former West Germany.

In contrast, the gap between the North East of England and London, which in 1990 was similar to that between East and West Germany, remains just as wide in the most recent figures. Of course, life expectancy has risen markedly in both countries and their regions; modern North East English life expectancy is significantly higher than that which obtained in 1990 for West Germany. But the English failure to narrow its inequality gap despite overt national efforts signals that those efforts are simply too light-touch to be effective.

As Johan Mackenbach has commented, in reflecting on the English strategy from 1997-2010:

“it did not address the most relevant entry-points, did not use effective policies and was not delivered at a large enough scale for achieving population-wide impacts. Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the overall targets.”

Of course, fundamental to this problem is economics. The wealth of London and the South East in comparison to, well just about anywhere else in the UK, is now extraordinarily stark. London now feels more alien to my Northern sensibilities than much of Europe, and the reason is not people but cash.

The difference is illustrated rather well by the contrasting artistic expectations of the South Bank Centre — close by the Waterloo offices of Public Health England, for whom I worked last year — and the Culture budget of the City of Newcastle — for whom I now work as Director of Public Health.

On consecutive days in 2013, the Guardian and BBC reported the Southbank Centre’s unveiling of its £100m redevelopment plans (6 March), having made a successful first stage bid for £20m from the Arts Council, and Newcastle City Council was reported (7 March) as having cut its £2.5m culture budget by 50%. This comparison could equally be drawn in many other ways: for transport and infrastructure, investment in business, development of academic institutions (why did the Crick Institute need to be in King’s Cross?). And it all matters because, despite the cleaner air and wide open spaces, the English provinces and in particular the North, are losing out — on culture, mobility, urban environment, jobs, and crucially on health.

The English North has many charms, both for its natives and many who come upon its joys by accident (see this delightful, recent New York Times piece). For too many, however, it remains a place of shorter and poorer lives. The German experience suggests that it need not be so.

Prof. Eugene Milne became Director of Public Health for Newcastle upon Tyne earlier this year, after working nationally for Public Health England as Director for Adult Health and Wellbeing. He is an Honorary Professor in Medicine and Health at the University of Durham, and joint-editor, with his colleague Prof. Ted Schrecker, of the Journal of Public Health. He has research interests in health improvement, inequalities and ageing.

The Journal of Public Health invites submission of papers on any aspect of public health research and practice. We welcome papers on the theory and practice of the whole spectrum of public health across the domains of health improvement, health protection and service improvement, with a particular focus on the translation of science into action. Papers on the role of public health ethics and law are welcome.

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An Illustration Friday submission for the word “return”.  Duck is all nice and tanned from his stay in the sunny south!

The Northwoods Children's Book Conference had a neat event In honor of keynote speaker Anita Silvey's wonderful book, Everything I Need to Know I Learned from a Children's Book. Each of the presenters, plus some attendees, go up and spoke very briefly about the children's book that most influenced them.

I found this impossible and failed the assignment. I don't remember specific reading moments like so many people do. I just lived in books. I read so many books, and I didn't love all of them equally, I'm sure. But there's no way I remember my reactions enough to choose a favorite or most influential. So I cheated. Here are 10 books/series I read and loved, plus something they taught me. I didn't pick up on those "lessons" at the time, of course. But looking back, I think these are some tiny examples of how books shaped me. The Bobbsey Twins taught me that no matter how bad things were, I could escape into a book.

Are You There God? It’s Me, Margaret taught me to ask endless questions and accept that there aren’t always answers.

Where the Red Fern Grows taught me that love is risky, but worth the risk. And teachers cry, too. (One of the very few specific book-memories I have is my third-grade class sobbing--at least all us girls--while Mrs. Gracey read us this book.)

From the Mixed-Up Files of Mrs. Basil E. Frankweiler taught me to fight for my own worth and create my own adventures. 

Harriet the Spy taught me that words are powerful and demand careful handling. And, as an adult, that if you're going to write a journal about family members, password-protected files are helpful.

The Figure in the Shadows taught me the pleasure of one good friend, one trusted grownup, and one scary book, read alone, at night, curled up in a comfortable chair.

A Wrinkle in Time taught me that being different, a “sport,” a misfit, was ok.
 
Nancy Drew mysteries taught me that adults were often incompetent and teenagers could do anything they set their minds to. And that I wanted a wealthy father and a nifty convertible. 

The Agatha Christie mystery with a child as the killer taught me that humanness doesn’t start with adulthood. We’ve got it all—the good, the bad, and the ugly—inside us from a very young age.