The one reference to “health inequalities” in the government’s welfare reform green paper suggests ministers are mired in a “chicken and egg” riddle (Report, March 18). It quotes the observation in the landmark 2010 Marmot Review that good-quality jobs can reduce health inequalities.

Yet ministers and their officials seem incapable of seeing the link going the other way — that is, between deprivation and the “lifestyle diseases” linked to obesity, smoking and excessive alcohol consumption.

The 11-year difference in life expectancy for men living in the most and least deprived areas is well known. However, my research has shown that people in the poorest communities typically experience poor health up to 21 years earlier than those in richer areas. In Blackpool, for instance, “healthy life expectancy” is just 53.5 years, compared with 70.2 years in Richmond and 74.6 years in Rutland. People in Blackpool are therefore far more likely to leave the workforce before state pension age — and therefore claim health and disability benefits — than those in Richmond or Rutland.

The government must pursue a longer-term approach to curb the rising welfare costs of poor health and disability. We need a comprehensive public health strategy with real teeth to tackle the root causes of premature poor health.

For too long successive governments have shied away from bold actions around smoking, obesity and alcohol to significantly improve public health — partly because the results will not be obvious for decades. They must have the moral courage to implement measures that will limit and reverse the costs to individuals, the taxpayer and the economy.

Professor Leslie Mayhew
Faculty of Actuarial Science, Bayes Business School, City and St Georges
University of London, London EC1, UK