If you thought the gap between rich and poor was merely a question of contested statistics, you would be wrong. It’s a matter of life and death. A new report published today in the British Medical Journal (BMJ) shows that the gap in life expectancy between the richest and poorest people in Britain is wider than in the 1930s. The 1930s. The decade before the NHS, when the poorest people lived in unsanitary slums, surrounded by untreated disease, when industrial deaths and injuries were commonplace and the air in the cities was heavy with smoke.

The research, led by Danny Dorling who is fast becoming the UK’s guru of health inequalities, backs up the points made in his book Inequality. Behind the academic veneer is a simple truth: the poor die sooner than the rich, because they are poor. Between 1999 to 2007, for every 100 deaths before the age of 65 in the richest tenth of areas, there were 212 in the poorest tenth. This compared with 191 deaths in the poorest areas from 1921 to 1930 and 185 deaths from 1931 to 1939.

If you want to do some research for yourself, walk around a graveyard in Doncaster, and note the average age of death, and repeat the exercise in Surrey. You should discover that on average, in Doncaster they die seven years younger than in Surrey. A review by Sir Michael Marmot in health inequalities earlier this year reported to Andy Burnham that up to 202,000 early deaths could be avoided, if everyone in the population enjoyed the same health as university graduates. The report suggested inequality in illness accounts for £33 billion of lost productivity every year. Marmot called for an increase in the national minimum wage as a sure way to increase public health.

The National Health Service has failed to adequately address health inequalities over its 60 years, which is why Labour sought to reform it after 1997. In the 1960s the Fabian academic Brian Abel-Smith wrote ‘if socialists believed 40 years ago that all that was needed to equalise health status between social classes was to remove the money barriers to access to health care, they were seriously mistaken.’

Dr Julian Tudor Hart, in an article in the Lancet in 1971, had identified this as the ‘inverse care law’ – those that needed care the most, got the least, and vice versa. The Black Report in 1980, commissioned under Labour and suppressed under the Tories, showed a clear link between poverty and illness. The historian of the NHS Charles Webster wrote that:

‘the NHS…tended to mirror and perpetuate the accumulated idiosyncrasies and inequalities in health care provision contained in the inherited system, and which in the main reflected deep-seated patterns in the distribution of wealth, which had determined that those sections of the community experiencing the greatest problems of ill-health were provided with the worst health services.’

Under Labour, just four per cent of health spending went on preventative care. Under the Tory-led government, it will probably be less. They’ve already cancelled schemes to tackle smoking, teen pregnancy and drug abuse. Whilst attacking the Tories for their failures will be an important job over the next five or ten years, putting forward a serious alternative from Labour will be even more important. Modernisers in the Labour party have to step up the argument for reform of the NHS, and the department of health, so that more is done to prevent disease than cure it. If we get into an argument about the level of spending, without an urgent demand for reform, we will fall into the Tory trap. Andy Burnham showed real courage to challenge Andrew Lansley’s ringfencing of the NHS budget. He did it because as a former health secretary he knows full-well that the NHS is inefficient and wasteful, and could do more for less, for example by rationalising its purchasing of drugs.

But we need to win a broader egalitarian argument. We need to tackle, not just poverty, but inequality, as David Miliband states in his leadership campaign pledges. It will require standing up to the doctors, and demanding more surgeries on tough estates, and not just in leafy suburbs, with longer opening hours and more time spent per patient. It will require tough regulation on food manufacturers and retailers, to cut out the salt, sugar, fat and alcohol which is killing our kids. It will need further restrictions on smoking, driving it further to the margins of society, on the route to sending the ashtray the same way as the spittoon. It will need a rebalancing of health spending, with more on ‘talking therapies’, community health centres, advice for families on diet and exercise.

In a decade or so, we will see the impact of the smoking ban – a piece of legislation which cost the state next to nothing, yet may have done more for the long-term health of the population than all the NHS reforms put together. It proves that to improve public health, we need measures which change lifestyles, not just to treat people when they are ill. The Tories have already shown that they don’t care: they won’t stand up to the food manufacturers, and may well cave into the smoking lobby. Labour governments in the past have meant well, but as today’s report suggests, failed to narrow the gap. The next Labour government should make sure that how long you live should not depend on what work you do, where you live, and where you shop.