Living in poverty and dying prematurely are inextricably linked.

People living in the most deprived areas of Scotland have the lowest life expectancy and spend more than twice as long in ill health health before they die - roughly 25 years - compared to the most affluent.

Rates of everything from alcohol-induced liver cirrhosis and obesity to diabetes and cancer are highest among the those with the lowest incomes.

Closing these so-called "health inequalities" has been a flagship ambition of the Scottish Government, but one that has proven stubbornly difficult to achieve.

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Delegates who gathered at Strathclyde University in Glasgow on Wednesday for the launch event of the Scottish Health Equity Research Unit (Sheru) - a new think tank bringing together expertise in economics, data and public health in the hope of working out what's going wrong, and how to fix it - were well-versed in these dire statistics.

But what about another, more disturbing question: have we, in the UK, simply become accustomed to really high economic and social inequalities?

This was the title of the keynote address by Danny Dorling, a professor of human geography from Oxford University renowned for his work on how the widening gulf in living standards between rich and poor has fuelled Britain's stalling - and now falling - life expectancy, and our dismal population health record compared to much of Europe.

The overarching theme of the talk was that, over successive decades, we have lost sight of what is normal when it comes to tax-and-spend policies, investment in public services, and the wealth gap.

It wasn't always this way.

In the 1960s, income inequality in the UK was the narrowest it had been "for millennia", said Prof Dorling. In western Europe, only Sweden was more equal at the time.

It seemed as though we had turned a corner on the class divide and were moving in a more egalitarian direction with the rise of the welfare state, widening university access, and healthcare for all via the NHS.

After narrowing from the 1930s, income inequality in the UK began widening again in the late 1970sAfter narrowing from the 1930s, income inequality in the UK began widening again in the late 1970s (EqualityTrust)

Between 1938 and 1979, the share of income held by the top 10% fell from around 35% to 21%.

The bottom 10% were still getting relatively small share - 4% - but from the 1980s onwards even that began to reverse.

By 2009/10, when this trend peaked, the top 10% of earners once again accounted for 31% of UK income, while the bottom 10% had just 1%.

There has been little change since then.

Today, the UK has the highest income inequality - based on household disposable income - of any Western European country.

The UK, said Prof Dorling is "Eastern European in all but geography".

Perhaps that is unfair: Poland and Estonia are more equal, according to the OECD, and the average Slovenian household is better off in 2024 than its British counterpart.

Income inequality (by disposable income), 2021, where zero is complete equalityIncome inequality (by disposable income), 2021, where zero is complete equality (Image: OECD)

Prof Dorling noted that that the UK also spends a lower percentage of its GDP on public services (around 45% this year, up from 41%) than similar affluent European nations.

France, Belgium and Finland all invest around 55%.

What is puzzling, argued Prof Dorling, is that there is so little public debate - or even awareness - that the UK is a low tax-low spend country.

Instead, he said, the mainstream discourse seem bizarrely preoccupied by things that are of little consequence to the majority of the population: VAT on private schools, for example, or inheritance tax, something that applies to fewer than 7% of all estates.

During one year, for which he analysed the figures borough-by-borough for England, he found that inheritance tax was paid by no one at all in Hull and even in Kensington and Chelsea had applied to just 12% of estates.

Professor Danny DorlingProfessor Danny Dorling (Image: Newsquest) Danny Dorling is the Halford Mackinder Professor of Geography at Oxford University, where his work concerns issues of housing, health, employment, education, wealth and poverty. In 2023 he published Shattered Nation: Inequality and the Geography of a Failing State. Due out in 2024 is his latest book: Seven Children: Inequality and Britain's Next Generation.

Turning the tide would require a change of mindset, said Prof Dorling.

In countries such as Finland, progressive taxation means that middle-income workers on salaries of €30,500-50,400 (£25,700-£42,500) pay 30% income tax rates (compared to 20% in the UK), rising to 34%, 42%, and a top rate of 44% on salaries over €150,000 (£126,500), but there is little pushback because satisfaction with public services is high.

In the UK, voters' tend to be hostile to income tax hikes on all but the wealthiest - those "with the broadest shoulders" - but Prof Dorling said suggested that increases should be cascaded through the salary brackets to maximise the revenue-generating potential as well as narrowing overall income disparities.

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One cause of the hostility to tax rises among UK voters may be that people feel they are seeing little bang for their buck when faced with crumbling public services.

Of course, this goes back to the earlier argument that UK investment is comparatively low because we raise less in taxes in the first place, and then invest a smaller proportion of what we do raise into public services - from transport to healthcare - but, as Chris Birt, associate director for Scotland at the Joseph Rowntree Foundation put it, "incompetent government puts people off tax".

Mr Birt also stressed, however, that services such as health and social care, which already seemed doomed by an ageing population back in 2008, have been destabilised even further as "deep hardship" made people sicker.

As SHERU found in its inaugural report, published on Wednesday, median household incomes in Scotland have never returned to pre-2010 levels.

Prof Dorling added that workers toiling through the period from 2008 to 2024 have been up against the "longest pay squeeze since 1822".

Prof Dorling: 'It is not a good sign that our children are getting shorter'Prof Dorling: 'It is not a good sign that our children are getting shorter' (Image: NCD-RisC)

Prof Dorling's argument is that, in the long-run, all the signs of the UK's public health malaise - from falling life expectancy to the shocking decline in the average height of five-year-olds (a signal of poor nutrition) - will only be reversed if we address income inequality and shift towards a more European style of tax-and-spend.

He is optimistic that we have reached "peak injustice" in the sense that empty coffers and the consequences of inequality are so now bad that the new Labour Government has no choice but to do something radical.

Or, as Chris Birt put it: "If we stick with the status quo, we'll get the same outcomes."