We know the country has extreme regional imbalances, but what accounts for excess mortality among prime age northern adults . More and more people coming into the hospital with alcohol related liver injury and illness and actually, you know, in more and more desperate states. They have probably got nothing to live for and alcohol is an easy way out, an anaesthetic. Well ask if this is a health issue or a National Failure to deal with inequality between North And South. President trump ramps up the rhetoric on north korea. They will be met with fire and few are, like the world has never seen. Is he making us safer or not . Were in amiens, in northern france, birthplace of president macron, to hear how he finds out whether faith in his leadership is failing. After an extroadinary campaign, which entirely new political scheme was deployed, president macron must now deliver. And there are already voices in france who doubt his ability to do so. And, a Property Dispute Dating back to the Partition Of India and pakistan, 70 years ago. The Indian Government is laying claim to my property saying its Enemy Property. Hello. We know theres a North South Divide in england. Thats literally been noted since the 11th century. We also know your chance of dying prematurely is significantly higher in the north than the south. But a paper published today raises some alarming questions about mortality, and its connection to economic and social imbalances. It looks at data on five decades of death, about 25 Million People in the midlands and north, versus about 25 Million People in london, the south and east. The good news is that premature deaths have plummeted North And South over the years. We are better off. But the bad news is that over the years theres a persistently higher premature death rate in the north, despite efforts to narrow the gap. And for those between mid 20s and mid 40s, prime age adults, something strange has happened. Since the mid 90s, the north south gap has jumped. Lots of data to digest, helen thomas has been on stoke to see whats going on. Industrial decline, ailing city centres, a dwindling population. And, in contrast, a region, or more specifically a capital, ever greedier in taking the nations jobs and wealth. It wouldnt be a piece of tv about the North South Divide without images of the north which suggest industrial decay. And chopping england into two contrast enhanced is a little bit and chopping england into two contrasting halves is a little bit cliched, and it is certainly crude. But this report highlights a particular issue. For decades, you have been more likely to die young if you live in the north. What is worrying is over the past 15 years or so, the grim outlook has got worse, specifically if you are a young adult. There is some good news. The University Of Manchester looked at the mortality rate, or deaths per 10,000 people under 75. It has fallen. But this graph shows the stubborn gap between the North And South of england. If you look at specific age groups, you see a surprising trend. Among 25 to 34 year olds, the gap had virtually closed 20 years ago. Since then it has grown considerably. The 35 to 44 age group is similar, but the gap is now even bigger. The question, is why . We didnt want to draw too much attention to the dealing with the intermediate factors, rather than the root causes, which are social and economic. But commonly, any group rise of death rate of people in that age are the diseases of despair. Alcohol related, drug related, suicide, violent deaths. His description is to wait Government Investment towards the north, a positive discrimination to build the economy. Other research has suggested that extra Financial Support isnt as important as encouraging healthier lifestyles. To invest in risks pastors alone is to ignore the underlying causes of early death. Which are accessed to resources in general, have good Living Conditions, more control of your own life, so you can make those healthy choices. So, is it time to relaunch the Northern Powerhouse . Efforts to rebalance the economy towards the north have largely failed, and measures specifically aimed at health have fared us badly. Targets set in 1997, to narrow Health Inequality between deprived and affluent areas were not met by 2010. A report on wye, called progress exceptionally slow. Staffordshire universitys centre for health and development is an Unusual Partnership with two local councils. The aim a new approach of tackling Health Inequality. Top down investment is vital and we need more of it. However, we also need the bottom up approach and we need to give people a voice in our community is actually to help direct that investment so it goes to the right places. We need to be looking and asking questions about quality of work and work life. This is working age cohort. What it is like to be unemployed in this day and age, impact about welfare reform, housing policies, education. Alcohol related death rates have risen since the mid 19 90s. Consultant at Stoke University hospital of wales seen that first hand. We are seeing more people and the age of people is younger because people are drinking at a younger age. We are seeing more women. There is more desperation. People dont drink because they want to, they drink because it is a way out. This is a big picture study about abroad, long standing problem and it isnt clear what might change quickly. Very targeted programmes around obesity, Mental Health may help some people, but that risks missing the most entrenched divisions. Major structural changes to the economy may be the answer, but no one knows for sure and it certainly isnt a quick fix. Helen thomas reporting. Sir Michael Marmot is the director of the Ucl Institute of health equity. He is also responsible for drawing up the 2010 Marmot Review which set out a six point strategy for combating Health Inequality. Good evening. Lets go back to the beginning because we are used to premature death rates falling over the decades, why is that . It is good news, obviously. Because we are a richer society, everything is better, nutrition is better, housing is better, Living Conditions are better. Everything has improved. Fewer accidents at work and all of that. One of the things we havent talked about, this Report Tallies with some stuff you have said but that has flattened off over the last few years so it is not falling any more . Yes, this is looking at premature mortality under age 70 five. It has flattened. Flattened in the north and the south. It affects everybody, what is driving that . We speculated, we speculated that policies of austerity post 2010 decrease in Adult Social Care spending, decrease in expenditure per person could play a role. We said it is urgent to investigate if it is related to it. Lets get to the north, south issue. There is a long standing gap. What is the best succinct summary of what drives this gap because it is at all ages over the decades, there has been some percentage higher premature death in the north . We have some insight into it because when we look at mortality according to where you are in the Social Hierarchy. The lower you are in the Social Hierarchy defined by education, jobs or degradation, the higher the mortality. But the disadvantage of being low is bigger in the north and the south. Someone in the middle of the hierarchy has higher mortality than somebody at the top. But the access is bigger in the north and the south. If you are a poor person in the south, equally poor to someone else in the north, you will live longer in the south as that poor person in the north . You will, if you are professional. Why would that be because you said deprivation is driving this . Because what i identified in my review are worse in the north than they are in the south. We could look at child poverty. Lets take the first one on early childhood. Child poverty is worst in the north than in the south. We have talked about the importance of sure start childrens centres. They funded by Local Government. The decrease in funding to Local Government is bigger, it is bigger in the north than the south. Short start centres are closing in the north. This issue goes back to the 90s, it is not for ever, which is these younger, middle aged adults. 25 to 45 where you have seen a gap. The rates have improved, or not got much worse, but, much bigger gap, what is going on there . Lets go back ten years earlier. What we saw in the 1980s, the difference for 25 to a5 year olds in the North And South was almost not there. But it was rising, mortality was rising both in the North And South, particularly young men. That was suicide, alcohol, file and deaths, the kind of disempowerment we saw just then in your clip. But then what happened, in the mid 90s, things improved in the south. Mortality started to decline and it didnt in the north. My speculation is, but disempowerment related to social economic conditions, persisted in the north when things were Getting Better in the south. That issue around drink, the death by despair, is part of what is going on in that group . Yes. If you will hang on there. Joining us from leeds is susie brown the Chief Executive Officer at zest, an Organisation Offering Support to People Living in disadvantaged areas of yorkshire, and in brighton is Christopher Snowdon the head of Lifestyle Economics at the institute of economic affairs. Suzy, just explain what you do and what you find and how successful what you do is . We have been working in disadvantaged areas of leads leeds for 15 years and we try and level the playing field, essentially. So there is great inequality and disadvantaged areas. We offer a range of practical support and more general support as an example of the practical support we work with Jamie Olivers ministry of food. We have projects that teach cooking skills, healthy eating, budgeting and shopping to people, offering them the chance to learn to cook from scratch and lead a healthier lifestyle. Does it work . It does, it is strong evidence based that shows it does make a huge difference to health outcomes. More generally, we offer people just general support and we are trying to lift them up and give them a leg up and inspire them to lead a more fulfilling life. Let me ask christopher, i know you have a critique of certain bits of policy. It doesnt feel like policy has worked over the last 20 years in reducing these health disparities, what is going on . The health rates themselves have fallen over the last 15 years, certainly. I feel we are addressing a cold case, in a sense. Its not news in the normal sense of the word. Were looking at a specific portion of the population, men under the age of 45 and looking at wide death rates amongst those people rose in the mid to late 19905. I dont know why that is, the author of the study says hes not sure why. We know what Michael Marmot has said, the main causes of death in that age, it is generally very low amongst people who are in their 205 and 305 anyway, but it is suicide, alcohol and drugs. You are right to describe these things as depths of despair. But income and Economic Growth are the great prophylactic5 for this. You see the north has less money and it has higher death rates and over time, society generally has got more prosperous and the death rate has fallen. But we have this anomaly in the north of england. In the 19905 specifically, 15u5pected Drug Overdose is significant and other things. But the gap is still there where there was no gap in that group to speak of in the 1980s. That is absolutely right. And there has been no recovery if you like. The rates have fallen very much since around 2003 or so. But they have not caught up. And it seems whatever caused that spike in deaths in the 19905 is still having an effect and it would be useful to know what it is. But the studies have not pinpointed that. I dont think it has anything to do with austerity or the slowdown in Economic Growth. The mid 19905, when deaths was biking, the economy was in strong growth. Do you ever feel. One of the things that the paper suggests is that Public Health measures have done their bit in victorian times, with the sewers and vaccinations and the like, and now many Health Measures are individual measures. The paper doesnt believe we should rely on individuals to look after themselves, but do you ever feel youre just trying to basically tell people how to live their lives as individuals, it is not really so much a Public Health matter. No, i dont think we are telling people how to live, we work very much with people and offer a range of activities and groups aimed at lifting people and their self esteem and confidence and giving them the tools to lift themselves perhaps out of a very bad place. If you walk around a deprived community you will see a lack of infrastructure perhaps, a lack of care, a lack of good things in that community. And if youre born into that or find yourself in that community, its really hard to imagine ever getting out again. And, yes, there is all this on television we see these lives and young people in that community think, thats not for me, im not somehow deserving of that. And people really do see themselves as never having the opportunity or the hope, they do not have the same aspiration to lift themselves up and we are trying to help from the bottom up and help people out into better situation. Thank you all very much. Not long before we came on air, President Trump aimed some pretty threatening remarks towards north korea. Ramping up the rhetoric, certainly. He was at an event where he was talking about Drug Addiction and was thrown a question about korea. North korea best not make any more threats to the United States. They will be met with fire and fury, like the world has never seen. He has been very threatening beyond normal statement. And as i said, they will be met with fire, fury and frankly power. The likes of which this world has never seen before. Thank you. Fire and fury might turn into one of those memorable trump phrases. Those remarks follow a report in the Washington Post today that said the Us Defense Intelligence Agency thinks north korea has developed Small Nuclear warheads that can fit into its ballistic missiles, if those assessments are right, they would imply kimjong un has crossed a crucial threshold. Im joined by Mark Fitzpatrick who worked in the Us Foreign Service for over 25 years and now is the Executive Director of the non Nuclear Proliferation organisation iiss americas. You have heard the comment, what do you make of them . This sounds like blustering. It sounds like the president does not know how to respond and when he does not know he responds with bluster. The United States is not going to attack north korea, north korea is not going to attack the us but these kind of statement and the kind of statements that north korea has made ratchet up the tensions and could lead to misperceptions that could lead to war. Just tell us what north korea, your assessment would be, what north korea could do in terms of retaliation or pre emptive strike if it wanted to using Nuclear Warheads . First of all theres no doubt north korea has missiles that can reach anywhere in south korea and japan. And hit us bases there. I believe north korea could mount a Nuclear Warhead on those missiles and they would have no trouble delivering it. That is the situation now for several years. Most recently of course north korea has tested missiles that could reach parts of the continental United States but whether they are reliable enough and could survive the intense friction in the atmosphere, that is not known. Your question is what could north korea do, they could start a war, a conventional war that could soon escalate into a nuclear war. They could try to attack us bases injapan with a Nuclear Weapon and then threaten to attack the continental United States cities if the United States