It is a matter of life and death. Yesterday�s report from the World Health Organisation about inequities between and within different countries contained much material that is sadly familiar in Scotland.

It is a matter of life and death. Yesterday's report from the World Health Organisation about inequities between and within different countries contained much material that is sadly familiar in Scotland. Readers of The Herald can hardly be unaware that within Scotland in general and Glasgow in particular there are alarming gaps in life expectancy, especially among men. Drawing from figures already discussed by this newspaper, the WHO points out that a baby boy born in Calton in the east end of Glasgow can expect to live on average 28 years less than one born in Lenzie, less than 10 miles away.

A number of factors skew these figures radically, such as men in deprived communities dying young from drugs-related causes, alcohol abuse and violence, as well as the prevalence of high levels of obesity, diabetes and heart disease. Specific local factors, such as the concentration of hostel accommodation for homeless men can also distort the figures. This sort of reporting inevitably whips up false arguments between those who depict these life-limiting conditions and lifestyles in terms of moral failure and those who see them as the inevitable outcome of social determinants. This argument is exemplified by the convoluted double-speak on this issue emerging from different parts of the Conservative party.

Yet it is self-evident that in societies with high levels of poverty and joblessness, problems accessing good housing and affordable fresh food, where high levels of violence, obesity, alcoholism and drug abuse are normal, it is more difficult to sustain a healthy lifestyle. It is equally self-evident that many individuals in these communities defy expectations and manage to live long, healthy lives. In the grey area between nurture and nature is the impact on an individual's outlook and self-discipline of growing up in communities suffering from a collective paucity of self-confidence and hope and high levels of stress and anxiety.

There is in Scotland a sophisticated appreciation by professionals, politicians and academics of how all these factors connect and an impressive record of measuring them. That is one reason why Scotland features so prominently in studies such as this one. The past decade has witnessed a number of relevant initiatives: the minimum wage, tax credits, nursery education for three-year olds, the Pathways to Work scheme, better cancer treatment and, most significantly perhaps, the smoking ban in public places. The Scottish Executive's Centre for Population Health has helped bring different policy strands together in tackling health inequalities and the SNP administration's Equally Well report is attempting to build on it.

Still, there is plenty of room for improvement. Health and social policy have suffered from too many short-term projects that have not been sustained. More needs to be done to tackle the looming obesity crisis, after recent research revealed a postcode lottery in treatment on offer. There is even disagreement among GPs on their role in tackling the subject with overweight patients.

Personal responsibility and political action are not mutually exclusive. People need to understand what and why they need to change and they need more help from the state to do it.