A new study asking what it will take to eradicate health inequalities suggests drives to reduce smoking and drinking will not change life expectancy among the poorest.
NHS Health Scotland, the health promotion body which plays a key role in quit smoking drives, instead says there is an urgent need "for action to address inequalities in income, resources and power across society".
Dr Gerry McCartney, of NHS Health Scotland, said illness which had once taken a greater toll on the deprived such as cholera and tuberculosis had been replaced by new killers such as drugs and alcohol.
"Those with greater resources at their disposal can protect themselves from what we learn is dangerous for health," he said. "Be it accessing healthcare or vaccines or housing or less stressful jobs or stopping smoking, they can take advantage of whatever they need to be healthy."
The report, published today, showed there is little difference in death rates from non-preventable diseases like ovarian cancer across the social spectrum but large differences in death rates from more preventable conditions such as heart disease.
Andrew Fraser, a director at NHS Health Scotland, warned the "burden of health care facing the NHS, communities and families will become progressively greater" unless the root causes of poor health are tackled.