The contrast between the life expectancy of the National Health Service patients I saw, who either lived in a relatively deprived inner-city council estate in Norwich or later in Whitechapel, East London, and those I met as private patients in Devonshire Place, close to Harley Street, always worried me.

Although the life expectancy of most people has obviously been improving over the years, the gap between the standards of medical care and healthy lifestyle between the affluent and the deprived has widened, rather than shrunk.

It isn’t that the successful and opulent, whether by birth, occupation or marriage, or even the “type A” social class – who are ambitious and goal-orientated – have a lifestyle that makes them less likely to develop potentially lethal diseases. It is that although affluence, exercise and a balanced diet cannot prevent disease for ever, any medical problems for people in these groupings are more likely to be diagnosed at an early stage, treated more efficiently and followed up more assiduously.

In many deprived areas high blood pressure is still grossly underdiagnosed and treated poorly. Hyperlipidaemia – raised cholesterol levels – is ignored and few NHS patients know that their low-density lipoprotein levels are an essential indicator of possible trouble ahead. Breast screening, when compared with that of the rich, is too infrequent, discontinued too early and can even be desultory.

The average NHS practice still does not carry out or organise worthwhile cardiovascular assessment. It doesn’t measure blood sugar levels and renal function routinely, or determine the PSA levels of men so that it can diagnose prostate cancer in time for worthwhile intervention, or even understand the cardiac implications of progressive impotence.

Once a potentially lethal disease has been discovered, the quality of care that money can buy either in this country or abroad when compared with the standard NHS treatment is deeply worrying.

Babies born to the rich in the London Clinic, when my eldest son was born there well over 40 years ago, were on average nearly 1lb (450g) heavier than the ones I was delivering in Isleworth. Smaller babies are more likely to suffer cardiovascular diseases in adult life and die younger. This tendency is increased if they catch up quickly by putting on too much weight too fast after birth. The rich have a medical advantage at birth that they often keep for the rest of their lives. Money does not necessarily bring happiness, but a lack of it, as Mr Macawber pointed out, produces misery.

A good early education that encourages a lively interest in a wide variety of subjects will help to encourage a healthy lifestyle, as will pressure from schools and peer groups which determines that people take daily exercise and remain slim.

Factors that lead to longevity and delay the onset of Alzheimer’s include adequate funds in middle and old age to ensure better food and that regular wine is taken with a meal rather than binge drinking; interesting, comfortable travel and a wide social life.

Today’s figures demonstrate that the length of life is related to improved circumstances, but they do not demonstrate that the quality of life of the wealthy elderly is also better because they are mentally and physically fitter than the poor, and that this gap is widening.