Background Due to its topography and history, Halton, Merseyside, provides a valuable natural experiment to investigate the divide between lay and official knowledge about environment and deprivation, and how these may influence health choices and outcomes.

Methods To gain a cross-section of the local population, households in every street in each of six predefined areas received an invitation. Fifty-five semi-structured interviews were carried out to assess residents’ perceptions and experiences of health, environment and lifestyle. A life history approach was taken to examine health over time, and how lifestyle choices were constructed.

Interviews were taped, transcribed, and analysed for themes using a Structuration Theory approach. Residents’ viewpoints were then presented to twenty local public organisation officials, whose own perceptions were also obtained.

Results While local residents were aware of health messages, these were adopted out of personal choice, not in order to accord with perceived edicts. Residents expressed scepticism about how official knowledge was constructed, and dismay that official knowledge viewed ill-health as the result of lifestyle rather than environmental or socio-economic factors.

There was a perception that enduring deprivation was sought to be maintained in order to attract funding which would benefit officials with vested interests who lived outside the borough and could therefore afford to be unconcerned about its problems.

An illustrative quotation from a resident is: ”Why kill the goose that laid the golden egg? Why get rid of poverty, deprivation and poor health when these big pots of money keep rolling in?”.

Discussion Health messages, like other forms of knowledge, may be interpreted more from the presentation and perceived motivation for issuing the message than from the content of the message. Where there is a divide between lay and official knowledge, this motivation may be seen as a means of asserting power rather than either a scientifically-based or an altruistic programme of education or information.

If lifestyles are viewed by officials as the prime factor influencing an area’s health profile, this view may be interpreted by lay knowledge as a means of social control meaning that the perceived root causes of socio-economic inequality need not be tackled, and that the priority of interventions is to maintain a privileged position.