Background Improving the public’s understanding of how socioeconomic inequalities create and perpetuate inequalities in health, is argued to be necessary for building support for policies geared towards creating a more equal society. However, research exploring public perceptions of health inequalities, and how they are generated, is limited. In particular, there is a dearth of studies exploring young people’s perspectives. Our study sought to explore young people’s lived experiences and understandings of health inequalities.

Methods We carried out focus group discussions (n=18) with 42 young people aged 13–21 recruited from six youth organisations in England in 2021. The organisations were located in areas of high deprivation in South Yorkshire, the North East and London. Young people from each organisation took part in three interlinked focused group discussions designed to explore their i) perceptions of factors impacting their health in their local area, ii) understandings of health inequalities and iii) priorities for change. Due to the Covid-19 pandemic, most discussions took place online (n=15). However, with one group in the North East, we carried out discussions face-to-face, once social distancing restrictions permitted, as the youth group building did not have facilities to support virtual focus groups and not all young people had the necessary technology to participate from home. Data were analysed thematically using NVivo-12 software to facilitate data management.

Results Young people from all groups demonstrated an awareness of a North South divide. They described how disparities in local economies and employment landscapes between the North and the South led to tangible differences in everyday living and working conditions. They clearly articulated how these differences ultimately led to inequalities in people’s health and wellbeing, such as linking poverty to chronic stress. They also highlighted the interweaving of regional and intergenerational inequalities over time. Young people did not believe these inequalities were inevitable. They described the government as prioritising the South and thus perpetuating inequalities through uneven investment.

Discussion Our study affords important insights into how young people experience and understand geographically patterned socioeconomic and health inequalities in the context of their lives. It underscores quantitative analyses highlighting longstanding and growing disparities in incomes, job creation and unemployment. It supports calls for pro-equity policies to address regional divides and move from rhetoric to action in 'levelling up' the country. Further research, exploring the perspectives of young people in contexts of socioeconomic advantage, could build on this work.