Background Inequalities in health between the North and South of England are stark, longstanding, and of major significance to both policy and the public. Despite this, academic study of the ‘north-south health divide’ has so far been limited to a handful of epidemiological studies - with a marked absence of qualitative methodologies or multi-disciplinary engagement. This includes a lack of lay perspectives: whilst increasingly recognised as central to understanding health inequalities, lay knowledge on England’s regional health inequalities has been as yet absent from the academic literature.

The current project was conducted as a pilot in advance of a larger scale qualitative study. The larger scale study aims to examine lay perceptions of regional health inequalities and the north-south health divide, and will involve multiple focus groups and interviews across the north and south of England. The aims of the current pilot were to inform the process and content of the larger scale qualitative study, as well as to explore lay perceptions of England’s north-south health divide (including causes and potential solutions).

Methods A pilot focus group discussion was conducted in July 2022, in a town in County Durham, with ten participants living in and around the area. Participants were recruited via a local community group connected to the ‘Equal England’ public panels. Data were analysed thematically using a framework approach.

Results Five themes were identified from the discussion as causal factors for England’s north-south divide: (1) unequal distribution of resources; (2) unequal opportunities; (3) overstretched health and social care; (4) power imbalance; (5) lack of community cohesion. Participants’ perspectives on potential solutions were also summarised within these themes. The pilot was useful in generating reflections on the process and content of the workshop, which were summarised as a list of learning points for the future focus group discussions and interviews.

Conclusion Lay participants from a pilot focus group discussion in the North East of England discussed structural determinants as key to explaining the north-south health divide. Themes correlated closely with existing literature on academics’ perceptions of the causes of the north-south health divide; whilst presenting a contrast to current policy literature on regional health inequalities. Valuable reflections on the recruitment process and workshop format will help to inform further focus groups and interviews across the north and south of England, with a view to gaining crucial lay insights into England’s health divide.