Inequality in health is not a minor issue confined to small areas, but a major feature of contemporary Scotland and a massive public health problem. Comparison of mortality rates in Glasgow and Edinburgh is instructive, not only because of the large current difference in mortality rates between the cities, but also because the availability of data for both cities for most of this century provides an opportunity to view current differences from a historical perspective. This shows that current large differences in disease-specific mortality rates are part of a broader pattern of earlier death from all causes which has been established at least by the age of 25 in successive generations. Whether and how this pattern may be reversed and prevented deserves urgent discussion and debate. In the meantime, differences in life expectancy between sections of the Scottish population should be included as part of routine health monitoring. Reduction in differences in life expectancy should also become a national health target.