Public health in England has improved but 'stark' inequalities remain despite huge investment, according to a government review.
Life expectancy has improved and targets to cut deaths from heart disease and stroke have been met, said the Audit Commission report Healthy Balance.
But the effect on teenage pregnancy and obesity has been muted despite billions of pounds of additional spending, said the commission.
Andy McKeon, Audit Commission managing director for health, said: 'Billions are directed to deprived areas. But it is not always clear how much has actually been spent on reducing health inequalities, and what the impact of this or that programme has been. Progress is often disappointing.'
The commission's report assessed the effect of a £58 billion increased annual NHS spend on health inequalities in England since 1999.
It estimated that the NHS allocated £21 billion in 2009/10 to PCTs to address health inequalities. But this has not resulted in any further systematic shift of resources to deprived areas, it said.
Teenage pregnancies have fallen just 13 per cent since 1998, far short of the 50 per cent reduction target.
Since 1999, the gap in mortality rates between England's most deprived areas and the national average rose for both men and women.
Although mortality rates for women fell overall, in some areas rates did not change, while in others they fell by 40 per cent.
GPC deputy chairman Dr Richard Vautrey said health inequalities are best addressed through social care policies. PCTs have a huge number of other priorities and are expected to deliver a wide range of services, he added. 'We need a greater honesty on what PCTs can do,' said Dr Vautrey.
Mr McKeon said: 'We know the health of the nation is improving. But variation in the health of people living in different parts of the country remains stark.'