It is not clear whether billions of pounds worth of spending on health inequalities is providing value for money, a report has claimed.
The Audit Commission study said it is hard to pinpoint an "obvious" link between investment and improvements in rich and poor divides on health, with efforts to narrow the gap described as "disappointing".
A total of £21bn is to be spent on reducing health inequalities this year, but despite some improvements in life expectancy, there is still work to be done on tackling teenage pregnancy and obesity, the commission said.
Within the last decade, life expectancy rates have increased in England, along with a reduction in infant death and government targets to cut deaths from heart disease and stroke by 2010 have already been met.
The report said: "It is hard to see an obvious link between spending and improvement, or get any clear view of value for money.
"Progress in reducing inequalities, and in some aspects of health such as that of very young children, has however been disappointing, even if general progress on, for example, life expectancy and other broad measures has been very positive."