The gap between average life expectancy and that of the poorest in England is widening despite efforts to close it, a National Audit Office report says.
Life expectancy is now 77.9 years for men and 82 years for women but in poor areas it falls to 75.8 and 80.4 years.
The NAO says this means that from 1995-97 to 2006-08 the life expectancy gap grew by 7% for men and 14% for women.
It is calling for more investment to help GPs tackle problems like smoking and poor diet in poor communities.
The NAO says the figures mean a Labour government target to reduce the difference in life expectancy by 10% by 2010 is unlikely to be met.
Its report says it is not possible to show how much money has been spent on tackling health inequalities, as primary care trusts (PCTs) are not allocated specific funding for the task.
But it says that at present the system "does not provide enough of an incentive" to encourage family doctors to focus on the neediest groups in their practices.
The report says it would not cost "a large amount of money" - £24m a year - to take key actions which would improve health in deprived areas.
These include increasing the prescribing of drugs to reduce cholesterol and control blood pressure, and doubling the capacity of services which help people quit smoking.
The report contrasts that amount with the £3.9bn spent by PCTs in the poorest areas on treating circulatory and respiratory illness.
Life expectancy for everyone in England improved under Labour, and now stands at almost 78 years for men and 82 years for women.
But the improvement rate has been slower in the most deprived communities, and currently the equivalent figures are 75.8 years for men and 80.4 years for women.
Analysis also showed that success rates in stop-smoking programmes were lower in the poorest communities than in other areas.
Karen Taylor, from the NAO, said: "This has been an intractable and costly problem.
"It's likely improvements will start to happen - but at the moment, health inequalities are widening.
"Moving forward, there needs to be much more targeted action - with GPs and other healthcare professionals being aware of the need to actively intervene with the lowest socio-economic groups, to educate them and to provide the drugs which will improve their health outcomes.
"People in those groups are less likely to attend GPs, and also those areas still tend to be under-served with doctors."
Health minister Anne Milton said: "We want the public's health to be at the very heart of all we do.
"I want to see the NHS, doctors and local government acting at the right time to improve the health of those who need it most."
The government has pledged to increase the proportion of the health budget in England which is spent on preventing illness - something the NAO welcomed.
Ms Taylor said: "It's stayed steady - at about 4%. The new government has talked about an increase to perhaps 5%. That's actually a big increase, when you think about the whole health budget."
Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, said sustained action to tackle inequalities was essential.
"It's like turning round a supertanker. It takes time, and the combined effort of healthcare, social services, education, housing, employment, and environment. But we've got to keep the pressure up - the very survival of the NHS depends on closing this gap."
A spokesman for the British Medical Association, which has just concluded its annual conference, said: "We are disappointed that today's report says that the Department of Health will not meet its target to reduce the health inequalities gap.
"At our meeting, the BMA passed a motion calling on the government to increase expenditure on prevention services to reduce health inequalities.
"It is particularly important to do this in early years to give every child the best start in life. We will also lobby for fiscal policies to narrow the income gap between the poorest and the richest in society. Doctors believe it is necessary to take this action to tackle health inequalities."