The key to reducing Scotland's health gap is to address social inequalities, according to a new study.
Attempts to decrease the gap will fail unless the fundamental causes of poor health are dealt with, the NHS Health Scotland report concludes.
During a 30-year period, trends in Scotland's health inequality and particular causes of death were monitored.
It was revealed that death rates across social groups were fairly consistent for non-preventative deaths such as brain and ovarian cancer, but there were big differences for preventable deaths related to alcohol and heart disease.
Dr Gerry McCartney, head of the public health observatory at NHS Health Scotland, said thousands of "unnecessary and unjust deaths" happened every year because of health inequalities.
"The reason that health inequalities did not fall as particular causes were successfully tackled may be because individuals with more resources were able to protect themselves against new threats to health.
"Elimination and prevention of inequalities in all-cause mortality will only be achieved if the underlying differences in income, resources and power across Scotland are reduced."
There have been periods when health inequality has decreased in the UK, which suggests this can be tackled and that the most common factor to health inequalities is social inequalities, according to NHS Health Scotland.
Andrew Fraser, director of public health science at NHS Health Scotland, said: " Patterns of death that are evident in this report are the end-points of circumstances that span Scottish life rather than focus on a particular disease group.
"Prevention is achievable, and inequalities are not inevitable. We can anticipate that the burden of health care facing the NHS, communities and families will become progressively greater if we as a country don't provide the answers."
Michael Matheson, minister for public health, said: "I welcome this report, which reflects the fact that health inequality is one of Scotland's greatest challenges.
"Overall, Scotland's health is improving, with people living longer, healthier lives, but we need to do more to reduce the health gap between the richest and the poorest people.
"This is not just a health problem, and the responsibilities for the underlying causes - poverty, income inequality, our environments - lie outwith the health system. We are shifting our emphasis from dealing with the consequences to focus on prevention.
"The UK Government's welfare reforms will have a profound effect on people in Scotland and the changes are likely to widen the health inequality gap, increase poverty and have a negative impact on local economies.
"We are working within our existing powers with all of our partners to tackle poverty, inequalities and injustice that will make a real difference to health inequalities."
Scottish Labour's health spokesman Neil Findlay said: "This is just the latest in a long line of reports that show that a long-term strategy to tackle health inequality is desperately needed.
"We need real practical action to address these matters and the Scottish Government must outline how it will respond to this report."