User Needs Assessment of ASTHMAXcel Voice: A Novel Mobile Health App for Asthma Management.

People in the North of England (North East, North West, and Yorkshire and Humber regions) live on average almost two years less than those in the rest of the country []. Those in the North are 20% more likely to experience premature death - amounting to 1.5 million Northerners dying before their time since 1965 [; . This ‘North South health divide’ in England is longstanding, documented both before and after the epidemiological transition []. Similar regional health divides exist in countries like Italy, Brazil and the USA (; ) but England’s is particularly stark - now greater than the divide between the former West and East Germany []. Evidence suggests the gap is worsening, especially among younger adults (; ; ). Addressing this divide has become more urgent. Austerity measures introduced by the UK government in 2010 have disproportionately impacted Northern regions (; ). The economic consequences of Brexit are expected to be regionally uneven (). Deaths from COVID-19 were 17% higher in Northern regions, as well as the North experiencing harsher lockdowns, hospital pressures, and greater mental health effects []. The cost of living crisis is now hitting Northern regions hardest, severely impacting child poverty (; ). Recently there has been increased political interest in the North, evident in initiatives like the Northern Powerhouse (NPH, 2023), regional devolution deals () and the government’s ‘levelling up’ agenda – which aims to narrow the gap in Healthy Life Expectancy (HLE) by 2030 and increase HLE by five years by 2035 (, p. 200). However, critiques highlight limited action and funding of these developments (; ; ).