There is a longstanding and well-established regional health divide in England: on average, people in the Northern region of England live two years less than those in the rest of the country. These geographical divides were exacerbated by austerity and feelings of being ‘left behind’ are considered to have contributed to the 2016 Brexit vote and spurred the Conservative Party to propose a regional development policy of levelling up as a centre piece of their successful 2019 election manifesto. In 2020, the COVID-19 pandemic hit against this backdrop of severe regional inequality. While the pandemic affected all aspects of life, all people, and all parts of the country, it did not do so equally: the North was hardest hit. This book addresses this vital contemporary issue of regional inequalities through the prism of the impact of the COVID-19 pandemic.We demonstrate that COVID-19’s regional impact has been unequal across three domains: mortality, mental health, and the economy. We also further explore regional inequalities in relation to sex, ethnicity, and income/deprivation. Using original data analysis of a wide range of sources (including health and social care survey data, administrative health care data, mortality data, economic data), we show how the pandemic disproportionately impacted on the three Northern regions of England (North East, North West, and Yorkshire and The Humber), exacerbating existing regional inequalities in health and wealth. It demonstrates that: COVID-19 deaths were higher in the North of England, the North experienced six weeks more in lockdown, higher wage reductions, more furlough, higher unemployment, and worse mental health. We calculate that the unequal regional impact of the pandemic will cost the UK economy over £7 billion in lost productivity due to higher mortality and £2 billion in increased mental ill health.We will draw on a wide range of interdisciplinary concepts to contextualise our original data analysis. Our book therefore also aims to make a conceptual as well as an empirical contribution to the COVID-19, health inequalities, health geography, and regional economics literatures. We argue that the COVID-19 pandemic interacted with – and exacerbated – longstanding regional inequalities in health and wealth. We conclude by setting out what we can do post-pandemic to reduce inequalities in health and wealth in the future.