Behind the healthy and wealthy facade of the northern beaches lies a secret problem: alcohol.
For the second year in a row, a Fairfax Media analysis of health statistics has found residents of some of the northern suburbs are the healthiest when it comes to everything but alcohol use.
Hospitalisations linked to alcohol use were highest in the wealthiest parts of Sydney, with Manly having a higher rate than any other local government area for the second year in a row, and Sydney, Mosman, Hunters Hill and North Sydney were not far behind.
The figures, from Health Statistics NSW, show the problem is getting worse. In all but Hunters Hill the rate of hospitalisations increased between 2009 and 2011.
The hospitalisations are linked to long-term alcohol use, and include only residents of those suburbs - not people who visit them to drink.
The analysis reveals stark differences in the health of the rich and poor in Sydney, with almost all the highest rates of deaths and hospitalisations linked to conditions such as diabetes, body mass and heart disease clustered in the poorest areas.
The director of Curtin University's public health advocacy institute, Mike Daube, said the analysis showed we were developing a two-tiered health system.
''The haves have better health and the have-nots have poorer health and live shorter lives,'' Professor Daube said. ''This isn't a coincidence; this fits with everything we know about patterns of health and
it really does show that good health is essentially the preserve of the most affluent.''
Once again Campbelltown, which is the second-poorest local government area in Sydney according to Bureau of Statistics rankings, was found to be Sydney's most unhealthy area.
It was in the worst-performing areas in every category except alcohol-related hospitalisations.
More than a quarter of all women in Campbelltown smoke during pregnancy, compared with about 1 per cent in Willoughby, Sydney's healthiest area.
But Fairfield did far better than its ranking as the poorest local government area in Sydney would suggest, managing to avoid being among the worst performers in any category.
Professor Daube said the figures showed a huge number of hospital stays were linked to preventable, lifestyle-related conditions.
''The preventable health problems are putting massive pressures on a health system that is already heavily stretched,'' he said. He was concerned that the state government had cut funding for anti-smoking campaigns while such high smoking rates were still being seen.
He said it was clear alcohol did not respect social status, and governments were unwilling to tackle the problem.
The chief executive of the Foundation for Alcohol Research and Education, Michael Thorn, said more needed to be done to find out why alcohol hospitalisations were affecting wealthy areas.
''Age could have an impact,'' he said. ''It's one of these sort of unspoken things that we target young kids drinking … but we certainly know that wealthier people and older people are consuming a lot.''
The foundation's annual poll showed that people aged over 40 drank more regularly than younger people, who tended to have between two and four days off in a week.
''We know from looking at total alcohol consumption in a year that people in their 20s and 30s ease off, that's driven in part by economics and family considerations … and then they certainly take it up again as they get older,'' Mr Thorn said.