Middle earners have still not recovered from the recession and are falling behind in some key areas of health and education, according to a new report.
Leading health expert Professor Sir Michael Marmot said it was important not just to focus on the poorest in society but to also look at the middle-classes.
His new study found that people living in parts of the country that were somewhere in the middle in terms of affluence, were doing less well than those in some deprived areas.
He said middle earners were still facing "extreme" pressures and did not feel comfortably off.
'We are still not quite at the 2007 levels," he said.
"The pressures on families in the middle are still extreme.
'If you are in the middle of the distribution, and you haven't got back to the 2007 levels, you are still struggling to get back to where you were.
''That has an impact on families."
Fuel poverty is going up in areas considered to be middle affluence, as it is in deprived areas, and children from middle-class families are still behind those at the top when it comes to GCSE performance, data for the report showed.
People in middle income areas also do not report significantly greater levels of life satisfaction than those in the most deprived regions. But the highest earners are significantly more likely to say they are happy with life.
Simple things - like reading to children every night - are not happening in middle-class families as often as in higher income families, Sir Michael said.
More than 75% of children in the highest income groups are read to every day aged three. This compares to just over 60% in the middle income bracket.
Middle earners are also less likely to give their children regular bed times aged three than higher earners.
Sir Michael said: "'People in the middle are not immune to what is going on.
"In terms of life expectancy they are behind those at the top.
"Middle England is benefiting from longer life expectancy, as everybody is benefiting. But the disadvantage of being in the middle, compared with being at the top, persists.
"I think it relates to not quite having all the money you need to do all the things that you think are important, not quite having the kind of work that you need to fulfil your aims and dreams.
"It relates to more difficulties with housing costs.
"We see that children in the middle, not just those at the bottom, do less well at early child development at age five, and GCSE performance, than those at the top.
"So it starts at the beginning of life with early child development, with education, work, income, housing, and continues throughout your life.
"That's why I think it's really important not to think only of the lot of the poor, but to think of everybody below the top."
Sir Michael said that the health of the nation followed a gradient.
"The better off your circumstances, the better your health," he said.
"Children from families in the middle are not doing as well as children from families at the top.
"What is driving that?
"We look at parenting activities which look at one very simple indicator - proportion of children aged three who are read to every day.
"Children in the middle are less likely to be read to every day than children in the top 20%.
"They are less likely to be played with, singing or cuddling, than those at the top.
"It starts early in life, that social gradient.
"Parents' social and economic situation impacts on their ability to do these normal parenting activities.
"It is just harder."