Tackling health inequalities since the Acheson Inquiry
- Correspondence to: M G Marmot International Centre for Health and Society, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; m.marmotpublic-health.ucl.ac.uk
Policies are in place that could make a difference
It has been said that there are two types of people in the world: those that think there are two types of people and those who do not. If I were not disbarred by the contradiction, I would belong to the second group. This applies to my view of health inequalities—both to the problem and its solutions. Health inequalities are not confined to differences in health between rich and poor; health follows a social gradient: the higher the position in the social hierarchy, the lower the risk of ill health. Similarly, the policy responses to health inequalities are likely to be graded—shades of grey rather than black and white.
In Britain, we have recognised the problem of health inequalities for a long time.1 That is not news. The news would be if a government took seriously reduction of health inequality. Governments take health care seriously. The newspapers and politicians are full of stories about how many nurses or surgeons there are, how much is being spent on health care, how long is the waiting list, how long the wait for surgery. The magnitude of health inequalities is not the currency of daily debate. How, then, could we tell if a government took seriously reduction of health inequalities? They might declare publicly that health inequalities are a problem to be solved; perhaps set in motion a process to garner expert advice to tell them what to do; it might help to set targets for reduction of health inequalities, as an aspiration; policies need to be put in place; and a system set up to determine if any of the policies are having effect.
Based on this list, one could almost conclude that the British government has taken seriously reduction of health …
