The United Kingdom has unacceptable inequalities in health and life expectancy by socioeconomic status, ethnic group and gender.1 Many of these differences have widened over the past two decades. This means, for example, that over 17 000 fewer 20 to 64 year old men would die each year if all adult men shared the death rates of social classes I and II.1

The Acheson report reviewed the evidence on inequalities in health in England and concluded that they related primarily to social inequalities in health determinants like income, education, employment and the material environment.1 The report made a series of recommendations to reduce inequalities by acting on these determinants. It also recognised a need to try to prevent future inequalities, by ensuring that government policies improved the position of the worst off people. Its first recommendation—one of three given priority among Acheson's 39 recommendations—proposed that: “as part of health impact assessment, all policies likely to have a direct or indirect effect on health should be evaluated in …