Inequalities in health

Editor—The editorial by Davey Smith et al1 devoted to the Report of the Independent Inquiry into Inequalities in Health2 is welcome in many ways but gives a misleading account of some aspects. The authors give the impression that the 39 recommendations were presented without any priority being given. In fact, we selected three clear priorities, which are the focus of our first three recommendations. These are paraphrased in the synopsis as follows: “There are three areas which we regard as crucial: all policies likely to have an impact on health should be evaluated in terms of their impact on health inequalities a high priority should be given to the health of families with children further steps should be taken to reduce income inequalities and improve the living standards of poor households.” The editorial also states that “the key fact that inequalities in health follow closely inequalities in wealth” is underestimated. On the contrary, in addition to nominating the reduction of income inequalities as a priority we note on page 33 of the text that “without a shift of resources to the less well off, both in and out of work, little will be accomplished in terms of a reduction of health inequalities by addressing particular ‘downstream’ influences.” In line with our remit to identify priority areas for policy development we assembled and assessed a large volume of evidence on each major area. It is important that each recommendation should be read in conjunction with the accompanying text. This gives a summary of the scale and nature of the inequality at which the recommendation is directed, a review of the evidence on how that inequality might be reduced, and an assessment of the expected benefit from the recommended action. In respect of the recommendations relating to the prevention of suicide and the reduction of the fear of violence, which Davey Smith et al find “too vague to be useful,” several specific suggestions as to how these goals could be achieved are summarised respectively on pages 54 and 55 (crime and violence) and 78 and 107 (suicide). We believe that this report has assembled in one volume, which includes over 500 references, a wide ranging and up to date body of evidence on actions to tackle inequalities in health. It would be a pity if those who read the BMJ’s editorial were discouraged from making use of it.