This book examines and explains a simple fact: that at the end of the 20th century inequalities in health are extremely wide and are still widening in Britain. These inequalities are shown most clearly through the premature deaths of hundreds of thousands of people living in this country over the last two decades. We argue that such inequalities are patently unfair and that inequalities in health are the direct consequence of inequalities in wealth and the growth of poverty in Britain. We also propose that policies to reduce poverty would reduce inequalities in health and that without such fundamental policies we can only expect inequalities in health to continue to widen. However, before we present the evidence of the health gap in Britain, how it has been widening, and, most importantly, what we think should be done about it, it is appropriate to first consider the context of health inequalities and policy in Britain over the past two decades.

From the Black Report to the Independent Inquiry into Inequalities in Health

At the end of the 1970s the previous Labour government appointed Sir Douglas Black to chair a working group to review the evidence on inequalities in health and to suggest policy recommendations that should follow. The report was published (DHSS, 1980) – although with no press release and only 260 copies initially printed. Under the incoming Conservative government in 1980 the Report received a cold reception. A subsequent edition published by Penguin, however, made the findings widely available, and it was later published in conjunction with a later report The health divide, which updated the findings (Townsend and Davidson, 1988). The major finding of the Black Report was that there were large differentials in mortality and morbidity that favoured the higher social classes, and that these were not being adequately addressed by health or social services. The Report presented a number of costed policy suggestions, and concluded: