This book engages with the contemporary challenge of health inequalities in rich, industrialised countries, with particular focus on the UK, drawing on different disciplinary perspectives and policy instruments. It reviews the trajectories of problem analysis and policy responses following the Independent inquiry into inequalities in health (Acheson, 1998) in England and Wales, which was set up and published early in the heady days of the New Labour government, elected in the UK with a landslide victory in 1997 on a mandate to reduce ‘unacceptable inequalities in health’ among other ills. Even at the time, the process of the inquiry, with its consultations, background briefing papers and choice of policy areas, seemed fresh, appropriate and full of exciting promise. Perhaps it was inevitable that there should be disappointment; the accounts given here, while sometimes reminiscent of the caricatured curate's response to his egg of merely ‘good in parts’, largely conclude that things could in fact have been better (cf Chapter Three).

There have clearly been some social policy achievements, such as the reductions in child poverty (see Chapter Five) and the introduction – and uprating – of a minimum wage. Stopping smoking is no longer entirely left to ‘education versus the free market’ (Chapter Nine), and another of the main determinants of health – diet – has risen up the policy agenda, such that the worst excesses of market liberalism in the food system are being acknowledged, with attention to school meals, food labelling and advertising (see Chapter Eight; Morgan, 2006). Also, reflecting contemporary notions of involvement and consultation, policies that try to engage with local people, whether characterised as residents, users or patients, have been initiated – and often rapidly changed – as discussed in Chapters Ten and Eleven. They too highlight some achievements, both in general and through specific examples of the involvement of people with serious mental health problems or who are homeless. These, among other examples of good practice documented throughout the volume, do point to serious attempts to understand causality upstream and downstream and to put appropriate instruments in place to address the challenges identified. In Chapter Two, Ray Earwicker gives a cogent account of the internal mechanisms of government necessary to achieve upstream change, although within the confines of a contributory chapter and his current position, he perhaps has limited space and personal agency to explore detailed reasons for policy shift.