The purpose of this chapter is to examine the realistic policy options that would halt and then reduce the ever-widening health gap that has been documented in the four preceding chapters. The government White Paper on public health, Saving lives: Our healthier nation, published in July 1999, set out two key aims of the Labour government’s health policy (DoH, 1999a). The first aim was to improve the health of the population as a whole by increasing the length of people’s lives and the number of years spent free of illness. The second key aim was to improve the health of the worst off in society and to narrow the health gap (DoH, 1999a). In the White Paper, it is argued that these twin goals “are consistent with the health strategies being adopted by other countries of the United Kingdom” (DoH, 1999a). They are also consistent with the new programme of the World Health Organisation (Europe) for the 21st century, Health 21 (WHO, 1999), and the European Community’s developing strategy for public health (DoH, 1999a).

The first of the government’s aims is the less challenging – average life expectancy in Britain has been rising since reliable data were first collected over 150 years ago (Charlton, 1997). Unless Britain suffers from an economic catastrophe, such as that which has befallen the former countries of the Soviet Union, it is likely that average life expectancy in Britain will continue to increase. It is the government’s second aim of narrowing the health gap that will require major policy changes if it is to be realised. As the evidence presented in Chapter 4 showed, it has been the increases in poverty and income inequality that have preceded greater inequalities in health in Britain.