Health inequalities were identified in 1997 as a priority for the new government elected in May of that year. Prime Minister Tony Blair told the House of Commons that ‘inequalities do matter and there is no doubt that the published statistics show a link between income, inequality and poor health. It is important to address that issue and we are doing so’ (Hansard, 1997).

This message was taken up in the home countries of the UK – in Scotland, Wales and Northern Ireland. In England, Sir Donald Acheson was commissioned to survey the position on health inequalities and identify possible responses. The result was the Acheson Report, published in November 1998 (Acheson, 1998). It has provided a cornerstone to policy development on health inequalities ever since and guided thinking in England, the rest of the UK and beyond. This chapter seeks to explore how government policy has developed on health inequalities and how the Acheson Report and its recommendations have contributed to its development.

Background

Tessa Jowell, the new Minister for Public Health, appointed to attack the root causes of ill health (Labour Party, 1997), wrote to Sir Donald Acheson, a former Chief Medical Officer for England, on 10 July. She invited him to undertake a review of health inequalities that would contribute to a new strategy for health. Sir Donald agreed to conduct the inquiry with the support of a small scientific advisory group consisting of Professor Sir Michael Marmot, Professor David Barker, Professor Hilary Graham, Professor Margaret Whitehead and Dr Jacky Chambers.

In the eyes of many, setting up the Acheson Inquiry was intended to help make good the fate of the earlier Black Report on health inequalities (DHSS, 1980). Commissioned by the last Labour government in 1977, Sir Douglas Black, a former president of the Royal College of Physicians, produced a detailed and costed blueprint for action on health inequalities. Reporting in 1980, the opportunity for translating his recommendations into action had passed, ended by a change of government in 1979.

Its recommendations were effectively buried by a limited edition release of the report on August Bank Holiday Monday (DHSS, 1980). The treatment of the report still rankled. Black remained an inspiration for those who wanted to see action on health inequalities – including many of the new Labour ministers and MPs elected in 1997.