Increasing inequalities in the health of the nation

Abstract

Raising the subject of socioeconomic inequalities in health can produce the weary reaction that these are now so widely recognised that little purpose is served by flogging this dead horse again.1 Certainly the flat denial of such inequalities has almost become a thing of the past. The well known attempt by the government to stifle any reaction to the Black report on inequalities in health 14 years ago2 has given way to an apparently more reasoned approach. Indeed, it was announced at a conference organised by the BMA earlier this year that the government was establishing an interdepartmental working group to examine the links between social position and health3 as part of the continuing review of the Health of the Nation's targets.4 The setting up of this working party is timely, given the accumulating evidence that socioeconomic differences in health have increased since the Black report was published.5 6 7 In this week's journal McLoone and Boddy show that between the early 1980s and the early 1990s differences in mortality between deprived and affluent small areas of Scotland have increased substantially,8 a phenomenon that has also been reported in the largest Scottish city, Glasgow (p 1482).9 Much has been made of the poor health picture in Glasgow, which in the popular media has been awarded the title of “heart disease capital of the world.” But, as McLoone and Boddy show, inhabitants of the more affluent parts of Glasgow have the same favourable mortality as residents of equivalent areas in the rest of Scotland. There is no special Glasgow effect; the …