Equity in health and equity in health care have been ill-served in recent years. While for many health care systems equity is stated to be an important goal, in several of these equity in policy terms has been paid little more than lip-service. While it is also the case that there has been an increasing research interest in the social determinants of health, the extent to which the recognition of the impact of these on health has led to action at a policy level has been limited. Poverty and inequality are now well recognized in the academic literature, especially in social epidemiology but in public health more generally, as contributing to population ill health. National and global policy makers, however, have been all too little concerned to address poverty and inequality and, inevitably, even less concerned to do so for reasons purely of improving health.

Health economists have contributed considerably to debates about the construct of equity in health care, be this seen in terms of health, access or use and whether horizontal or vertical equity. Beyond considerable success in the 1970s and 1980s in assisting methodologically to improving equity in health care through needs-based, RAWP-type resource allocation formulae (DHSS 1976), policy on equity in health care has been a field where health economists have made relatively little impact.

Considerations of ‘need’ were initially very useful in RAWP-type resource allocation formulae and indeed the scene of most policy success by economists on equity in health care.