Introduction

Unlike other disciplines represented in this book, a focus on addressing inequalities in physical health was not already established in social work discourse at the time of the Acheson Inquiry. However, in the intervening period, a major theoretical shift has occurred. Social work's contribution to tackling inequalities in physical health has gained recognition as a crucial component of theorising social work's engagement with inequality (Mullender, 1999; McLeod and Bywaters, 2000; Davies, 2002). The fundamental reasons why inequalities in physical health should be on social work's agenda are that:

• • inequalities in physical health are endemic among social work service users;

• • social work may compound social disadvantage implicated in unequal chances and experience of physical health;

• • evidence is accumulating that social work generally – not simply in healthcare settings – that targets health inequalities and addresses unequal social conditions can contribute to more equal chances and experience of physical health.

In presenting this account, we are not perpetuating a false division between mental and physical health – our position is that physical and psychological well-being are intertwined – but registering the emergence of a further critical dimension to social work analysis. For the sake of brevity, in the remainder of the discussion physical health will be referred to as health.

A pervasive problem

Social work service users are overwhelmingly drawn from people experiencing social disadvantage. Therefore it is not surprising that inequalities in health are endemic among them. The majority live in relative poverty (Jones, 2002), cross-cut by other dimensions to social disadvantage such as racism (Cambridge and Williams, 2004) and disability (Swain et al, 2003). Disproportionately high levels of ill health and inferior treatment in the course of ill health have, for example, been evidenced for care leavers (Broad, 2005), asylum seekers and refugees (Gray, 2003), and service users with learning disabilities or who are mental health service users (Kmietowicz, 2005). This should constitute a key issue for social work practice, as a situation of social injustice endured in individual pain and suffering (McLeod and Bywaters, 2002).

Social work's complicity

Despite the prevalence of inferior health and healthcare among service users, social work's engagement with socially constructed health inequalities remains marginalised in social work policy and practice.