Key points

• Health and well-being shows a strong and consistent social gradient.

• Socio-economic inequalities in health are widespread in all countries.

• They are caused by the unequal distribution of the social determinants of health such as power, income, goods and services and the impact this has on conditions of daily life.

• At the individual level, the social determinants of health differentially affect people’s abilities, or what Armartya Sen has called ‘capabilities’, to lead a flourishing life.

• They affect individuals across their life course with prenatal and early-life influences having a sustained impact on people’s health experience later in life.

• Tackling health inequalities requires action at multiple levels involving many agencies with government playing a pivotal role.

• Resisting the tendency for policy to focus predominantly on individual behaviour change – what has been called lifestyle drift – is important.

• Successfully tackling health inequalities challenges public health practice and calls for a new approach to governance, partnership, leadership and accountability

What are health inequalities?

That my health is better or worse than yours does not necessarily indicate the presence of health inequalities. According to the Global Commission on the Social Determinants of Health, which reported to the World Health Organization in 2008, the term ‘health inequality’ refers to differences between groups or populations defined socially, economically, demographically or geographically’ that are ‘unfair and avoidable or remedial’ rather than to any innate differences between these groups [1]. Statistics used to quantify health inequalities are discussed in Chapter 4 (and see the Internet Companion).