'Punchily written ... He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed' Times Literary Supplement 'Splendid and necessary' Henry Marsh, author of Do No Harm, New Statesman There are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

The Department of Health has made a serious attempt to tackle health inequalities across England. But having set a target in 2000 to reduce health inequalities, it took time to embed the issue in the policy and planning framework of the NHS and to develop an evidence base of the most cost-effective interventions. Although life expectancy overall has increased, the gap in life expectancy between the national average and the Government's dedicated "spearhead" areas has continued to widen. The Department will not meet its target to reduce the health inequalities gap by 10 per cent by 2010, as measured by life expectancy at birth, if current trends continue. The Department's strategy lacked effective mechanisms to achieve the target because the evidence base was still being developed. Three key, cost-effective interventions to reduce the gap in life expectancy were identified by the Health Inequalities Intervention Tool: increase the prescribing, first, of drugs to control blood pressure and, second, of drugs to reduce cholesterol, by 40 per cent; and double the capacity of smoking cessation services. But these interventions have not yet been used on the scale required. Primary care trusts are required to address health inequalities from within their general budgets and it is not possible to identify how much money has been spent. PCTs in spearhead areas had £230 more per head to spend than the PCTs in non-spearheads, but there is evidence that some of the extra money is absorbed by higher hospital costs in deprived areas.

The Government recognises that many lifestyle-driven health problems are at alarming levels: obesity; high rates of sexually transmitted infections; a relatively large population of drug users; rising levels of harm from alcohol; 80,000 deaths a year from smoking; poor mental health; health inequalities between rich and poor. This white paper outlines the Government's proposals to protect the population from serious health threats; help people live longer, healthier and more fulfilling lives; and improve the health of the poorest. It aims to empower individuals to make healthy choices and give communities and local government the freedom, responsibility and funding to innovate and develop ways of improving public health in their area. The paper responds to Sir Michael Marmot's strategic review of health inequalities in England post 2010 - "Fair society, healthy lives" (available at http://www.marmotreview.org/AssetLibrary/pdfs/Reports/FairSocietyHealthyLives.pdf) and adopts its life course framework for tackling the wider social determinants of health. A new dedicated public health service - Public Health England - will be created to ensure excellence, expertise and responsiveness, particularly on health protection where a national response is vital. The paper gives a timetable showing how the proposals will be implemented and an annex sets out a vision of the role of the Director of Public Health. The Department is also publishing a fuller story on the health of England in "Our health and wellbeing today" (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_122238.pdf), detailing the challenges and opportunities, and in 2011 will issue documents on major public health issues.

"The Handbook on health inequality monitoring: with a special focus on low- and middle-income countries is a resource that enables countries to do just that. It presents a comprehensive yet clear overview of health inequality monitoring in a user-friendly manner. The handbook succeeds in giving those involved in health inequality monitoring an appreciation of the complexities of the process, as well as building the practical knowledge and skills for systematic monitoring of health inequalities in low- and middle-income countries. The use of the handbook will enable countries to better monitor and evaluate their progress and performance with a high degree of accountability and transparency, and allow them to use the results to formulate evidenced-based policies, programmes and practices to tackle inequalities in an effective manner."--Publisher's description.

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