Poverty and inequalities in health

The first objective of the World Health Organisation’s ‘Health For All’ policy is the reduction of health related inequalities by some 25% (WHO, 1985). The UK Government’s endorsement of the HFA targets therefore indicated that health inequalities should never have been off the political agenda. Their continued importance as an issue of health-policy was confirmed recently by the health minister, William Waldegrave, who announced that the reduction of the remaining inequalities in health should be a prime aim of health services. The purpose of this paper is to explore the possibilities for reducing health inequalities by reconsidering the role structural or material conditions play in their determination and role health care might play in their eradication. Since the work of people such as Chadwick and Rowntree no one has doubted the association between ill health and poverty and so it is reasonable to question why the link should be reconsidered here. One reason is the pace of economic change during the 1980s. This period was characterised initially by increased unemployment, widened income differentials and then rapid economic growth which brought a fall in the rate of unemployment. By the end of the decade, the economic boom had ended and the economy was entering a recession which some commentators have suggested may be the worse since the 1930s. The effect of these economic changes on the levels of poverty is disputed and the effect on health inequalities is unknown. In this paper, the evidence on the numbers of people living on low incomes and the relationship between ill health and personal economic circumstances is reviewed before consideration is given to the implications of each on policy to reduce health inequalities.