This Report addresses an issue which is fundamentally a matter of social justice; namely that although the last 20 years have brought a marked increase in prosperity and substantial reductions in mortality to the people of this country as a whole, the gap in health between those at the top and bottom of the social scale has widened. Yet there is convincing evidence that, provided an appropriate agenda of policies can be defined and given priority, many of these inequalities are remediable. The same is true for those that exist between the various ethnic groups and between the sexes.

In July 1997, I was invited by the Secretary of State for Health to review and summarise inequalities in health in England and to identify priority areas for the development of policies to reduce them. To accomplish this task, I have been aided by a small group of scientists. This Report is the result of our work together.

In this work, we have consulted widely and drawn on the expertise of a range of colleagues whose names are acknowledged in the Report. We also acknowledge and have built on the work of those who have gone before us. We mention in particular Sir Douglas Black's ground breaking report "Inequalities in Health". We have also found inspiration in the work of the World Health Organisation which, in its European "Health for All" Policy, gives precedence above all other objectives to the promotion of equity in health within and between countries.

There have been many relevant developments between the appointment of the Inquiry and our submission of this Report to Ministers. From its earliest days in office, the Government has expressed its concern about inequalities in health and in February 1998 translated this concern into a central premiss of its consultation paper "Our Healthier Nation". This has been followed not only by the 1998 Budget but by a succession of consultation documents and White Papers relevant to our inquiry.

As our work developed, it has become clear that the range of factors influencing inequalities in health extends far beyond the remit of the Department of Health and that a response by the Government as a whole will be needed to deal with them.

We believe that the policies and areas for policy development which we have identified from the available evidence, comprise an effective agenda. Its components are congruent and mutually reinforcing. We are convinced that if this agenda is implemented it will make a major beneficial impact on inequalities in health. We hope that it will also provide a sound basis for policy development well into the next millennium.

At this point, the scientific work of the Inquiry is done. We commend the Report to the elected Government as a significant contribution to social equity worthy of urgent consideration. It is now for the Government to decide the rate of implementation and the affordability of our recommendations.

Sir Donald Acheson
September 1998