In Chapters 3 to 6 we have presented examples of gains secured for lay health workers through social work practice within and outside professional social work agencies. These have focused on action at the local and/or inter-personal level. But it has been apparent throughout that countering the factors involved in creating and sustaining inequalities in health also requires intervention on a wider basis. For example, redressing the inequitable distribution of income and wealth, and changing policies which result in substantial levels of homelessness amongst young people or in the discharge of older people from hospital without adequate sources of practical and social support, require action at government level. Racism, resulting in institutionalised inequalities in access to health care services, or homophobia, resulting in unprovoked violence, cannot be adequately remedied by action solely on a local or inter-personal basis.