ABSTRACT

Introduction ............................................................................................................ 144 What Are Inequalities? ...................................................................................... 144 Inequality and Equity ........................................................................................ 144 Social Determinants of Health .......................................................................... 146 Inequalities in Health Care ................................................................................ 147

Inverse Care Law .......................................................................................... 147 Clinical Practice Variations .......................................................................... 147 Medicines and Health Care Inequalities ....................................................... 148

Evidence of Health Inequalities ............................................................................. 149 Summary of Evidence ....................................................................................... 149 Reports of Evidence .......................................................................................... 149

Black Report, 1980 ....................................................................................... 149 Acheson Report, 1998 .................................................................................. 150 Marmot Report, 2010 ................................................................................... 152

Explanations for Health Inequalities ...................................................................... 153 Cultural and Behavioural Explanations ............................................................ 153 Social (or Natural) Selection Explanations ....................................................... 154 Structured Explanations .................................................................................... 154

Tackling Health Inequalities .................................................................................. 155 Local Action ...................................................................................................... 155 National Action ................................................................................................. 156 International Action ........................................................................................... 157

Conclusion ............................................................................................................. 157 Acknowledgement ................................................................................................. 158 Further Reading and Information Sources ............................................................. 158 References .............................................................................................................. 159

KEY POINTS

• The social determinants of health refer to the range of interacting factors within the social structure of society that shape health and well-being.