Unhealthy societies: the afflictions of inequality


To have worked on the school and economic determinants of health for the last 20 years has been an enormous privilege. I first became involved when, after completing a Master’s thesis, i wrote a newspaper article in the form of an open letter to the then Secretary of state for health and social Security, David Ennals, in Callaghan’s Labour Goverment in 1976. Pointing out that, as a Labour minister, he presided over the largest social class diferences in morality then on record, i asked him to set up on “urgent inquiry”. Three months later, after having read my article, be announced the setting up of the DHSS Working Group under the chairmanship of Sir Douglas Black. Three years later it produced the Black Report entitled Inequalities in Health and Ushered in a new era of research on the social causes of health and illness through out the developed world.

Sir Douglas Black, who had been Chief Medical Officer in David Ennal’s deparment, described his minister-with a characteristically neat turn of phrase-as “a man who tried to do good and on the whole succeded”

The continuing research stimulated by this report is transforming our understanding of both society and health. Havingstarted off with issues to do with the veracity of the basic figures, the progress of research has felt like a long and difficult clim, but we are now getting our first views of the landscape ahead. What we can see is destinated to transform social and economic policy and hopefully, the direction of the social development of modern society is one of the most powerful determinants of health standards in different countries, and that it influences health through its impact on social cohesion. These basic facts have implications which go far beyond the health data from which they have emerged.


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