Editor—We are sorry that Sir Donald Acheson, the chairman of the independent inquiry into inequalities in health, thinks that we have not done justice to the report’s recommendations and that we will thus discourage BMJ readers from using it.1-1 This was not our intention. Acheson’s letter, however, illustrates what we think is the main issue. In the present and foreseeable political climate the best—and maybe the only—hope of serious governmental action to tackle the inequalities in health so fully described in the report is to produce concrete and costed proposals. These, moreover, should engage as much as possible with the government’s social agenda. The proposals need to be explicit enough for it to be clear where current policies are inadequate or will work against the government’s declared aim of reducing inequality.
Ashton considers the degree of specification in the recommendations of the report to be adequate; we do not. Other readers must judge this issue, but the short section on crime referred to by Ashton starts: “It is beyond the scope of this Inquiry to recommend particular approaches to prevent or reduce crime.” We agree with the implication of this statement and think that it also applies to the other areas. For example, to improve equity of access to—and quality of—public transport the privatisation policies that have led to escalating public transport charges and reduced services must be changed. We find it strange that professionals in the policy domain do not recognise the need for concrete recommendations which translate directly into action.
Current understanding of the factors underlying inequalities in health is well summed up in the report’s statement that “without a shift in resources to the less well off, both in and out of work, little will be accomplished in terms of reduction of health inequalities by addressing particular ‘downstream’ influences.”1-1 The prioritisation of a discrete collection of focused proposals would provide for the future evaluation of what has and has not been done in response to the issue identified by the report. Others—such as the Joseph Rowntree Foundation—are developing clear indicators which will allow assessment of whether the government is succeeding in meeting the challenge set by the prime minister. Similar indicators, reflected in key policy priorities, could have been established by the independent inquiry, thus taking full advantage of its automatic access to government policy makers. This task will now have to be taken on by other bodies, but with lower chances of success.
