In most European countries health has been shown to be linked to social circumstances--gradients in health status have persisted for decades, despite major changes in the principal causes of death. In central and eastern Europe life expectancy has stagnated since the mid-60s, whereas in the West it has increased; but even in the West it is related to income distribution. Social differences in mortality in men are three times as large in some countries as in others, and are influenced by factors other than conventional risk factors. Substantial declines in mortality and morbidity could result from a narrowing of health inequalities even when differences in health risk between social groups are comparatively small. Policies to reduce health inequalities can be introduced in smaller communities and organisations such as the school and workplace. National policies are variable; factors generating inequalities require action across several policy areas.

The importance of tackling social differences in health to improve national health status is now explicitly recognised in many European countries, such as the Netherlands and Finland, as it is in other developed nations, including Australia and Canada.*RF 1-4* The World Health Organisation European strategy for Health for All states that “by the year 2000, the actual differences in health status between countries and between groups within countries should be reduced by at least 25%, by improving the level of health of disadvantaged nations and groups.”5 The commitment to this strategy continues in discussions at the European level, as is apparent from a recent public hearing on the development of public health policy held by the European parliament.6

Evidence linking health and social circumstances is available for most European countries,78although much of the early evidence came primarily from Britain,9where it continues to generate considerable debate.10

It is …