The adverse health effects of social inequality are enormous. In the United Kingdom death rates at all ages are two to three times higher among people in social class V than among those in social class I. 1 2Poor socioeconomic status also erodes social, psychological, and physical health.3 Reducing health inequalities is central to the United Kingdom government's recently outlined health policy,4 a commitment confirmed by the positive reception given to the recently published Acheson report on inequalities in health.5 However, in spite of their importance both to the overall health care of individuals and in health policy, socioeconomic factors are not routinely assessed in clinical practice.

The power of the socioeconomic determinants of ill health requires that we should adapt the traditional medical model. We now understand that diseases have both biological and societal causes, yet our interventions remain focused on the biological.1 We need to begin to take histories which routinely include the eliciting and recording of societal risk factors, and we need …