There is little doubt that inequalities in health are difficult to tackle. In England the gap in life expectancy has continued to widen, despite bringing health inequalities increasingly into the mainstream of performance management in the NHS. However fast the most deprived areas or disadvantaged groups improve their health, everyone else's health improves faster. It sometimes seems that the most effective contribution to tackling inequalities in health that the professional classes could make is to be a little less healthy and die a little earlier.

In fact the government's strategy for health inequalities is now more akin to redistributing health than to redistributing income or wealth. Health is being redistributed pharmacologically by statins, antihypertensives, and nicotine replacement therapy. This is creating the paradoxical situation of a medical rather than a social model of public health, and a key role for pharmaceutical companies in a new definition of prevention based on drugs. The use of statins, for example, in the effort to narrow health inequalities has seen the term “primary …