The UK government has a clearly stated commitment to tackling health inequalities, while perversely allowing disparities in wealth to widen. The problem is that health inequality is directly related to socioeconomic inequality and cannot be separated from its underlying cause or solved independently. It is convenient for governments to believe that this can be done but the medical profession should not collude with them. There has been some attempt to tackle health inequalities by initiatives across government, but the rhetoric has outweighed the substantive achievement by a considerable distance and the health service still seems to be expected to make the major contribution.

Two entirely different but potentially complementary approaches to tackling health inequalities date back to the 1840s. During that decade both Edwin Chadwick and Friedrich Engels described the appalling conditions endured by poor people in 19th century Britain. Chadwick published his Report into the Sanitary Conditions of the Labouring Population of Great Britain in 1842 and, two years later, Engels followed …