Observations Body Politic

Solving the mystery of health inequality

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h3389 (Published 24 June 2015) Cite this as: BMJ 2015;350:h3389
  1. Nigel Hawkes, freelance journalist, London
  1. nigel.hawkes1{at}btinternet.com

The emerging science of epigenetics could hold the key

The persistence of wide inequalities in health, even in a system with two generations of universal free access to care behind it, is one of the great unsolved mysteries of medicine. Might new discoveries in genetics be about to provide some answers, at last? Wearing my hopeful hat, I think they might.

Unequal provision of healthcare used to be blamed for the gap between the life chances of rich and poor people, and still today it remains a favourite trope of Labour health secretaries to point out that, with every station on the London Underground heading east, life expectancy falls by a year. But hasn’t more than 65 years of the NHS laid that explanation to rest? I do not pretend that everybody yet has equal access to care, but the inequalities that remain are far too small to explain the huge gaps in life expectancy.

Nor does blaming poor people for their own misfortunes meet the case. Poor diet, smoking, and other risky behaviour can account for some but not all of the differences. In the end we are reduced to arguments that are little …

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