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Clinical Review Recent advances

International perspectives on health inequalities and policy

BMJ 2001; 322 doi: (Published 10 March 2001) Cite this as: BMJ 2001;322:591
  1. David A Leon (, professor of epidemiologya,
  2. Gill Walt, professor of international health policya,
  3. Lucy Gilson, associate professor in health economicsb
  1. a London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. b Centre for Health Policy, University of Witwatersrand, PO Box 1038, Johannesburg 2000, South Africa
  1. Correspondence to: D A Leon

    Inequalities and inequities in health have long been central to the concerns of public health. Governments in several countries, including the United Kingdom, have recently shown renewed interest in tackling these issues.1 Concerted attempts have also been made to push them up the global health policy agenda,2-4 and at the same time international agencies and donors are giving priority to efforts to reduce poverty. In this article we provide an overview of the current debates around inequity, inequalities, poverty, and health, drawing together current international understandings of the problem.

    Poverty and health: powerful connection

    Although targeting “the poor” is clearly important, inequalities and inequities in health are not only about the plight of the most deprived in each society. In many low income countries, over half the population may be living in poverty and those who are not will still be living in circumstances that contribute to the poor health of the country as a whole. Even in high income countries, where there is little absolute poverty, there are fine and graduated inequalities in health status that span the full socioeconomic spectrum. For example, in a study of 300 000 men in the United States, mortality declined progressively across 12 categories of household income from less than $7500 (£5000) to more than $32 499.5

    Although not all governments perceive inequalities in wealth and health to be something the public sector can or should address, all governments are interested in improving economic growth. Under the leadership of Gro Harlem Bruntland, the World Health Organization now argues forcibly that health is key to reducing poverty and to development. If improving health can have a positive effect on economic growth, then health should become a central priority of every government: “Because ill-health traps people in poverty, sustained investment in the health of the poor could …

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