Intended for healthcare professionals


Importance of monitoring health inequalities

BMJ 2013; 347 doi: (Published 05 November 2013) Cite this as: BMJ 2013;347:f6576
  1. Michael Marmot, director,
  2. Peter Goldblatt, deputy director
  1. 1Institute of Health Equity, Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
  1. m.marmot{at}

In democracies, voters need to know what is going on, for better or for worse, in good times and in bad

Health inequalities have been recognised in official statistics in the United Kingdom at least since William Farr was active in the Victorian era. T H C Stevenson in 1911, with the introduction of the registrar general’s social classes, began a remarkable series of publications, continuing for a century, of “social class” inequalities in health. In 1980, the Black report summarised this evidence, gave an explanatory framework, and made recommendations.1 At the time of Black, observers from many countries scoffed at this health manifestation of the British class system. It was then perhaps a little shocking to some that—in the “egalitarian” United States, Australia, and the Nordic countries—there were socioeconomic inequalities in health of the same order as those found in the UK. Subsequent research has confirmed that all countries have inequalities in health, although the magnitude varies.2 3 The UK led the world, not in having the most striking differences in health between social classes, but in having the best data and, based on this evidence, in developing policies to combat health inequalities.

Regrettably, this world leadership in systematic and routine monitoring …

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