Intended for healthcare professionals

Rapid response to:

Editor's Choice

What are your burning issues for 2018?

BMJ 2018; 360 doi: (Published 04 January 2018) Cite this as: BMJ 2018;360:k9

Rapid Response:

The hottest burning issue for 2018

Let us not use the vague phrase “social determinants” when we really mean income. And it is vital that we focus more and more sharply on the fact that it is income that is of overwhelming importance in determining health. The 70 year history of the NHS proves this beyond doubt: its main purpose was to narrow the health gap between the socio-economic classes and in this it has signally failed, the gap between the richest and poorest is as wide as ever. Here in Devon there is a 13 year difference in life expectancy between the richest and poorest areas and doubtless the same applies countrywide.
We must accept that no amount of tinkering with the NHS, of which there has been a great deal since its founding, will make a scrap of difference to health inequality while income inequality remains as it is.
The implication of this is clear: if the medical profession is serious about reducing health inequality it should constantly be emphasizing the necessity of reducing income inequality and it should make this its first priority for 2018 and beyond.

Competing interests: No competing interests

08 January 2018
Justin Robbins
Retired GP
Wood Cottage, Yealmpton, Plymouth, Devon