This book makes the case for re-invigorating the political priority afforded to health inequalities in Britain by demonstrating unequivocally how the contemporary health divide my colleagues and I identified over two decades ago has continued to widen since that time. The book takes our early work forward in a number of ways. At the simplest level it updates our statistics, but it also updates our methods, our understanding of the processes involved and refines the policy options we presented two decades ago with both hindsight and insight. What this book calls for is a rethinking of government policy on inequalities in health. The book’s authors are kind enough to start their study by referring to the Black Report and so I too will start there in my explanation of why we need changes in policy in order to reduce inequalities in health in Britain today (for a fuller version of the arguments see ‘Structural plan needed to reduce inequalities of health’ in the companion volume to this book – Inequalities in health: The evidence (edited by Gordon et al, 1999).

The Black Report of 1977-80 (DHSS, 1980; Townsend and Davidson, 1988; see Glossary) showed that inequalities in health had been widening since the 1950s, that this trend was principally related to inequalities of material resources, and that a programme of higher social security benefits and more equal distribution of income, as well as action on housing and services, was required. The Report was rejected by the Conservative government at the time of its publication, principally on the grounds of cost. Yet the Report continued to exert influence on research and over the next two decades that research continued to point to the need for structural action to achieve better health among the population of Britain. For example, a report for the Health Education Council in 1987 listed hundreds more papers with new research evidence generally supporting this position; the same position being advocated by this book (Whitehead, 1987; and see Townsend and Davidson, 1988).

After winning the election of May 1997 the Labour government set up an Independent Inquiry to examine inequalities in health. This reported in December 1998 (Independent Inquiry into Inequalities in Health, 1998).