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BOOK REVIEW
Inequalities in Health
Gordon D, Shaw M, Dorling D and Davey Smith G (eds) (1999) Bristol: The Policy Press
Review by Jan Rigby
A change in Government between the commissioning of the Black Report in 1977 and its publication in 1980 virtually guaranteed that its stark findings were not widely disseminated nor addressed by policy initiatives. Several of the authors of chapters in this new publication, Inequalities in Health, have demonstrated a sustained commitment to ensuring that the concept of inequalities has maintained a strong profile in the health arena over the years, and have not allowed it to 'die a death'. The recent Acheson Report (1998), the output from an Independent Inquiry into Inequalities in Health would seem to have received a more positive response. It is to be hoped that these latest recommendations are reflected in 'joined up' policy which has a direct impact in reducing the inequalities by improving the health prospects of those at the lower end of the scale, and, moreover, assist those who are seldom counted.
Inequalities in Health is a collection of evidence commissioned by the Acheson Scientific Advisory Group in the early stages of its inquiry. The editors (and publishers) are to be congratulated in producing such a cohesive work from the no doubt individual styles of the original submissions.
There are nineteen chapters, concisely written and highly accessible, especially as they were designed for a very specific audience. The first four cover life stages, followed by some fundamental determinants of inequalities: housing, the social environment, and poverty. Two chapters explore the role of the NHS, followed by a return to factors relating to nutrition, education and transport. Ethnicity, geography, gender, mental health, lifestyle and oral health considerations follow. The editors have presented the work in the order listed in the Acheson Report, although there was perhaps scope for reorganising the chapters into closer 'themes'.
Many of the authors had gone to considerable lengths to consult widely before submitting their final reports. Hence the book is a very good resource for those commencing work in specialist fields, or exploring health inequalities more generally. The written content is well-supported by very clear tables and figures. As with all collections of such breadth, the reader is often left wanting more in a particular area of interest. However, it is rewarding to find explicit and detailed consideration of the most marginalised groups of people, for example the homeless in Richard Best's chapter on housing.
The chapters are preceded by a critique of policy aims and achievements, written by Peter Townsend. As ever, he is prepared to directly address issues and cost strategies with a much-valued pragmatism seldom demonstrated by policy makers.
With the publication of this book the editors have made available a clearly presented body of evidence which should facilitate the monitoring of subsequent policy initiatives. I sincerely hope that they do not find themselves assembling similar material twenty years hence.
REFERENCES
Acheson D (1998) Independent Inquiry into Inequalities in Health, Report of the Scientific Advisory Group. London: The Stationery Office
Black D, Morris J, Smith C, Townsend P (1980) Inequalities in Health: Report of a working group. London: DHSS
Jan Rigby
School of Geographical Sciences
University of Bristol
University Road
Bristol BS8 1SS
E-mail: Jan.Rigby@bristol.ac.uk
