Toward equality in health through social policy.

Although the 1979 report of the Royal Commission on the National Health Service upheld the public organization of a free health service in Britain, it did not provide a comprehensive review of the relationship between health experience, health goals, and health service policies. This paper examines recent data about trends in inequalities in health in Britain. For most age groups and for both sexes mortality rates of partly skilled and unskilled occupational classes worsened relative to those of professional, managerial, and administrative classes between the early 1950s and early 1970s. For some age groups in partly skilled and unskilled classes there has been little or no improvement in mortality rates; in others there has been absolute deterioration. There is further evidence of continuing marked inequalities in health. These must be explained in relation to class structure and inequalities in material-especially working-conditions of life. Action to redress inequalities in health must therefore lie as much outside the scope of the health and welfare services as within it. The implications of this observation for both health care and wider social policy are briefly discussed.