Editorial

Abstract

if we are truly concerned for the good health of humanity, the environment and the earth on which we depend, we need to reduce inequalities in those things which either hinder or enable us to have good health. i once thought this statement was unproblematic but it is clear that language around health inequalities becomes problematic in many ways; two of which are its politicisation and in terms of complex definitions.one way of problematising our language is where people propose that 'variations' in health outcomes are just how things are, and seek to remove the sense of social justice from it. this often goes hand in hand with political and commercial actors seeking to frame health as primarily or solely determined by individual responsibility and 'lifestyle choice' -despite the evidence that determinants are at work which are beyond individual control, and which have profound influences on all our health. 1 this politicisation should not surprise us, because it absolves actors -governmental and commercial -of responsibility: 'it's not our fault people buy our unhealthy products. it's not our fault poor people get worse healthcare.' a second way is how we frame and define inequalities. there are multiple definitions, terminologies and debates around inequity or inequality. the danger here is the language becomes a debate in itself which makes it difficult for allies to work with us and easier for those who would erase the social and structural aspects of inequalities to do so because a concern with terminology almost to the point of obsession makes the discussion in the field risk looking self-referential. the key point about health inequalities is that we must work to change them, not over-describe them. i choose to use the definition by McCartney et al. 2 that 'Health inequalities are the systematic, avoidable and unfair differences in health outcomes that can be observed between populations, between social groups within the same population or as a gradient across a population ranked by social position.' a third problem with our response to health inequalities, which goes beyond language, is that we need to move beyond describing to acting and evaluating. We have strong evidence that a range of environmental, social, economic and cultural factors determine our prospects of good health and good life. We have equally strong evidence that the impacts of these fall unequally across populations -whether we segment them by poverty, educational attainment or other variables. 3 the fewer resources for good health you have -whether you define that as income or good environment -the worse your health status. 3 resources such as social solidarity and connections between populations (4) or faith (5) can offer protection, but the fact remains that unequal distribution of the means to good health persists, harms, and kills unequally and unjustly, especially for populations which are and remain marginalised globally (6). 6 all of this should focus us on how we act to change them. and research in three key areascommercial de...