Health inequalities include many different factors. We're talking about differences in life expectancy—healthy life expectancy—and difference in access to healthcare. We're talking about the differing levels of prevalence of long-term health conditions, physical and mental, and differences between who—well, it could be along socioeconomic lines where poverty drives so many health problems; it could be geographic even and geographic differences in access to care, including between rural and urban areas. Experiences can differ along the lines of ethnic backgrounds as they often, often do, and according to physical ability. This isn't a uniform phenomenon. And it's about the inverse care law, isn't it, described for the first time by Dr Julian Tudor Hart just over 50 years ago, meaning those who most need care are least likely to be able to access it.

The scale of the challenge, the complexity of how we deal with all these inequalities is huge—frighteningly so—but that can't allow us to shy away from addressing those challenges. Indeed, there can be nothing other than to look at those challenges that could do more to spur us on to try to get to grips with the situation. Our health and care services, we know, right now, face enormous challenges. Levels of ill health made worse, of course, by the current pandemic mean that our fragile services are bursting at the seams. And we can't just say, 'Well, this is the hand we've been dealt; this is just how it is. People become unwell and our services then deal with that.' We potentially have an enormous amount of control over the cards that we ourselves hold. As the World Health Organization said in a report 30 years ago now, these inequalities are socially produced, and therefore modifiable. This is taking the preventative to its ultimate degree, if you like—not just working with individuals or families to try to promote good health and to help steer people away from as many risks as possible, but rather, taking a systemic preventative agenda, looking at all those issues that mean we are not a healthy nation, and importantly, crucially, that the burden of that ill health is not evenly shared between us.