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In the interest of trying to stimulate a bit of discussion on the list, I've decided to reply to Alex's message from my perspective as an observer at the HEN inaugural meeting last March. The other core organisers of HEN and myself are keen for the mailbase list to serve as a forum for constructive discussion, but we realise that some of you might not want to receive these messages. Perhaps if you have feelings one way or the other you could send your comments directly to me and to David McDaid ([log in to unmask]). A lot of you were not at the inaugural meeting, but, in short, it was pretty lively, and there were plenty of dichotomies going on. One of the problems that we'll overcome in time was that there was quite a lot of misunderstanding of what other people in different disciplines do. I think Alex in his message is saying that there are those who want to study inequalities but not politicise them, and those who want to study and politicise them. Just speaking for the moment from my own perspective as an economist, I know there are a lot of economists who are genuinely passionate about reducing health inequalities both within countries and between them. But before making recommendations on how we might tackle the health inequalities, I think most economists would want to see good evidence that a particular programme does in fact benefit those in relatively poor health more than those in relatively better health (and therefore reduce inequality). For example, if we take smoking cessation policies, when introduced generally, does the prevalence of smoking go down more in social classes IV and V than in social classes I and II. The historical evidence suggests the opposite might happen, which implies a widening of health inequality. So what else do we have to do to reduce smoking amongst the lower social classes, and how much would it cost to do it? Would it represent a worthwhile use of resources compared to other things that we might do, given that we can't do everything with the resources that we have available? The Acheson Report recommended smoking cessation policies, some of which have already been put into practice. Ideally, given what I said above, many economists would probably want to see more evidence that these measures are likely to reduce health inequalities before they are put into practice (assuming for the moment that we are only interested in reducing health inequality - i.e. smoking cessation policies are probably useful for improving general population health). Some may argue that by the time we have collected all appropriate evidence, the issue of health inequality may be off the political agenda, and nothing would ever be implemented. So what should we do? I don't really think I've addressed Alex's points very well, but rather raised some different ones. But I think there may be a third group of people in addition to the two Alex mentioned: a group that believes in reducing health inequality but wants to make sure that they have very good evidence that a programme will reduce health inequality before recommended it for policy. b/w Adam Adam Oliver OHE %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%