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Really tackling health inequalities 30 June 2007 Alex Scott-Samuel, Senior Lecturer in Public Health University of Liverpool, L69 3GB Rapid response to Iona Heath's paper - see www.bmj.com/cgi/eletters/334/7607/1301#170513 As a public health physician who has worked with health inequalities for 30 years, I find this correspondence both frustrating and - just a little - inspiring. If there is one thing I have learnt in my 35 years as a medical practitioner, it is the truth of what Virchow said over a century ago - 'medicine is a social science and politics is nothing but medicine writ large.' My own area of public health has benefited immensely from the advent of multidisciplinary public health under the present government, whereby non-medics can now become directors of public health (let us hope that the Brown government allows them to fulfil their potential role in promoting the public health, as opposed to reluctant collusion in the undermining and privatisation of our welfare state, as at present). In my view, medical training should include a lot more social science and should explicitly include political science. One of the reasons that we have the frustrating situation described by Iona Heath is that - unlike medical sociology, health economics etc - the discipline of health politics, concerned with the political determinants of health, still awaits formal recognition. Some of the correspondence betrays ignorance about socialism and socialists. The commonly held view among the so-called liberal intelligentsia - far from representing Stalinist apologism - is that the excellent values and principles of socialism have never been fully implemented. The limited evidence from societies which out-perform their levels of wealth, such as Costa Rica, Cuba and Kerala, is that egalitarian social organisation is of general benefit. In former socialist kibbutzim, there is published evidence that male life expectancy increases towards that of females, by comparison with the surrounding capitalist Israeli society. A key dimension in health inequality which Heath however fails to mention is patriarchy and so-called hegemonic masculinity. Virtually all social and economic inequalities can be traced back to power inequalities which have their roots in the dominant form of masculinity into which our children are socialised. The necessary social revolution which is required if we are to seriously challenge health inequality must also include changes to parenting and socialisation such that we cease to value boys and men who are tough, aggressive, competitive rather than collaborative, who take excessive risks, and who suppress their emotions. It will be a long haul - not least, because the social revolution must involve the successful challenging of the major religions which sustain patriarchy. Best wishes, Alex Scott-Samuel Competing interests: None declared