Over 50 years ago at a World Health Organization global meeting, the delegates expressed the need for urgent action by all governments to tackle the ‘existing gross inequality in the health status’ both between and within countries (WHO, 1978). Unfortunately today there is still much to be done, and in the UK progress has stalled. Health inequality results in more health problems and an earlier death but that journey starts with the inequality in our communities, in the environment, housing, education, employment and income, access to and availability of services including (but not exclusively) health services. Of course individual behavioural factors – smoking, alcohol, diet and exercise – play a part but it is well documented that it is easier to make healthy life choices when other factors are in your favour. In addition to life expectancy, there is the important issue of the quality of the life lived. Inequality in both healthy life expectancy and disability-free life expectancy are even wider than inequality in life expectancy. People in more deprived areas spend, on average, a far greater part of their already shorter lives in poor health. In England, the gap in healthy life expectancy between the most and least affluent and between the geographical north–south divide is widening. In 2015–2017, people living in the least affluent areas could expect to spend a third of their lives in poor health, twice the proportion of those from the most affluent areas (Williams, Buck, and Babalola 2020). The Marmot Review, Fair Society Healthy Lives (Marmot 2010) highlighted the social gradient in health; the lower a person’s social position, the worse their health. Marmot argued that reducing inequality and the gradient is a matter of social justice and gave a clear road map of six policy actions to achieve this:

中文翻译：

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健康不平等：英国的进展停滞不前

50 多年前，在世界卫生组织全球会议上，代表们表示，所有政府都需要采取紧急行动来解决国家之间和国家内部“健康状况方面存在的严重不平等”（WHO，1978）。不幸的是，今天仍有许多工作要做，而英国的进展已停滞不前。健康不平等会导致更多的健康问题和更早的死亡，但这一旅程始于我们社区的不平等，包括环境、住房、教育、就业和收入、服务的获取和可用性，包括（但不仅限于）医疗服务。当然，个人行为因素——吸烟、饮酒、饮食和锻炼——起到了一定的作用，但有充分证据表明，当其他因素对你有利时，更容易做出健康的生活选择。除了寿命，生活质量是一个重要的问题。健康预期寿命和无残疾预期寿命的不平等甚至比预期寿命的不平等更广泛。平均而言，更贫困地区的人们在他们本已较短的生命中有很大一部分时间处于健康状况不佳的状态。在英格兰，最富裕和最不富裕之间以及南北地理鸿沟之间的健康预期寿命差距正在扩大。2015-2017 年，生活在最不富裕地区的人们预计将有三分之一的时间处于健康状况不佳的状态，是最富裕地区人口比例的两倍（Williams、Buck 和 Babalola，2020 年）。Marmot 评论《公平社会健康生活》（Marmot 2010）强调了健康的社会梯度；一个人的社会地位越低，他们的健康就越差。