It's official. A ruler can kill you!

My own primary care trust has long been careless with the term "Health Inequalities". They always include within their strategic plans the lofty aim of: "eliminating health inequalities within the trust's area". They also have another lofty aim of making sure that our resident's health is at least as good if not better than the London average. To me, the first aim misses the point and the second is at best contradictory and at is also illogical (if we get better then we have shifted to inequality somewhere else).

Whenever someone sees some else getting a better NHS deal elsewhere, they trot out the "postcode lottery" weapon and fire it off in all directions. Well, in terms of primary care, we like differences. We like to think we do things better than average. We like to think that when we refer a patient to hospital, we arrange for all the tests that the hospital are likely to need to have done so that the hospital diagnosis and treatment is not unnecessarily delayed. We know (from feedback) that we are reckoned by hospitals to be one of the better practices. That means others are not as good.

This is an "health inequality". The cure is to set sensible minimum performance standards and then ensure that all of us maintain them. It would be even nicer if they then recognised those that exceed them and held the underperformers to account but I'm not holding my breath.

Now the WHO has passed its ruler over "health inequities" and found out that these measurements can be lethal. Their report contains much sense although some of their conlcusions are less than revolutionary:

"The Commission found evidence that demonstrates in general the poor are worse off than those less deprived, but they also found that the less deprived are in turn worse than those with average incomes, and so on. This slope linking income and health is the social gradient, and is seen everywhere – not just in developing countries, but all countries, including the richest. The slope may be more or less steep in different countries, but the phenomenon is universal."

God alone knows how much it cost to reach that conclusion!

I just get an awful feeling that somehow using the jargon phrase makes easier reading for those who hold the public purse strings. "Health inequity" is a measurement. It doesn't kill anyone. The actions and inactions of policy makers and politicians lead to changes in mortality (for good and ill). Yet somehow "health inequity" doesn't have the same ring as unhealthy housing, hunger, ignorance and waste. It's softer.