"Inequalities in health" is the theme of the January issue of the Bulletin of the World Health Organization. In spite of tremendous progress in improving human health over the past half century, the health gaps between different sections of society, particularly the rich and the poor, remain wide.

"There is much evidence that public subsidies – be they for health, education, water, power, food or whatever – intended to promote equity and benefit the poor are largely captured by the non-poor, especially by the middle class," writes Richard Feachem, the Bulletin's editor-in-chief, in his editorial.

He is echoed by Donald Acheson, former Chief Medical Officer of England, who says that "experience shows that a well-intended policy which improves average health in a population may have no effect on inequalities. Indeed, it often widens them by having a greater impact on the better-off. This has happened in some initiatives concerned with immunization and cervical screening, as well as in some campaigns to discourage smoking or promote breastfeeding".

The main paper in the Bulletin, "Health inequalities and the health of the poor: What do we know? What can we do?" penned by Davidson R. Gwatkin, Director of the International Health Policy Programme, calls for "movement from analysis to action". Global opinion has begun to shift towards an increased concern for the health of the poor and for a reduction in health inequalities. As a first step, according to Gwatkin, health objectives should take into account conditions prevailing among the poor rather than in society as a whole. "Averages typically disguise as much as they reveal". Health goals, now expressed primarily in terms of population averages, should aim directly at improving conditions among the poorer groups and at reducing the differences between those groups and others in society. For example, instead of adopting a goal to reduce child mortality by two-thirds in the entire population—as the Organisation for Economic Co-operation and Development (OECD) has called for—countries would be better advised, says Gwatkin, to aim to reduce infant mortality by two-thirds in the poorest segment of society.

Elsewhere in the issue, Geeta Rao Gupta, President of the International Center for Research on Women, points out that while women constitute 70% of the world's poorest people, "poor women suffer the interactive consequences of two of society's most persistent and damaging inequalities, of poverty and of gender. If the goal of health policy is to reduce health inequalities, it is imperative to set explicit goals for improvements in women's health."

Health appears poised for a significant move towards the centre of thinking about poverty. As WHO Director-General Dr Gro Harlem Brundtland told the WHO's Executive Board earlier this week, "ill-health is both a cause and a consequence of poverty [and] better health can offer a route out of poverty." We must, she said, "move from a vicious to a virtuous cycle…focusing resources on improving and protecting the health of the poor."

For further information, please contact Mr Valery Abramov, Office of the Spokesperson, WHO, Geneva. Telephone (+41 22) 791 25 43. Fax (+41 22) 791 4858. Email : abramovv@who.int. 

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