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Despite numerous government reports and strategies for reducing inequalities in child health, there is no evidence of reduction except perhaps in infant mortality rates. The paper by Hargreaves et al 1 suggests that gaps are widening in some important child health outcomes. If we accept that inequalities due to social circumstances, referred to here as inequities, are unjust and avoidable, as Sir Michael Marmot2 (among many others) maintains, then Hargreaves et al's findings should prompt a rethink of the strategic approaches to this important public health problem.
Public Health impact of social inequities
There can be no doubt of the public health impact of these inequities. Table 1, taken from the position statement published by the European Society for Social Paediatrics and Child Health,3 shows the potential reduction in common adverse child health outcomes that would occur if all children had the same outcomes as the most socially advantaged using data from population-based studies. Reductions of this magnitude in any of these outcomes, were they to be realised, would represent a major improvement in the health of the child population.
Given that social inequities are responsible for such substantial differences in child health between the most socially advantaged and the rest, why do they …