What can health services contribute to the reduction of inequalities in health?

Policies to reduce inequalities in health are needed in many different settings, one of which is the healthcare setting. This paper, drawing on the conclusions of the Copenhagen conference, explores the contribution that such policies can make within the healthcare system. In doing so it examines four themes. It begins by exploring the contribution that healthcare makes to health. It challenges the widely held view that this contribution is small, arguing that there have been major advances in the effectiveness of medical care and the use of evidence-based healthcare, so that interventions of proven effectiveness are increasingly delivered to those who will benefit. Unfortunately, there is growing evidence that the benefits of modern healthcare do not benefit all groups equally. Thus, there is an unfinished agenda in many countries to enhance the equitable distribution of access to effective healthcare. Second, it explores the dynamic relationship between illness and poverty and, specifically, the impoverishing nature of illness in the absence of effective mechanisms to ensure solidarity and to provide social safety nets. It identifies how all elements within a healthcare system have a part to play. Those responsible for healthcare financing should ensure that funds are obtained in an equitable manner. Those who provide healthcare can do much to promote access for the disadvantaged and to use their facilities to promote health as well as cure disease. Third, it considers the specific needs of disadvantaged populations, and especially those whose needs are least visible, such as illegal migrants. It concludes by reviewing the need for better information to document the scale of inequalities, to evaluate interventions designed to reduce them, and to disseminate evidence of good practice.