The inequalities in the health of the nation (Townsend et al., 1988) have been subject to extensive debate and policy initiatives over a number of years. Many of the 'problems' and needs have been long identified but are still awaiting resolution. As long ago as 1980, the Black Report on inequalities in health reported that:
One of the most important dimensions of inequality in contemporary Britain is race. Immigrants to this country from the so-called New Commonwealth, whose ethnic identity is clearly visible in the color of their skin, are known to experience greater difficulty in finding work and adequate housing. Given these disabilities, it is to be expected that they might also record higher than average rates of mortality (Townsend et al., 1988:50).
"Health inequalities are the systematic, structural differences in health status between and within social groups within the population. The term "health inequalities" is closely linked to "social determinants of health" (Marmot and Wilkinson 1999) as it refers to the multiple influences upon health status, including socioeconomic status, diet, education, employment, housing, and income. It is thus concerned with the "causes of the causes" of disease. Inequalities in health care do exist (notably in access to care) but these are not considered the principal cause of inequalities in health status (Marmot 1999).
The social determinants of health and health inequalities pose particular problems for policymakers. The causes are multifaceted and the solutions must be too. Policies may need to be long-term, require the collaboration of multiple agencies, and generate few outcomes measures initially. Unless policy processes are understood, current and future policies may not achieve their goals. Indeed, some policies such as those that have reduced overall levels of smoking have unwittingly increased socioeconomic inequalities in smoking (Jarvis 1997; Evans 2002). Also, the lack of evidence about effective policies is significant given the policies to tackle health inequalities that have been recently proposed by the U.K. government" (Marmont, Michael, 2003).
The Macpherson Report
The Macpherson Report (1999) has now given a momentum and legitimacy to action against racism rarely seen in the UK before. It created a clear definition of institutional racism that moved away from blaming and labeling individuals as racist to an understanding that long-standing practices can cause organizations to discriminate unwittingly. This has enabled us to take a new approach to racism, moving away from 'witch-hunting' and attributing racism to particular individuals or groups, towards a search for positive solutions (Dylan Ronald Tomlinson, Winston Trew, 2002).
Overt racism from individuals remains a very significant problem in the UK, as suggested by findings of the Fourth National Survey of Ethnic Minorities cited earlier. Just over one quarter of white respondents had a preference for a doctor of their own 'ethnic origin' and while 60 per cent of this group stated that this was because they had difficulty understanding a non-white doctor, and thus, for them, overt racism cannot be assumed to be proven, for the other 40 per cent the reasons given suggest, 'more clearly contained