Black Report Foreword


The Working Group on Inequalities in Health was set up in 1977, on the initiative of my predecessor as Secretary of State, under the Chairmanship of Sir Douglas Black, to review information about differences in health status between the social classes; to consider possible causes and the implications for policy; and to suggest further research.

The Group was given a formidable task, and Sir Douglas and his colleagues deserve thanks for seeing the work through, and for the thoroughness with which they have surveyed the considerable literature on the subject. As they make clear, the influences at work in explaining the relative health experience of different parts of our society are many and interrelated; and, while it is disappointing that the Group were unable to make greater progress in disentangling the various causes of inequalities in health, the difficulties they experienced are perhaps no surprise given current measurement techniques.

It will come as a disappointment to many that over long periods since the inception of the NHS there is generally little sign of health inequalities in Britain actually diminishing and in some cases, they may be increasing. It will be seen that the Group has reached the view that the causes of health inequalities are so deep rooted that only a major and wide-ranging programme of public expenditure is capable of altering the pattern. I must make it clear that additional expenditure on the scale which could result from the report’s recommendations – the amount involved could be upwards of £2 billion a year – is quite unrealistic in present or any foreseeable economic circumstances, quite apart from any judgement that may be formed of the effectiveness of such expenditure in dealing with the problems identified. I cannot, therefore, endorse the Group’s recommendations. I am making the report available for discussion, but without any commitment by the Government to its proposals.


Secretary of State for Social Services

August 1980