Few would disagree with your point that a reduction in income inequality would help to reduce health inequalities. But few primary care trusts in poor health areas will agree with the idea that the health service can do no more for health inequalities or that the redistribution of health resources has gone far enough.

The equitable access initiative will only tackle 20 per cent of the GP shortfall in the North West. The Choosing Health money for spearhead PCTs provided a kick-start in prevention, but it needs to be scaled up. And there is still no ringfenced public health allocation.

The historical health service principle of resource allocation - equal access for equal need - was not designed to reduce inequalities. It deals with interventions, not underlying healthiness. Health inequalities require an overtly expanded principle of allocation. For example, the creation of a separate allocation pot for prevention measures, to be distributed in favour of PCTs in deprived areas.

Technical improvement of the equal access formulas could then be pursued as a separate issue from that of reducing health inequalities.

John Hacking, senior research officer, Manchester joint health unit