Julia Miller recommends a look at how inequalities affect public health.

This easy to read book looks in some depth at the correlations in the developed world between a variety of social, environmental and health issues, and inequalities in income.

The Spirit Level confirms that deprived areas have greater crime, teenage pregnancy, obesity, mental health problems, lower life expectancy - the list goes on.

But it seems not to be the poverty itself which is creating an environment for these issues, but the inequality in the distribution of wealth. A society where people are valued according to how much they earn ghettoises a sector of the community. Individuals will adapt to the community they are in - in a deprived area this might mean a teen pregnancy, crime, alcohol, drugs and an early death.

The book provides credible explanations based on evidence for the evolution of a number of health and social ills. Stressful and poor environments will define people and those born to them and the way they feel valued and respected. It is fairly uplifting in that it provides possible ways to build more equal societies in developing greater trust, community activities and workers’ co-operatives. It also shows how Japan and a number of Scandinavian countries have achieved greater equality of wealth.

However, the book’s main focus is to provide a greater understanding of many of the issues facing health, social and voluntary sector organisations, and I recommend it to anyone who is commissioning or working in these areas.

Dr Julia Miller is a commissioning and health inequalities senior fellow at the NHS Institute for Innovation and Improvement and director of JSM Consulting.

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