Published: 22/04/2002, Volume II4, No. 5902 Page 24 25

HSJ is to be applauded for its balanced focus on the causes of health inequalities (Comment, page 17, 25 March). For too long, the simplistic argument that 'health inequalities exist mainly because of a lack of healthcare provision' has been repeated incessantly, despite a wealth of contrary evidence (Black report, 1980; Acheson report, 1998). The concepts of 'social cohesion' and 'urban regeneration' as key drivers of improved health must not be forgotten in today's preoccupation with neat soundbites.

Tackling the scourge of poor social cohesiveness requires a multifaceted approach. The NHS cannot deliver this on its own: it has to work with private partners and draw on external capabilities and expertise. Real partnerships and collaborative working between multiple primary care trusts, local residents, councils, regeneration agencies and the private sector will mean investment is co-ordinated and targeted at priority areas.

The first step will be better communication, trust and understanding between the various parties (not forgetting the residents) and between the private and public bodies. It is common to find that one regeneration agency has not communicated with a neighbouring agency. Councils have given the go ahead for massive housing developments with no consultation about the likely health impact with PCTs or health authorities.

Initiatives such as the local improvement finance trust scheme and the government's Millennium Communities programme and Constructing Excellence will eliminate this silo approach and provide an integrated framework to a problem that affects us all.

The challenge ahead is for us to make it work.

Dr Immi Gandhi Associate director Prime UK