Poor people may well wait longer for treatment in the NHS, but Neil Pettinger's data does not show this. Indeed, such an article diverts attention from more significant inequities.

The data in the tables can be interpreted in different ways: for example, table 1 shows that a patient from the more affluent categories is more than three times as likely to wait more than 12 months than a patient from deprived areas. This 312 per cent excess of affluent patients waiting more than a year is much larger than the 15 per cent excess of poorer patients waiting more than three months. Yet the author uses the latter finding to argue that 'there is a long way to go if acute trusts want to redress the balance in waiting times'. But both of these observations are selective and, overall, the tables show remarkable equity.

Efforts to improve equity should concentrate on interventions of known effectiveness, such as the investigation and secondary prevention of heart disease and early detection and treatment of breast cancer. In Iechyd Morgannwg health authority, poorer women are twice as likely to present late with breast cancer and are less likely to be investigated for angina, or receive secondary prevention, than their male counterparts. Addressing such condition-specific differences is likely to result in much larger health gains than further action on waiting lists.

Dr Christopher Payne

Specialist registrar in public health medicine

Iechyd Morgannwg HA