With all the emphasis on world class commissioning, it is important to remember that primary care trust boards are tasked with improving the health of the population they serve, not just with the delivery of healthcare.

One area where little progress is being made is in reducing inequalities in health outcomes - years of life and years of good health - between the better off and those who are comparatively disadvantaged.

Studies of other countries, for example Scandinavia, have found that where society is more equal (with less of a marked gap in income levels and so on), there is also less health inequality and a better overall population health status. Evidence of the link between levels of education attained and health status is clear. Is it time to shine the spotlight on schools?

Case study

This summer, Christine [not her real name] achieved three A grades at A-level and is off to Durham University to read law, with ambitions to be a barrister. She's not "gifted". She went to a well-regarded local comprehensive school (where boys appear to do particularly well) in a semi-rural area where there is no choice of state school, although there are a couple of minor league private schools.

Her mum has severe and enduring mental health problems and has four children with three different dads. Christine lives with her dad, who has some difficulties with reading and writing. Neither parent has more than two or three GCSEs. Her younger sister lives with her mum. She has a history of self-harming but has done better than expected at GCSEs at the same school and has decided to stay on into the sixth form to study A-levels.

Breaking the cycle

This is a true story - well done, Christine. The choices and opportunities Christine now has will offer her significantly enhanced income potential as well as providing her with knowledge, experience and networks that will enable her to give support to other members of her family. It is also a great example of breaking Sir Keith Joseph's famous "cycle of deprivation".

Joseph asked in 1972 why, despite the creation of the welfare state and rising living standards, patterns of deprivation persisted. He suggested the answer might lie in a "cycle of transmitted deprivation", in which some parents passed on poverty and deprivation to their children. While acknowledging the existence of the cycle, social scientists have since argued that the main causes of poverty are structural rather than behavioural.

Education offers a clear structural way out of the cycle of deprivation. Perhaps it would be helpful if all PCT boards were provided with information about the quality of local state schooling and asked what more they could do to support their education colleagues. Going further, and in the spirit of true joined-up partnership working, should they set themselves shared local performance targets related to the proportions of children achieving five good GCSEs and staying on in the sixth form or going to college?

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