Health equity does not translate to absolute equality of health outcomes, because it recognises that some people will enjoy better health at various times in their lives than others for reasons that cannot be avoided or remedied (including aspects of both nature and nurture). But it does suggest that everyone should have the same opportunity to live a healthy life, and that any unfair or avoidable differences in health outcomes should be eliminated. This means, firstly, that good quality healthcare should be equally available to everyone, regardless of their ability to pay, and with priority given to those in greatest need (the founding principles of the NHS), even if some people choose to pay for private treatment that is either better or quicker. But it also means that the underlying causes of poor health, such as poverty and poor housing, must be tackled. Failure to do this will result in a failure to prevent the inequitable burden of ill-health falling on the most disadvantaged in society, which is both unfair and inefficient (since cure is always more expensive than prevention).
Health inequalities that can be prevented reasonably easily are unfair, and removing them is a first step in building a fair society. We need to move away from a situation in which the more disadvantaged in society not only die sooner, but also spend more of their shorter lives with a disability or in ill health. The ‘social gradient of health’ means that the higher someone’s social position and income is, the better their health will be, and this gradient is steep. Creating a fairer society in which health inequalities have been minimised will make this gradient shallower and so improve the health of almost the whole population, as well as ensuring a fairer distribution of good health across it.