Introduction

Health inequalities between social classes and neighbourhoods have been a persistent feature of the health landscape of the UK for many decades, with more disadvantaged communities suffering greater and earlier morbidity and mortality. These unequal health experiences have remained in spite of multiple policy interventions implemented under the Labour governments in power from 1997 to 2010. The relationship between alcohol and health inequalities is, however, under-studied. In this context, this chapter starts by providing an overview of evidence and theories concerning health inequalities in morbidity and mortality before moving on to consider evidence and theories that specifically relate to the role of alcohol within these broader inequalities. The available evidence suggests that alcohol-related harms follow the expected social gradient, with more disadvantaged groups suffering greater harms, at least for men and for younger women. However, some statistics suggest that people living in deprived communities consume less alcohol than more advantaged communities. This apparent tension is often referred to as the ‘alcohol harm paradox’ and the chapter provides a brief overview of potential explanations for this paradox before considering evidence concerning the impact of alcohol-related interventions on inequalities. It concludes by setting out a range of relevant research and policy recommendations.

What are ‘health inequalities’?

The term ‘health inequalities’ refers to systematic differences in health between different social groups that are ‘socially produced’ and, therefore, ‘potentially avoidable and widely considered unacceptable in a civilised society’ (Whitehead, 2007, p 473). In the UK, research and policy tends to focus on health differences between people classed as being in different socio-economic classes or people living in different geographical areas. The 2010 government-commissioned Marmot Review of health inequalities in England (Marmot, 2010) provided a snapshot of the impact that health inequalities have across a wide range of health and social issues. It found, for example, that in the UK, infant mortality rates were 16% higher in children of routine and manual workers as compared to professional and managerial workers, and that alcohol-related hospital admissions were 2.6 times higher among men and 2.4 times higher among women in the 20% most deprived areas compared to the 20% least deprived areas (Marmot, 2010).