Making sense of inequalities: a response to Peter Townsend

This article addresses the continuing controversy generated by the Black Report on Inequalities in Health, published in Britain in 1980, in response to the defense offered by Professor Peter Townsend. The author argues that Townsend's riposte to the critics of the Black Report is flawed in at least two respects. First, Townsend fails to acknowledge that the Black Report was as much an exercise in policy advocacy as in scholarly analysis, making rather large assumptions about the links in the reasoning leading to its recommendations for a massive program of income redistribution. Second, Townsend's defense of Black's use of social class as its main tool for analyzing health inequalities dismisses too easily much of the evidence; for example, the effects of social mobility and the historical dimension. Moreover, by concentrating on social class, a heterogeneous category, analysis may ignore what is most relevant for policy-making: i.e., specific factors associated with specific forms of deprivation, located within social classes or particular geographical communities. It would therefore be more constructive if scholars were to accept and research this complexity, rather than defending the Black Report as though it were a definitive (not to say sacred) text.