As Britain juggles with recession and inflation, I am reminded of Bill Clinton's much vaunted election slogan, ‘It's the economy, stupid.’ In doing so, Clinton reaffirmed the economy's role in shaping people's quality of life. Hilary Graham expertly reiterates this point to argue that our relationship to the economy more specifically has a significant impact on our health. At the core of her book is the argument that poor people suffer poor health. This may not be a surprise to those who have worked in priority neighbourhoods, but Graham manages to couch it in terms of class and wealth in a manner often overlooked.

In an engaging manner, Graham interlaces a complex and sophisticated reasoning that means she avoids being economically deterministic. Instead, the book considers how class relations are ‘structurally imposed and socially produced’ with an understanding of how they are also socially reproduced. In doing so, Graham provides a balance between agency and structure, complementing economic analyses with the influence of cultural capital.

Starting with discussion about the nature of inequality, both socio-economic and health, Graham engages not just with quantitative indicators, but also with people's lifestyles as a means of reproducing inequalities. Working with such a rich fabric, Graham easily raises issues of health inequity, thus provoking questions about social justice.

Having examined the nature of inequalities and engaged with relevant debates, Graham further examines global and national contexts. Whilst the global context seems to be a slight distraction from the rest of the book, given its overwhelmingly British orientation, it still reinforces the link between the economy and health. In doing so, Graham avoids simplistic generalisations that would be all too easy whilst still managing to produce a book that is both readable and engaging.

The third section of the book addresses ways in which we might begin to understand and analyse responses to what has so far been presented. In doing so, Graham looks at not only the presence of health inequalities, but the ways in which they perpetuate and carry on through people's lives and, indeed, through generations. In doing so, Graham completes a clear logic to the book that starts with inequalities/inequities, proceeds by looking at evidence, and finishes with a series of explanations.

Excellent as the book undoubtedly is, I still having a nagging concern in the back of my mind that I find troubling. Despite a sophisticated and well thought through analysis of economic inequalities, the book can lack a similar sophistication in what is meant by health inequalities.

Graham's analysis of class not only relies on economic indicators, but also examines social and cultural factors. However, her examination of health inequalities tends to focus too heavily on a medical model of health. In doing so, the book places a heavy influence on the usual suspects of heart disease, cancer and life expectancy. However, this seems to be slightly at odds with the book's starting point that inequalities have a strong socio-cultural dimension. Indeed, it also seems to be slightly at odds with Graham's excellent view that is not just about how long a person lives, but about the quality of health during that life.

The last decade has taught us that some of the major health issues affecting those living in poverty are not just cancer and heart disease, but instead the attritional effect on one's life of living in poverty. Poor diets, low birth weight babies, teenage pregnancy, lack of exercise, drug abuse, environmental factors and obesity are all health-related factors that limit people's lives. The link between all of these factors and poverty remains strikingly stark and illustrates connections between health and poverty not so easily expressed through the International Classification of Disease utilised by Graham. Ultimately, people do not experience poor health because of the limited resources in their bank accounts. Instead, it is the social conduit linking these two factors that needs more analysis.

Similarly, we need to take into account that service provision is not evenly spread, with those living in priority neighbourhoods not only being the poorest in society, but also experiencing the poorest facilities and lowest opportunities. Limited public transport, expensive leisure facilities, fear of walking the streets and a lack of shops in many estates are all major factors of poverty that influence levels of health. I hoped Graham's sophisticated analysis of social inequity, complemented by analyses of structure and agency, would have resulted in a stronger focus on public health models and a challenge to their sometimes implicit lifestyle agenda. This does not mean that Graham neglects the ‘social determinants of health inequalities,’ but my concern is that they need to play a stronger role within the book.

Overall, I would have no hesitation in recommending this book as an introductory text to those studying social policy, or as one that would prompt further investigation. The book will be of interest to anyone examining health, nursing, politics, social policy, sociology or many other subjects. Indeed, it is a useful book for expanding people's awareness of how social issues are linked, and how we need to look beyond the boundaries of our own disciplines.