Once again, and with no apology, we need to address health inequalities. Whether your interest is in international or more local comparisons, it is now very well recognised that inequalities in health afflict communities globally and many people and governments view them as undesirable, some as unacceptable. We hope we are representative of the public health community in regarding health inequalities as an affront to the development of civilised societies. Why then do we continue to identify inequalities, and why is the reaction to them so often tawdry?