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This article briefly assesses some important landmarks in recent English policy on health inequalities. It describes how despite some sustained focus and priority form national government there are still widening health inequalities. Health inequalities exist along a social class gradient, they affect almost the whole population to some extent – therefore action to reduce health inequalities must be universal although proportionate to need. The findings of the 2010 Marmot Review are described, this report clearly set out the scale of the problem and described the key drivers of health inequalities, which lie in social and economic factors, largely outside the health care sector. To take action on these social determinants of health requires a whole government, cross sector focus and sustained action for the long term. The national and local response to the Marmot Review is then discussed and some challenges described.