We have known for over 150 years that an individual’s chances of life and death are patterned according to social class: the more affluent and educated people are, the longer and healthier their lives. These patterns persist even when there is universal access to health care – a fact quite surprising to those who think financial access to medical services is the primary determinant of health status. In fact, recent cross-national evidence suggests that the greater the degree of socioeconomic inequality that exists within a society, the steeper the gradient of health inequality. As a result, middle-income groups in a less equal society will have worse health than comparable or even poorer groups in a society with greater equality.