Dr Linda de Caestecker of NHS Greater Glasgow and Clyde is right to highlight the relationship between health inequality and broader inequality in our society.

Scotland suffers the curse of inequality, and the considerable cost of our failure to address it. Inequality in health is inextricably linked to inequality in wealth, so much so that we can reliably predict the educational and health outcomes of a child in the poorest area from the moment he or she is born.

Successive political manifestos have argued the need for the “opportunity society”, but no political party has achieved this in practice. As the last economic boom fades and we begin to grapple with the reality of a public-sector recession, we should remember that, even during the good times, poor people had poor chances and rich people had rich chances.

Tackling inequality is a zero-sum game and, while capitalism remains the dominant means of allocating resources, there will always be people at the top and people at the bottom. The challenge we face comes in three parts:

- reducing the gap between the very top and very bottom;

- improving the mobility of people across the spectrum by ensuring merit is more powerful than birthplace;

- accepting that economic growth alone will not, by default, result in a fairer Scotland.

Inequality is not an abstract notion. Through our work in Barnardo’s Scotland, we see the daily effects of poor health, poor chances and poor motivation on children and families in Scotland. Our prisons, our care system and our health service are the parking lots for the problems of inequality and we need to address them.

Simon Watson, head of developments, Barnardo’s Scotland.