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The “inverse care law”—that is, those most in need of services are least well provided with them—is well known as it applies to health care.1 It may, however, be less often considered in relation to local provision for health promoting activities. Much health promotion advice focuses on individuals, and exhorts them to engage in better personal habits, or to encourage their children to do so. It is often noted that such messages are differentially taken up by different social class groups; better off and better educated people are more likely to modify their diets, give up smoking, improve dental hygiene practices, and take up healthy physical activities than are poorer and less well educated people.2 The lower take up of healthy behaviours among lower social class groups is often considered to contribute to their poorer health and mortality experiences, although such health behaviours do not in fact completely explain social class gradients in morbidity or mortality.3 It is often assumed that the barriers to the take up of health promotion messages lie in personal factors such as lack of motivation, fatalism …
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