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Contemporary efforts to promote population health improvement and to reduce inequalities in the UK are characterised by their complexity as they engage with a multiplicity of agencies and sectors. Additionally, the emphasis on promoting evidence-based practice has challenged evaluators tasked with collecting and interpreting evidence of impact in complex local health economies. National policy makers, local implementers and other stakeholders will have varying perspectives on impact and the Labour Government's centralising tendencies have acted to 'crowd out' local voices from the policy process. Drawing on the national evaluation of Health Action Zones (HAZ) this article 'gives voice' to local stakeholders and their perceptions of impact. Informed by a Theories of Change perspective, we explore HAZ interventions to articulate the nature of impact and its limits. We analyse the claims made by local HAZs with reference to the evidence base and examine their significance in the context of overall HAZ objectives. We conclude that local implementer perspectives are no less sophisticated than those at the policy centre of central government, but that they are informed by three important factors: the local context, a need to be pragmatic and the limited potency of evidence in the public policy system. Keywords: Evaluation; Impact: Health Action Zones; Local perspectives; UK

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined. Key words - inequality, income distribution, life expectancy, infant mortality, OECD countries

Richard Wilkinson puts forth his criticisms on the paper entitled 'Income Inequality and Population Health' which appeared in volume 46 of Social Science and Medicine in a letter yet to be published in the same journal. Among the criticisms he raised are problems with data and data analysis as well as the oversight committed regarding the use of studies with contradictory results. These concerns are answered and explained.