Recent statistics on health inequalities have been interpreted as showing the government has failed to meet its aim of narrowing the gap. But, according to Sir Michael Marmot  – who oversaw the development of the government report containing the statistics, and who spoke at the Fabian Health Inequalities Forum – it is far too early to tell whether actions taken from 2003-06, the period covered in the review, will have any impact on long-term inequalities in health outcomes.

The government should take real credit for putting inequalities on the health agenda since 1997. The challenge they face now will be keeping them there in the face of apparent lack of progress.

According to Marmot, progress will depend on action across government, from narrowing inequalities in education to improving working conditions in the lowest-paid jobs. Naturally, there is still much the NHS must do, by shifting its focus from making people better to one of making them well.

Poor communities are usually situated much further from primary care services than they are from acute services. There are four times as many GPs within a mile of affluent areas as poor areas. Increasing the provision of primary services in areas of deprivation is a priority if the gap is to be narrowed. Raising awareness and expectations of healthy lifestyles will be key to improving health outcomes in marginalised communities.

While public health practitioners may be in agreement about the need for concerted action on health inequality, there is less awareness among the public. The government must now break with the view that health policy is about the number of operations completed in big general hospitals, and make the case for a health service based on prevention and early intervention as much as it is based on treatment and cure.

The challenge will be to make such a policy tangible to citizens. After 1997 the government talked endlessly about the increases in health inputs, be it billions in new money or thousands of new doctors and nurses. If it is to legitimise a shift in resources to primary care and preventative health strategies, the government will need to explain what that means, ensuring it is an equally meaningful offer.

It might mean a major redistribution of the health workforce, away from hospitals and GP surgeries and into schools, chemists and community centres. It might mean free swimming lessons or subsidies for football club season tickets. These choices will need to be made visible to citizens. One way could be to place more resources in the hands of local communities, leaving them to decide between prioritising new cycle lanes or hi-tech kit for acute care according to local needs.

But if gaps in health inequality are to be narrowed and not exacerbated by such an approach, this strategy must be accompanied by a focus on health outcomes and a broader discourse about fairness and equality. This will be crucial to winning public permission to target measures at the most marginalised individuals and groups who suffer disproportionately from excess morbidity and premature mortality.

What is more, the stark inequalities in life expectancy between individuals and groups is perhaps the most powerful way to animate wider debates around inequality. It could offer a route into discussing the wider socioeconomic and status inequalities with which Marmot is concerned. All government departments must take action to build a fairer society, but a recast NHS can and should take the lead.