Inequality in America is growing and the toll on health is stunning. Economic inequality accounts for more deaths than lung cancer, diabetes, car wrecks, AIDS, suicide and homicide combined. This work aims to explain how this happned: how did the US develop such stark economic inequalities? what are the health consequences? and what should be done now? The answers all lie in the political realm. The growing gap between rich and poor is not a "natural" feature of society. Rather, the political process generates inequality. This work begins by exploring inequality and its effects on health - inside and outside the US. It then turns to the influence of race, gender, and culture; considers societal forces like the medical professions, business, labour, and social movements; and examines political institutions like Congress, the courts, state governments, the bureaucracy, Medicare, Medicaid and childrens health programmes.