This paper reports an analysis of income related health inequalities at the Autonomous Community level in Spain using the self assessed health measure in the 2001 edition of the Encuesta Nacional de Salud. We use recently developed methods in order to cardinalise and model self assessed health within a regression framework, decompose the sources of inequality and explain the observed differences across regions. We find that the regions with the highest levels of mean health tend to enjoy the lowest degrees of income related health inequality and vice-versa. The main feature characterizing regions where income related health inequality is low is the absence of a positive gradient between income and health. In turn, the regions where income related health inequality is greater are characterized by a strong and significant positive gradient between health and income. These results suggest that policies aimed at eliminating the gradient between health and income can potentially lead to greate r reductions in socio-economic health inequalities than policies aimed at redistributing income.