Minding the health gap

By BBC Health Correspondent Richard Hannaford

Ever since Sir Douglas Black published his famous report in the eighties on the effect of economic inequalities on the health of people, the Labour party has been committed to reducing them.

He showed quite clearly that people in the lower social groups were far more likely to get conditions like cancer and heart disease, than those in the more affluent sectors of society.

Its said Mrs Thatcher disagreed with its findings and - as it was a government report - ensured it had as little exposure as possible.

A few copies did however escape the net and I can remember the former health secretary Frank Dobson telling me with glee that he had one of the few original copies, which he treasures.

The problem for politicians like Mrs Thatcher was that if you accepted what the Black report was saying, you had to accept that the government had a role in targeting help on those who need it most, rather than offering everyone the same benefits.

That would mean supporting measures that ensured social justice - a left wing socialist concept.

It also makes improving the health of the public not simply a matter of medicine and sanitation, but of job creation and financial investment - matters of economic and political policy.

In attacking these health inequalities, politicians now have to accept that they will have to improve the economic prospects of people in the lower social groups.

Entrepreneurial society

Right wing thinkers argue that creating a more entrepreneurial society, will itself help create prosperity and employment.

That wealth will in its turn trickle down to all sectors of society and therefore improve the health of the nation.

And while during the eighties and nineties the wealth of those in the lowest social groups in society did increase - for those on the lowest rung of the social ladder - the improvements were far less marked than for those at the top.

This has led left wing thinkers to argue that Thatcherism was basically unfair.

Either way inequalities still exist and seem to be increasing.

A report by the think tank the Policy Institute last December highlighted that premature deaths are becoming more geographically concentrated.

More likely to die

It also went on "Children in the manual social classes are twice as likely to die in an accident as those in the non-manual classes, and the poorest two fifths are one and a half times as likely to be at risk of a mental illness as the richest two fifths".

It added that "the number of people living in households with less than half average income, after housing costs, was 14.25 million in 1998/99.

This is more than double the number of the early 1980's, and a half a million greater than at the previous high point in 1992/93."

This week the government has announced that it will publish the first ever health inequalities targets for England.

The first will be to reduce the health gap between children in different social classes.

Starting with children under one, by 2010, it aims to reduce by at least ten per cent the difference in infant mortality rates between manual groups and the rest of the population.

The second target is to reduce the differences in life expectancy.

Over the next ten years children born in the areas with the worst life expectancy figures should expect to live longer than their parents.

They should see the differences between their areas and the national average reduce by ten per cent.

Of course no society can expect to have perfect equality of access or opportunity.

However, these targets - all be they only long term markers - show that Ministers are prepared to provide criteria by which they can be judged in their attempts.