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Thursday, November 26, 1998 Published at 08:42 GMT


Health gap widens

As middle-class smokers kick the habit, the less well-off continue

A sustained 10-year attack on the huge gap between the very richest and and the very poorest is needed to improve the health of millions of Britons, according to the author of the biggest social policy paper in over 18 years.

Poor men are 68% more likely to die in middle age than their richer counterparts, with poor women having a 55% greater risk of dying young.

Sir Donald Acheson talks about his report's findings
Sir Donald Acheson, the government's former chief medical officer who was commissioned by the Health Secretary to write the report, said the government had already made steps to tackle problems faced by the poorest members of society.

But he said it needed to make health inequality the centre of all policies which have an impact on health.

"While they have done many things which are beneficial in this area what is required is a sustained effort over the next 10 years," he told BBC Radio's Today programme.

He said the mortality gap among men had widened for coronary heart disease, stroke, lung cancer, accidents and suicide and, for women, in lung cancer and respiratory disease.

"Health inequalities affect the whole of society and can be identified from foetus to old age," he stated, adding that a key factor in low weight babies was a mother's birth weight and her pre-pregnant weight.

"We are concerned about the next generation and ill health and premature mortality in these very low birth weight babies," he said.


The BBC's Fergus Walsh: Water fluoridation and NHS nicotine patches will be proposed
The one-year investigation into the health gap between rich and poor has culminated in 75 recommendations in 39 categories.

They include:

  • All policies likely to have a direct or indirect impact on health should be evaluated in terms of their impact on health inequalities and should aim to reduce them;
  • High priority be given to reducing health inequalities in women of childbearing age, expectant mothers and young children;
  • Benefits be increased in cash or in kind for women of childbearing age, expectant mothers, young children and older people;
  • Schools in poor areas be given extra funding, with the Revenue Support Grant formula being amended so that it is more strongly weighted in favour of the poor;
  • Schools provide free fruit, restrict unhealthy food, keep school meals free and develop cooking skills;
  • A high quality public transport system be developed which is affordable and which includes concessionary fares for disadvantaged groups;
  • The Common Agricultural Policy be reviewed so that surplus food redistributed to the poor can include fresh fruit and vegetables;
  • Food companies be encouraged to reduce salt content in processed food with no extra cost to the consumer;
  • Mothers be encouraged to breastfeed their children;
  • Fluoride be added to the water supply;
  • Tobacco advertising be banned and that nicotine patches be provided on prescription on the NHS;
  • The ethnic minorities ' needs be specifically considered in social policy.

Other recommendations cover issues such as housing and the environment.

The report includes a section on what the NHS can do to reduce health inequalities. It proposes, for example, that the National Institute for Clinical Excellence, which begins work in April, look at equality of access to health care as well as monitoring clinical preformance.

Improving living standards

Despite increasing prosperity in the UK, the health gap between social classes has grown since the 1980s.

[ image: Sir Donald: Calls for
Sir Donald: Calls for "a sustained effort over 10 years"
The report says children from poor families weigh on average 130 gms less than those from wealthy families.

Low birth weight plays a big role in infant mortality.

Some 2.2m children are living at levels which are 50% below average - the European Union definition of poverty.

The report shows that there were17,000 more deaths of poor men aged 20 to 64 between 1991 and 1993 than those in the top social class.

Five out of every 1,000 babies born to parents in the top two social classes died between 1994 and 1996, compared with seven in every 1,000 for those in the lowest class.

In 1996, 17% of professional men aged 45 to 64 said they had a long-term illness, compared with 48% of men in the lower classes.

The report also says that universal health campaigns, such as breast and cervical cancer screening, have actually widened the health inequalities because the take-up is higher among the better off than the less well-off.

And while more middle-class smokers have given up cigarettes, those on lower incomes are still smoking in high numbers.

It therefore promotes anti-smoking policies which target the poor.


The BBC's Richard Hannaford: Health campaigns have actually widened inequality
The recommendations go beyond the remit of the Department of Health.

It is expected to be the most far-reaching social policy paper since the 1980 Black report in which Sir Douglas Black linked poor health with poverty.

Health Secretary Frank Dobson welcomed Sir Donald's report, saying it would be " a key influence" on the government's long-term health policy.

But he added that inequalities would not be swept away overnight.

The government has pledged itself to reducing health inequalities via policies such as health action zones which encourage a holistic approach to reducing health problems.

The green paper on public health, Our Healthier Nation, is described by the report as "an important landmark".

A government group is now working on specific targets to reduce inequalities, which the report is likely to feed into.

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