Website of the Department of Health

It won't come as a surprise to you, incidentally, and this is an aside, that is largely  why I am opposed to the so called Patient's Passport, a policy that will undermine that basic principle of equity. You cannot maintain an NHS that provides equal access for all if you subsidise those people who can pay to jump the queue above those who cannot. And you cannot give everyone the same chance of surviving ill health if you subsidise those people that can pay to jump the queue over those that cannot.

But while I want to do nothing to move backwards, away from the principle of equity, I do not want to pretend either, that we have constructed a system that achieves it perfectly in practice. This conference is aimed at helping us put inequalities at the core of the nation's health. We want to use our consultation to promote a wide debate on the roles and responsibilities of individuals, the NHS, and all the other players in civil society as well as the government in the debate on choosing health.

From the Government's view this emphasis on reducing inequality is underpinned by our Public Service Agreement target on health inequalities: to reduce by 2010 inequalities in health outcomes by at least 10 per cent as measured by infant mortality and life expectancy at birth.

Today I specifically want to put this in the context of the ways in which the Government has worked to tackle inequalities as a whole, in general and to outline for you cases of how inequalities can be tackled that is not just down to government. We have been attacked for not being concerned about inequalities. This is just not the case - it is precisely because we are a radical new Labour government that we have been successful in tackling inequalities as a whole. Just because our language is moderate doesn't mean that we're not radical in intent.

If we look at one of the most significant issues related to inequality - unemployment. In 1998 the Government introduced the New Deal scheme which provides support to the long-term unemployed. Between April 2001 and December 2003, almost 100,000 individuals over 25 years old who had been long-term unemployed gained a job.  By December 2003, nearly 480,000 young people had taken up posts. And between October 2001 and the end of March 2003, over 98,000 people over 50 years old had been helped back into work. People in all age groups doing the hard work of working for a living.

But how has this been achieved? The only way in which increased employment opportunities created by the Government's handling of the economy has any impact at all on health is if people take up those jobs that they are offered. If they don't, anything the Government does is a waste of time as regards unemployment and as regards health. So health inequalities are improved only through people actually going to work and picking up these opportunities. Little happens if it's only the Government in some patronising way providing work.

If we look at education, another policy that has a direct influence on health inequalities, over the last 6 years there has been something like a 12% improvement in literacy amongst 11 year olds. The government has provided more money for schools, we have created a greater focus on literacy and numeracy within the curriculum, teachers have worked very hard to implement this, and therefore education has improved. No, not quite. The reason education has improved is also that more young people have worked hard at accepting the opportunities presented to them and have worked harder to improve their learning. More parents have recognised these opportunities and their children have chosen to work hard to use them.  Thus, since 1997 we have seen a steady increase in the number of 11 year olds achieving the expected standard in literacy and numeracy. It is not just because the government has provided the means to do so but because children and parents have responded to those opportunities.

Or, again, take the case of teenage pregnancies. Between 1998 and 2002 there has been a 10% decrease in the numbers of teenage pregnancies. Again a good indicator of existing and future health inequalities. The Government has done a wide range of things, but let's delicately make the point again that ultimately the reason there are less pregnant teenage mums is because more teenage girls have chosen to act in a different, certain way.

So, the new Labour government takes this issue very seriously and has clear commitments on many fronts to reduce inequalities. However to put the point simply - nothing can be achieved by anything we do unless real people chose to change their behaviour. We can provide the opportunities, we can provide the incentive, but real people engaged in the hard work of choosing to change their own lives makes the difference.  So, just as with rights come responsibilities, so to with opportunities come challenges. Governments on their own cannot reduce inequalities, they depend upon the hard work of disadvantaged people working to overcome the conditions that have in the past disadvantaged them. We help, but they do it themselves.

It is this politics that drives my view and our work on reducing health inequalities. That's why the headline for our consultation is 'Choosing health?'. Our responsibility is to create the conditions where disadvantaged people feel able to make healthier choices. But nothing ultimately happens unless people make those choices.

We now live in a society where the population is increasingly conscious of its own health and where helping people to choose health has never been a more achievable goal or offered a better reward for individuals and families, and the whole of society.

Our task is to help everyone make the choices towards health and to recognise that within the existing policy framework millions of people continue to experience significantly poorer health than the general population. The figures of life expectancy show this at a glimpse.  It remains the case that a boy born in Manchester is likely to die on average 8.5 years earlier than a boy born in Rutland.

An example that highlights this point is the different ways in which we eat healthily or not. Adopting healthy eating habits is one of the most important things, alongside smoking and exercise, people can do much prevent conditions such as cancer, coronary heart disease and diabetes. Healthy eating is a series of choices that each of us can make.

We don't make those choices in circumstances of our own choosing. Which is where the Government and you come in - in helping to mitigate the difficult obstacles of circumstance. But we do ultimately have to make the choice, and sometimes the effort, for ourselves.

There are huge differences in fruit and vegetable consumption between different social groups. People from manual groups tend to eat around 50% less fruit and vegetables than people from professional groups. These statistics are the accretion of a whole range of individual choices (and circumstances), but if we do nothing to support everyone then one group of people will consistently be iller than another group. That's why we have started with young children and our five-a-day schemes. Our National School Fruit Scheme has been well received, which is why I've extended the scheme nationally to all children aged four to six, - 97% of teachers and parents have expressed satisfaction with the scheme, and 27% of parents have reported increased consumption of fruit by children and families at home.

Empowerment

Our public health consultation is about ensuring that everyone has an opportunity to choose health by working with people to tackle the conditions that constrict their choice. That is why our consultation extends to the food industry and retailers, the media and advertisers, schools and communities, as well as individuals and health professionals. How together can we make the choice of a healthy diet a reality for more people?

Joined-up working

We recognised from the first, the importance of engaging with the widest range of organisations in the drive to reduce health inequalities.  As I have noted, health inequalities are a complex problem, and engagement across government, the whole of the NHS, local authorities, voluntary and community bodies is crucial.  As Secretary of State for Health I have overall responsibility for leading the work on health inequalities, but I also count on the support of my colleagues across Government to contribute to this agenda because none of this will work.

But we have started to directly achieve things through the health service. One example is the Sheffield City-wide Initiative for Reducing Cardiovascular Disease. By targeting resources at GP practices with higher Coronary Heart Disease prevalence and high-risk ethnic groups, the programme has successfully identified nearly 8,000 more people with Coronary Heart Disease and provided enhanced levels of secondary prevention. This has led to a faster decline in premature death from heart disease in the more deprived fifth of the population than in the city as a whole - over 14% in the most deprived fifth as opposed to 8% in all of Sheffield. Poorer people having their life chances improved.

Conclusion

Finally, I repeat our commitment to health improvement across the whole of society.  Tackling health inequalities is indivisible from this aim. The health of the population will improve, but we need the health of the poorest to improve at a faster rate than that of the population in general. As well as thinking about the particular health issues like smoking, obesity, and mental health, it means thinking about the delivery of mainstream services and the systems and processes that create barriers to health and health choices.

Our philosophy must be that we then take responsibility for improving the outcomes of our services in terms of access, but we work alongside people who suffer from inequalities to help them to improve the conditions to make better choices by them for them. 

What we need from you today, is some lively thinking outside the box bout the individuals and communities we serve, and about what will make it easier for them, for all of them to 'choose health'.