Website of the Department of Health

Introduction

13.1 No injustice is greater than the inequalities in health which scar our nation. The life expectancy of a boy born into the bottom social class is over nine years less than a boy born into the most affluent social class. The gap between health needs and health services remains stubbornly wide.

13.2 The worst health problems in our country will not be tackled without dealing with their fundamental causes. This means tackling disadvantage in all its forms - poverty, lack of educational attainment, unemployment, discrimination and social exclusion. It means recognising the specific health needs of different groups, including people with disabilities and minority ethnic groups. Improving health is now a key priority for all government departments. Action will be taken to step up the cross-governmental focus on health and inequalities.

13.3 The NHS too has a stronger role to play in prevention, as well as working in partnership with other agencies to tackle the causes of ill health so as to reduce health inequalities.

Setting a national inequalities target

13.4 The White Paper - Saving Lives: Our Healthier Nation - required the setting of local targets for reducing health inequalities. For the first time ever, local targets will now be reinforced by the creation of national health inequalities targets, to narrow the health gap in childhood and throughout life between socio-economic groups and between the most deprived areas and the rest of the country. Specific targets will be developed in consultation with external stakeholders and expert advice, as the new national statistics classification becomes available early in 2001.

13.5 In particular, we will set a target to narrow the longstanding gap in infant and early childhood mortality and morbidity between socio-economic groups as well as a target to address inequalities later in life.

13.6 These inequalities targets will be delivered by a combination of specific health policies and broader government policies, including abolishing child poverty, expanding Sure Start and action on cancer and coronary heart disease.

13.7 To underpin this national work on cutting inequalities we will by 2002 develop a new health poverty index that combines data about health status, access to health services, uptake of preventive services and the opportunities to pursue and maintain good health (eg access to affordable nutritious food, physical activity and a safe, clean environment).

Reducing inequalities in access to NHS services

13.8 'The inverse care law', where communities in greatest need are least likely to receive the health services that they require, still applies in too many parts of the country. Inequity in access to services is not restricted to social class and geography; people in minority ethnic communities are less likely to receive the services they need. Many deprived communities are less likely than affluent ones to receive heart surgery, hip replacements and many other services including screening.

13.9 By 2003, following the review of the existing weighted capitation formula used to distribute NHS funding, reducing inequalities will be a key criterion for allocating NHS resources to different parts of the country.

13.10 Linked to this there will be a new way of distributing resources to address inequities in primary care services. They have historically been excluded from the NHS 'weighted capitation' formula. Instead, the Medical Practices Committee (MPC) has sought to ensure the fair distribution of GPs across the NHS, with only partial success. For example there are 50% more GPs in Kingston and Richmond or Oxfordshire than there are in Barnsley or Sunderland after adjusting for the age and needs of their respective populations.

13.11 In future, the new Medical Education Standards Board (see chapter 8) will track the number and distribution of doctors in primary care. The Medical Practices Committee will be abolished and replaced with a single resource allocation formula covering all NHS spending including general medical services non-cash limited (GMSNCL) expenditure. Progress to new targets will be on the basis of a proper 'pace of change' policy. This will both improve equity and allow more flexible models of primary care services.

13.12 To improve further the equitable distribution of GPs and primary care staff, there will be 200 new Personal Medical Services schemes created principally in disadvantaged communities by 2004. New incentives will be developed to help recruit and retain good staff in disadvantaged areas. Health centres in the most deprived communities will be modernised.

13.13 By 2001 local NHS action on tackling health inequalities and ensuring equitable access to healthcare will for the first time be measured and managed through the NHS Performance Assessment Framework. The NHS will need to address local inequalities including issues such as access to services for black and ethnic minority communities.

13.14 By 2003 a free and nationally available translationand interpretation service will be available from every NHS premises through NHS Direct.

Children: ensuring a healthy start in life

13.15 Health at the very beginning of life is the foundation for health throughout life. It is now recognised that women's health in infancy can affect the health of their children. Although infant mortality rates have improved over recent years the English rate remains above the European average. Infant mortality rates vary widely across health authorities in England, with the highest health authority rate being three and a half times that of the lowest rate. There are also large variations in infant mortality rates by social class of father and ethnic origin of mother. Infants born to fathers in unskilled or semi-skilled occupations have a mortality rate 1.6 times higher than those in professional or managerial occupations. And children of women born in Pakistan are twice as likely to die in their first year than children of women born in the UK.

13.16 By 2004 there will be:

Reducing smoking

13.17 Seven in ten smokers want to give up, but smoking kills 120,000 people a year. It is the leading single cause of avoidable ill health and early death. It is the biggest single cause of the difference in death rates between rich and poor. Smoking in pregnancy reduces birth weight, and contributes to perinatal mortality. To boost the measures set out in the White Paper Smoking Kills - which include a ban on tobacco advertising and sponsorship - the NHS Plan sets out a major expansion in smoking cessation to give England a world-leading service.

13.18 By 2001:

13.19 The success of this programme will mean that by 2010, approximately 55,000 fewer women will be smoking in pregnancy: a major contribution to tackling health inequalities and improving infant mortality. By 2010 at least 1.5 million smokers will have given up smoking.

Improving diet and nutrition

13.20 Poor nutrition leads to low birth weight and poor weight gain in the first year of life, which in turn contributes to the later development of disease, particularly heart disease. Increasing fruit and vegetable consumption is considered the second most effective strategy to reduce the risk of cancer, after reducing smoking, and it has major preventive benefits for heart disease too. Eating at least five portions of fruit and vegetables a day could lead to estimated reductions of up to 20% in overall deaths from chronic diseases. In the UK, average consumption is only about three portions a day, and a fifth of children eat no fruit in a week. Information is important, but the food choices people can make are shaped by the availability and affordability of food locally.

13.21 People make their own choices about what to eat. The role of Government is to ensure people have information and proper access to healthy food wherever they live. So by 2004 action will include:

New partnerships to tackle inequality

13.22 The NHS cannot tackle health inequalities alone. The wider determinants of ill health and inequality call for a new partnership between health and local services. That is the key strategic role for health authorities.

13.23 The NHS will play a full part in the Government's National Strategy for Neighbourhood Renewal supported by £800 million over three years.

13.24 The NHS will help develop Local Strategic Partnerships, into which, in the medium term, health action zones and other local action zones could be integrated to strengthen the links between health, education, employment and other causes of social exclusion. In the meantime effective health action zones will continue.

13.25 By 2002 there will be new single, integrated, public health groups across NHS regional offices and government offices of the regions. Accountable through the regional director of public health jointly to the director of the government office for the region and the NHS regional director, they will enable regeneration of regions to embrace health as well as environment, transport and inward investment.

13.26 By 2002 there will be a Healthy Communities Collaborative to spread best practice under the aegis of the new Modernisation Agency using evidence from the Health Development Agency and the successful formula already in place in the Cancer Collaborative and the Primary Care Collaborative.

13.27 By 2003 there will be a leadership programme for health visitors and community nurses under the new NHS Leadership Centre to provide them with the skills and expertise to work directly with representatives of local neighbourhood and housing estates to support communities to improve health.

Conclusion

13.28 These changes will help embed work on prevention and health inequalities within the core of what the NHS does. Opening up opportunities for all to decent health and a decent health service will take time. But over the next few years we intend to make progress. These efforts will be given new impetus by tackling our country's biggest killer diseases - cancer and coronary heart disease.