Apologies for not circulating this earlier
How to reverse a decline
Guardian leader
Monday August 15, 2005
There were, as old hands in public health were quick to
point out, unwelcome echoes from the past in the
government's report on inequality last week. Like the Black
report of 25 years ago, it showed a serious widening of
health inequalities. Worse still, like the Black report it
was slipped out during the summer parliamentary recess in an
attempt to bury the bad news. A wholly inadequate press
release, which failed to lead with the report's findings,
omitted to provide even the title of the report, let alone
its key message. This is hardly the action of a government
intent on trying to restore much-needed public trust.
There was, of course, some good news. The health of all
social groups is continuing to improve. There is a welcome
reduction in the mortality rate of heart disease and cancer
- the two biggest killers - as well as a closing of the gap
between social classes too. Even so, the two main yardsticks
used to measure health inequalities - infant mortality and
life expectancy - show a widening, not narrowing, of the gap
between better off and poor. Ministers want to cut the gaps
by 10% between 1997 and 2010. Instead, the gap in infant
mortality rose from 13% to 19% between 1997-99 and
2001-2003, while the gap in life expectancy rose by 2% for
men and by 5% for women. Better-off people now live about
eight years longer than their poorer contemporaries.
Sir Michael Marmot, chairman of the scientific group that
produced the report, acknowledged that the reasons for the
widening of the gaps needed exploring but declined to
speculate. The fundamental causes are not difficult to
predict. True, poorer areas have poorer health provision in
terms of access to GPs and hospitals. Westminster has one GP
for every 717 people compared with one for 3,428 in Greater
Derby. But the fundamental reasons concern behaviour, living
conditions and wealth.
What has to happen on the public-health front are
improvements in housing, diets, exercise, smoking and
alcohol consumption. Last November's white paper was a start
but requires much more momentum. Ministers will shortly have
to decide, for example, whether bars that do not sell food
should be exempted from the ban on smoking in public places.
If they stick to the current plan - exemption - the health
gap will widen. More controversially, though the evidence
that Professor Richard Wilkinson has produced looks
incontrovertible, ministers need to reduce income
inequalities. More equal societies are not just fairer but
healthier too.
http://society.guardian.co.uk/health/comment/0,7894,1549325,00.html
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