Children at risk as health inequality between rich and poor increases

MOTHERS AND children should be the focus of a new strategy aimed at reversing the growing health gap between rich and poor, a Government inquiry said yesterday.

Concentrating help on parents, especially mothers, is the only way of breaking the cycle of deprivation in which ill-health and disadvantage is passed down from generation to generation, the report of the Independent Inquiry Into Health Inequalities says.

Recommending a socialist-style programme for redistributing resources from the rich to the less well off, the inquiry, chaired by Sir Donald Acheson, the former Government Chief Medical Officer, says that social security benefits for women and children should be raised and policies for improving schools, extending day care and providing cheaper and better food should be targetted on disadvantaged areas.

The report says "food poverty" - in which people are forced to go without food because of a lack of money - has reappeared in Britain and its effects could endanger future generations. Current benefit rates are "inadequate to meet the costs of an adequate diet for expectant mothers" and benefit rates for children cover only 67 to 90 per cent of their minimum needs.

The report sets out "39 steps to a healthier society", ranging from far- reaching improvements in housing and employment to specific measures such as providing free fruit in schools and nicotine patches on prescription.

But it was immediately criticised for producing a set of vague, uncosted recommendations which ministers may use as a shopping list, selecting for implementation those that are cheap and simple and suit their political goals.

The inquiry was conducted by a committee of six over 16 months who were charged with updating the 1980 Black report into health inequalities. That inquiry, chaired by the eminent physician Sir Douglas Black, found wide differences in death rates between the rich and poor and recommended measures costing pounds 2bn to address them. The report was dismissed by the then Conservative social services secretary, Patrick Jenkin. Sir Donald was determined that his inquiry, which found the health gap has widened since the Black report, would avoid the same fate and provided no costings for his recommendations.

The report said Britain is now the most unequal country in the world after the US in terms of the gap between rich and poor which is wider than at any time since the Second World War. While the rich have got richer over the past 20 years the numbers on Income Support have more than doubled from 4 million in 1979 to 9.6 million in 1996. A quarter of all children under 11 live in families on Income Support.

Frank Dobson, the Secretary of State for Health said the Government was committed to reducing health inequalities. "They have persisted throughout the century and often worsened in the past two decades and they will not be swept away overnight. Sir Donald's work will be a key influence in our long term strategy to narrow the health gap," he said.

t Whether people grow up to be geniuses or dunces may be partly decided by what they are fed in the first weeks of life, a16-year study of premature babies by Great Ormond Street Hospital, London, reported.

Report's Main Points

1 Government: Assess policies affecting health to see whether they would widen or narrow the health gap.

2 Poverty: Increase benefits for women, children and older people. Raise pensions.

3 Education: Provide extra resources for schools and more pre-school education in disadvantaged areas.

4 Employment: Improve job opportunities and training. Reduce psycho- social hazards of work by giving employees more control.

5 Housing: Provide more social housing, measures to help the homeless, better insulation and smoke detectors.

6 Transport: Improve public transport, reduce car use, lower speed limits and provide concessionary fares.

7 Nutrition: Provide cheaper, more varied food in disadvantaged areas, and free fruit in schools. Improve nutrition of women of child-bearing age. Lower salt in processed food.

8 Families: Provide more day care for working parents. Fluoridate the water supply.

9 Young people: Take measures against suicide and teenage pregnancies and encourage exercise in the young.

10 Smoking: Increase real price of tobacco and make nicotine replacements available on prescription.

11Ethnic minorities: Better housing and job opportunities.

12 NHS: Allocate more resources to disadvantaged areas.