Ministers in U-turn over 'health gap': Working group to study inequality between rich and poor

THE widening health gap between rich and poor was finally acknowledged by the Government yesterday in a remarkable policy U-turn.

After more than a decade in which ministers avoided the issue, an inter-departmental working group has been set up to examine health inequalities.

The move was disclosed yesterday by Dr Jeremy Metters, the Deputy Chief Medical Officer at the Department of Health, less than a week after research in the British Medical Journal showed that death rates in the poorest parts of northern England were rising for men aged 15 to 44 for the first time since the 1930s.

The group will make recommendations about 'practical action' and on the research needed 'to inform policy making and future strategy' on health inequalities, Dr Metters told a London conference organised by the BMJ and the European Public Health Alliance.

Its work will cover not only variations in health between different social classes and income groups, but also geographical and ethnic health variations. The working party will form only a sub-group of the Chief Medical Officer's standing group on the Government's Health of the Nation targets. But its work will cross departmental boundaries examining what needs to be done in areas outside the NHS.

Dr Metters was keen yesterday to play down its significance, saying it 'should not be magnified into some enormous new initiative'. In 1980, the Government came close to suppressing the Black report, which first spelt out how the health gap between social classes had been widening. Sir Douglas was refused permission to hold a departmental press conference and the Government produced only 260 cyclostyled copies of his report.

When the Health Education Council updated the report in 1987, it suffered a similar fate, the council's chairman declaring its findings to be 'political dynamite in an election year'.

The sensitivity of the issue is shown in all four health ministers declining invitations to speak at yesterday's conference. Virginia Bottomley, the Secretary of State for Health, however, sent a message acknowledging there were 'significant variations in ill health' in England which presented 'a challenge' even if there were no simple answers to the issue.

Michael Marmot, Professor of Epidemiology at University College, London, said: 'To my knowledge this is the first time this has been on the Department of Health's agenda since the Black report. The fact that they have acknowledged that this is an issue is important. I treat this with optimism rather than cynicism. The time for cynicism is when it has reported if it then turns out it has not done anything.'

Dr Sandy Macara, chairman of council of the British Medical Association, said the announcement was 'tremendous news'. It showed the Black report was 'an idea whose time had come' and that the Government was recognising 'that there are problems in the state of the country's health which transcend the (NHS) reforms'.

Figures from the Office of Population Censuses and Surveys showed yesterday that the death rate for men in 1992 ranged from 11 per cent below the national average in East Anglia to 14 per cent above in the North.

Heart disease deaths in the North were also 20 per cent higher for men and 22 per cent higher for women than the national average. Deaths from lung cancer in the North were 30 per cent above the national average for men and 36 per cent above for women.