LEADING ARTICLE:A nation ill at ease with itself

Britain's very poor are getting poorer - both relatively and absolutely. They are also dying earlier than they used to.

This is the picture, uncertain in detail but clear enough in outline, that emerges from a report published yesterday by the King's Fund, an independent health policy think-tank. Our reaction should not be passive or fatalistic. We may have become more fluent with the sociologist's language of relative and absolute poverty. We might certainly agree that a rising tide raises all boats. But a deterioration in the mortality rate among the poorest is not something that a civilised society can endure without reaction.

Many of those dying early are the very people living in the soulless "concrete wastelands" that John Major yesterday pledged to help. It is there that you will find most of the people whose lives are blighted and shortened because of poor diet, bad housing, smoking and drug abuse, problems increasingly associated with deprivation. But, as the Prime Minister made clear in his address, it is not enough to wring our hands. We can do something.

It is far easier to demonstrate a link between ill health and poverty than to identify the precise benefits of spending money on particular public health programmes. But there are, as the report points out, plenty of policies available that would bear dividends in terms of better and longer lives.

There are those who will brand the Prime Minister a hypocrite for making speeches against the backcloth of broken-down estates and stained concrete. After all, he and his predecessor are responsible for the revolution that has legitimised the pursuit of wealth, shifted the burden of taxation away from the better off and widened the gap between the highest and lowest earners. But Mr Major's government has also been bold in thinking about health. The NHS is no longer regarded merely as the national repair service. Its proclaimed job is also to look at the bigger picture. The Government's Health of the Nation White Paper has given preventive health policies the priority that all serious research suggests is necessary.

By setting targets for, among other things, reducing smoking and heart attacks, ministers have acknowledged that it is better to stop people becoming sick in the first place. Such an approach demands that people should be encouraged to address harmful features of their lifestyles.

Ministers are indeed already working on several of the ideas that the King's Fund has proposed. But a broader approach is needed. The tax and benefits system still discourages too many poorer people from working, as does the absence of affordable child care, not to mention Britain's inadequate provision for adult training. The Government should also face up to the need for a ban on tobacco advertising, to set alongside its policy of progressively higher taxation on cigarettes.

If Britain is to have a dynamic economy which does not produce unacceptable outcomes for its poorest citizens, Mr Major needs this kind of strategy to go with his soapbox.