Letter: Where Britain's health improvement must start

Sir: While the Department of Health deserves congratulations for finally persuading the Government to accept a national health strategy, there must be constant vigilance on the part of public health advocates to ensure that Virginia Bottomley's promise that the White Paper, The Health of the Nation, will indeed be 'a beginning, not an end' and that 'the strategy will grow and develop'.

There are two danger areas which threaten the strategy.

The first is the refusal of the Government to accept fully the link between income and health, despite widespread agreement among health researchers that this issue is central. In virtually all the strategy's target areas, the lower people's income, the higher the incidence of morbidity and death. Unless these health inequalities are acknowledged and addressed, it is again the better off who will benefit disproportionately from the strategy.

The second problem is the questionable commitment of the Government as a whole towards a meaningful improvement in the nation's health. Whitehall and its ministers are renowned for their territorialism, and who knows what battles will go on in the cross-departmental ministerial committee which is to oversee the strategy?

The Department of Health has lost the first round in trying to get a ban on tobacco advertising. There will be other battles, for example over food and alcohol. Is this committee evidence of a genuine integrated commitment to health, or will it simply become the focus for inter-departmental squabbles, as ministers protect their departmental interests which may conflict with those of health?

Let us indeed welcome the Government's targets, but let us not be under any illusions of how difficult it is going to be to achieve health for the whole nation. This is the beginning - we can agree with Mrs Bottomley - but only the beginning.

Yours faithfully,

MAGGIE WINTERS

Development Officer

The Public Health Alliance

Birmingham

10 July