Poverty is a sentence of death

SIR DOUGLAS BLACK said it nearly 20 years ago, to a government that was determined not to listen: poverty makes you sick. Just over a decade later, when John Major became Prime Minister, he spoke fondly about creating a classless society and about his own humble origins in Brixton. What he did not do was get out the Black report, commissioned by a Labour government and hastily shelved by Mrs Thatcher in 1980, and start looking at what inequality really means. Nor did he explain what he intended to do to turn his dream into reality, perhaps because he depended too heavily on his own experience.

But Mr Major's foolish pronouncements about class may also have something to do with the fact that the word signals superficial differences to most of us - accent, dress, whether you go to Thorpe Park in your spare time or to Ascot. (I once lived with someone whose discomfort, when anyone said the word "toilet", was exquisite.)

Last week another government-commissioned report, this time by the former chief medical officer Sir Donald Acheson, exploded all these myths. It revealed that men aged 45 to 64 in the professional classes have a 17 per cent chance of developing a long-standing illness. Among the unskilled, the risk shoots up to 48 per cent.

The affluent live longer, with a life expectancy of 75 by the late 1980s - five years more than the poor. But the most shocking statistic is about death rates, which were 53 per cent higher in the two lowest social classes when Black collected the figures in the late 1970s. By the end of the 1980s, death rates were 68 per cent higher in the poorest groups .

This means that being born into the wrong class is not merely a social misfortune, condemning you to bad housing, inferior education and dismal job prospects. It is also quite likely to consign you to a premature death.

Commentators have been quick to point out that the figures are not as bleak as they seem, representing improved health among the higher social classes - the people most likely to give up smoking, take exercise and avoid junk food - rather than a deterioration on the part of the least affluent.

But there are more complex ways of maintaining a class system than grinding the faces of the poor. One of them is to transfer money and resources from the less well-off to the rich, a longstanding trend in this country which is highlighted by the income tables in Sir Donald's report. Not that Conservative politicians have shown much reluctance to do a bit of grinding, especially at party conferences - think of Peter Lilley's performance in 1992 when he claimed to have "a little list ... of young ladies" who supposedly got pregnant outside marriage to receive State benefits, as though the cash was so generous as to compensate for the many disadvantages of single motherhood. Sir Donald specifically mentioned mothers on benefit, suggesting they "may not be able to afford a healthy diet and may go short of food to feed their children.".

A family of four living on income support receives between 67 per cent and 90 per cent of the minimum necessary for an adequate standard of living. Women in disadvantaged groups are likely to be under-nourished and give birth to smaller babies, who are then prone to heart disease - and will probably produce stunted babies of their own, carrying the effects of deprivation into the third generation. "Some health inequalities are so gross", said Sir Donald, "that a sustained effort will be necessary over 10 years to have an impact."

The Health Secretary, Frank Dobson, welcomed the report and called it "a further stage in our unprecedented commitment to tackle inequalities in health". But is the Government really prepared to spend money on the problem? A year ago, it forced through a cut in lone-parent benefit, hitting the very group whose vulnerability is highlighted in the Acheson report. A member of Sir Donald's team has already suggested that benefits might need to be raised by 25 per cent to ensure better nutrition for the worst- off. Unlike Mr Major's classless society, which consisted entirely of rhetoric, Tony Blair's version could turn out to be very, very expensive.

BEFORE returning to London from Australia, I spent a night in a Benedictine monastery in the bush, where fine examples of classical Spanish architecture cluster under a blazing sun. In a museum devoted to the order's history, glum groups of aborigines stare into the camera, while captions explain that the monks came from Spain in 1846 to convert the indigenous population to the "twin blessings" of agriculture and Christianity - partly by the incongruous means of forming them into a brass band.

I was relieved to escape from this monument to cultural imperialism and return to Perth, where billboards for a suburban shopping offer this frankly materialistic prospect: "Shopping heaven - without the unpleasant dying bit."