What's the prognosis?

Twenty-five years ago the Black Report revealed huge health
inequalities in the UK and was 'buried' by the then
Conservative government. Last month, Labour quietly slipped
out its own report, showing the problem is getting worse.
Mary O'Hara finds the public health community increasingly
frustrated

Wednesday September 7, 2005
The Guardian

Dr Mary Shaw Scientific director, South West Public Health
Observatory

The release of the report on health inequalities, Tackling
Health Inequalities - Status Report on the Programme for
Action on August 11 was reminiscent of the deliberately
covert release of the Black Report on August bank holiday
Monday in 1980. This latest report appeared at a time when
the official responsible, Caroline Flint, minister for
public health, was on holiday and her deputy was
unavailable. Even stranger, the press release referring to
the report deflected attention from the key finding of
widening inequalities in life expectancy and infant
mortality by headlining the 12 "early adopter sites" which
will be the first areas to have "health trainers". The
circumstances of the report's release, however, should not
be allowed to detract from its main message, that health
inequalities have widened. The fear that the hushed-up
release of this report raises is that the bold statements
and unprecedented promises of Labour's first years in power
have now been overtaken by the individualistic rhetoric of
behavioural prevention and "choosing health". Nowhere in the
report is there mention of measuring, let alone directly
tackling, the static or widening inequalities in income and
wealth that New Labour has presided over.

Danny Dorling Professor of human geography, University of
Sheffield

This is a new low for New Labour. It took eight years to get
around to it and this is what happens. It is sad to think
that Margaret Thatcher signed up to targets in 1985 to
reduce health inequality by 25% by the year 2000, yet look
where we are. The areas with the highest life expectancy 10
years ago are the places that have seen the biggest increase
in life expectancy since. Wealth lets you get health. The
areas that have benefited most are those that voted
Conservative in 1997. It is fair to say though, that New
Labour has done a lot. We are not about to become like
America. Look at the preface [to the government's report on
inequality last month], it is amazing how brazenly they
ignored the key issues. It is odd that they tried to release
it quietly when they did - during recess and on the
anniversary of the Black Report. I think this will become
New Labour's Black Report.

David Hunter Chair of the UK Public Health Association

This government came in with a commitment to reduce health
inequalities. Since 1997, it has become obsessed with the
NHS, with disease and cures, and not with health. The
government thinks there is no political mileage in tackling
health inequalities. It affects the disadvantaged, the
dispossessed and the marginalised, and they don't tend to
vote. Rather than moving toward the European model - where
they are trying to protect people in the long term - we are
moving more toward the US model.

Professor John Ashton NHS North West region director of
public health

Since 1997, some progress has been made. The question is
whether policies are joined up enough. In 1948 there was a
universalist approach [to public health]. Since 1979, we
have had targets and selective intervention. It has made it
much harder to determine if the people who need the help
most are really getting it. There are targets for improving
health inequalities by 2010 but you have to ask if it is
possible to meet this if the next two years are spent
distracted by yet another reorganisation of the NHS. The
issue is not to say this government has failed. We have to
create a system that is robust enough for the challenges we
now face: social justice and sustainability. The big
inequality opening up is not just length of life, it is
quality of life. A lot of working class people are living
into their 70s but often with multiple conditions, compared
with middle-class people who often get to their 80s before
problems emerge. Turning the current situation around will
be difficult. The challenge is to work out how we get back a
vision of a good society.

Alex Scott-Samuel Senior lecturer in public health,
Liverpool University and joint chair of the Politics of
Health Group

There has been a lot of rhetoric [on health inequalities],
especially since Labour first came in, but we now see that
these are not working. Material factors still underlie
inequality and these are not going to change as long as we
are following the policies of the World Bank. Income
inequalities are still at the same level as in the 1980s.
That is the greatest indictment of the government. I would
like an acknowledgment that some of the reasons for widening
inequalities are down to Labour's economic and public
policies. And I would like to see an independent commission
with the aim of looking at how all areas of policy impact on
health inequality.

Geoff Rayner Academic and former chair of the UK Public
Health Association

What's so different about now, compared to when the Black
Report came out, is that we live in a consumer society.
There is no language of paternalism any more. The government
has adopted the language of the market to sell public health
policy as well as buying into a philosophy of the market.
The state - as opposed to governments - needs to protect
people, and we need a state structure for intervention that
is agreed upon, one that doesn't change with a government or
a new health minister.

· Tackling Health Inequalities: Status Report on the
Programme for Action is at http://heh.pl/&1Vr
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