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Gaps between UK social groups in infant mortality are widening

Sally Hargreaves, London

Despite an overall improvement in infant mortality in the United
Kingdom, inequalities between different social and ethnic groups
are widening, says a Department of Health report published this
week.

A department spokesman said, "Infant mortality is at an all time
low, and the rate continues to fall. However, there remains a
gap between the routine and manual classes and the general
population.

"Our target is to reduce the infant mortality gap by at least
10% by 2010. We are not complacent. This remains a challenging
target."

Previous research has shown that people in routine and manual
occupations—such as porters and cleaners—and in ethnic
minorities show consistently poorer health outcomes than the
general population.

The government introduced targets in 2003 to reduce the gap in
infant mortality across social groups, as well as to raise life
expectancy in the most disadvantaged areas. By 2010 the target
is to reduce inequalities between routine and manual occupations
and the general population—as measured by life expectancy at
birth and by infant mortality—by 10%.

A total of 9132 infant deaths were recorded in England and Wales
between 2002 and 2004, almost half of which were caused by ill
defined conditions, predominantly sudden unexpected deaths in
infancy. The new report says that 40% of these deaths were
recorded among parents who reported being in routine and manual
occupations. In this group there were 5.9 deaths per 1000 live
births, whereas the national average was 4.9 deaths per 1000
live births. The figures vary considerably across the country.
Infant mortality was higher than the national average in 46
(66%) of the 70 "spearhead" local authority areas—those areas
the government has identified as being particularly deprived.

Importantly, the gap between infant mortality in routine and
manual occupations and that in the population as a whole has
widened in recent years. Whereas in 1997-9 mortality among
families who did routine and manual work was 13% higher than
that in the general population, by 2002-4 this had risen to 19%.

Inequalities across ethnic and migrant groups were also found.
For example, the number of deaths of infants of women who were
born in Pakistan (10.2 per 1000 live births) is now double the
national average.

The report highlights major shortfalls in the way local NHS
services have so far responded to the 2010 target. In many cases
service providers and management lacked knowledge and
understanding of the target. The report noted a lack of
leadership, poor handling of data, and gaps in the evidence base.

The report says that an additional reduction of around 800 to
900 deaths during 2009-11 will be needed to reduce infant
mortality sufficiently to achieve the 2010 target. The data
indicate that reductions in infant mortality in ethnic minority
groups could have a greater effect in the routine and manual
occupational groups than in the population as a whole.

Richard Congdon, chief executive at the Confidential Enquiry
into Maternal and Child Health, London, said that although he
supported the report's recommendations on further reducing
infant mortality, this measure needed to be considered alongside
maternal mortality and stillbirths.

He said, "There does not appear to be an overall improvement in
rates [for maternal mortality and stillbirths] matching that
reported in this report for infant mortality. Major risk factors
include social exclusion and ethnicity, and continuing and
increased effort will be needed to address these inequalities."

Moyra Rushby, from the health charity Medact, London, said that
the report's findings were relevant to broader discussions about
the ability of people from ethnic minorities to access
appropriate and timely health care.

"The recent tightening up and expansion of NHS systems to
identify and charge non-eligible migrants, at maternity services
in particular, means vulnerable individuals will increasingly be
less likely to present to services, or will present late, which
could impact on both maternal and child health status," she
said. She added that the Department of Health must do more
research to explore the experiences of people from ethnic
minorities in the UK health services.

Review of the Health Inequalities Infant Mortality PSA Target is
available at  http://tinyurl.com/2ejdny

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