Overcoming health inequalities that have built up over generations will take vision and determination

The slave trade may have been abolished officially inBritain200 years ago, but we still have large numbers of people 'enslaved' by inequalities in health - and it is our task to abolish this iniquity.

It is government policy, it is a major plank in the policy commitment of NHS North West,andEast Lancashire primary care trust has nailed its colours to the mast.

Too often, government ministries and health bodies are criticised for simply paying lip service to concepts such as ending child poverty for ever or to a review that promises to provide a fix.

East Lancashire PCT has signed up to specific, tangible pledges aimed at diminishing key health inequalities in our area and we are backing this commitment with£1m extra targeted expenditure. The PCT has put its money where its mouth is.

East Lancashire aims to make major inroads into its targeted 'big four' health inequalities within three or four years. If this fails, it will not be for want of effort. It took the anti-slavery movement 50 years to achieve its aim, we want to do it much more quickly.

But there are caveats: a major legacy of ill-health, accumulated cultural imperatives of behaviour, and high levels of alcohol consumption and rates of smoking.

Yes, we have to be realistic and manage expectations, but that should not lessen our resolve. So, as we move forward, what is the noose I am all too willingly stepping into?

The big four we are having a go at are coronary heart disease, excessive alcohol consumption and drug abuse, high infant mortality, and the targeting of our 20 worst areas of deprivation. My message to staff is: 'Don't agonise, just go for it.'

Building bridges

We need to bridge the gaps between ourEast Lancashirecommunities and theNorth West, betweenthe region and the rest of the country, and between the different wards and towns in our own patch. Life expectancy differences are up to seven years in the same borough, we have nearly twice the national infant mortality rate in the country in one of our boroughs, and the debilitating effects of too much booze and too many fags are there for all to see. Not to mention poor eating habits and lack of exercise.

I am reminded that with the anti-slavery movement, it was just a handful of good souls who started it all off when they held a meeting in 1783, the culmination being William Wilberforce’s Aboltion Act in 1833, years after the trade itself was banned in British colonies in 1807.

To my mind, they had several vital factors going for them: they had a just cause and a unity of purpose, they ultimately created sufficient critical mass to give it propulsion, and they had a firm commitment to see it through. We can learn from them and we intend to.

Our board has decreed the big four as our policy, and on 17 October we held our initial launch by getting on board all the partners needed to make the project meaningful. NHS chief executive David Nicholson was there to give it his blessing and focus, and I am hopeful that business, public sector, councils and the like will genuinely help our cause.

We are busy recruiting extra firepower for the targeted wards, we are running pilot projects and fact-finding initiatives. By next spring, our public health directorate will have our worked-out strategy in place, ready to launch the project proper, complete with facts, info on targeted groups and a set timescale.

I believe success is not predicated on good intent, but requires leadership, organising capacities, and grass-roots experience. We will also consider embracing techniques such as social marketing and a range of down-to-earth methods of penetrating the hard-to-reach groupings in our deprived areas.

Can we really break the habits of a lifetime, of not one but several generations? We shall see. At least we are having a go.