DH admits target on health inequalities is hard to meet

The admission came as DH officials appeared in front of the Commons health select committee last week to give evidence on what they called "persistent and stubborn" inequalities.

In a report published in tandem with the hearing, the department said overall life expectancies were improving. But the poorest areas have dropped further behind the English average for female life expectancy and infant mortality since 2002.

The 2003 health inequalities target is to reduce inequalities in infant mortality and life expectancy at birth by 10 per cent by 2010, with 1995-7 taken as the baseline.

DH director general for health improvement Dr Fiona Adshead told the committee that some of the slow progress was due to the "drag" between work to tackle inequalities in the 70 poorest "spearhead" areas and its tangible results. But she said improvements could be made through greater use of simple and proven interventions, such as exercise and statin prescribing. "Some of it quite simply is that we are not doing things that we know we should be," she said.

The committee heard that as little as 10 per cent of the causes of health inequalities were under the direct influence of the NHS. Factors such as poor parental education, bad housing, the environment and unemployment could have much more influence than access to health services. Policies in these areas must be directed towards improving public health and reducing inequalities, MPs were told.

But officials admitted a central recommendation from the government-commissioned 1998 independent inquiry into health inequalities had not yet been implemented.

Sir Donald Acheson's inquiry had recommended that "all policies likely to have a direct or indirect effect on health should be evaluated in terms of their impact on health inequalities". Although the Cabinet Office recommends that health should form part of the regulatory impact assessment for new policies across government, it is not legally enforced. An official told HSJ that the situation was being revisited by the DH's health inequalities review, due to be completed later this spring.

Speaking to a Fabian Society seminar on health inequalities in London, the chair of the DH's scientific reference group on health inequalities Professor Sir Michael Marmot said that research had found that almost one third of the chance that someone would develop heart disease was down to social and economic factors such as housing and income.

"These are things that are in the province of government control. We can figure out what we need to do to make people live healthier lives and we can do something about it," he said.