Ministers are ready to concede defeat in their efforts to set national targets for the reduction of health inequalities.

Our Healthier Nation, the public health green paper due to be launched next week, will concentrate instead on just four national targets - covering heart disease and stroke, accidents, cancer and poor mental health.

A draft of the document, seen by the Journal, represents a major overhaul of the previous government's Health of the Nation strategy, and will be welcomed by public health campaigners for its focus on tackling the causes of ill health.

In line with earlier promises, it reduces the number of national priority areas, and sets out what will prove to be testing targets in a new 'contract for health with the people of England'.

But the admission that it has not been possible to set targets on health inequalities will be a blow for campaigners, and for ministers, who have made the issue a central theme of their pronouncements since the election.

In their foreword to the document, health secretary Frank Dobson and public health minister Tessa Jowell lay the blame firmly on the Tories for widening inequalities over the past 20 years and for 'the slow progress of recent years'.

But the green paper argues: 'While inequalities can worsen in a matter of years, improvement may in many cases take much more time and could take decades to show through.'

It adds: 'A sense of realism on the difficulties we face in addressing health inequalities is vital, because false optimism and unreasonable expectations in the short term will only demotivate in the long term.'

And it concludes: 'The government does not propose at this stage to set national targets to narrow health inequalities between social classes, different parts of the country, ethnic groups and men and women.

'Because the causation is complex and many factors inter-react, it is not possible to set realistic quantified targets for greater health equality at this stage. And national targets for reducing inequalities in health could easily mask severe local inequalities, giving a false impression of improvement.'

However, the green paper - foreshadowing a white paper later this year - holds out the prospect of quantified targets once the inquiry into health inequalities led by former chief medical officer Sir Donald Acheson reports.

In the meantime, the green paper says groups and areas suffering most from ill health 'must be a key focus of local and national activity', and that every health improvement programme should set out how progress is to be achieved

But the document warns against making progress against targets 'simply by targeting social or ethnic groups whose health problems are more easily tackled'.

See News Focus, page 12; Comment, page 19.

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