books

Published: 06/02/2003, Volume II3, No. 5841 Page 34 35

Poor Health Social inequality before and after the Black report Edited by Virginia Berridge and Stuart Blume Publisher: Frank Cass. ISBN: 071465339X. 250 pages.£45 (hardback: softback to be published at£17.50). Available from: 020-8920 2100.

Day to day, history is a mess. It is only when people look back that it can be divided neatly into eras and epochs. In public policy, 1979 has come to feel like one of the great dividing lines.

Indeed, we could almost devise a new dating system - BT and AT, perhaps; before Thatcher and after.

Nothing symbolises this division like the Black report, the outcome of a committee on inequalities in health that was set up in 1977 and reported in 1980.

Some of the report's fame comes from the way in which it was - or wasn't - published. As the press release for Poor Health puts it: 'The Black report... has attained almost iconic status as the textbook example of a government cover-up.'

In the received version of the story, just 260 cyclostyled copies were slipped out shortly before the August bank holiday, with a withering introduction from then-health secretary Patrick Jenkin.

However, journalists persuaded Sir Douglas Black, who chaired the inquiry, to hold a press conference at the Royal College of Physicians, of which he was president, and ran a series of campaigning stories that pushed the government onto the defensive.

Poor Health doesn't set out to shatter this myth, but the articles and eyewitness material assembled in it debunk and complicate the rest.

Charles Webster, the NHS's official historian, is one of the debunkers.His 20-page chapter on research into health inequalities in the 20th century firmly puts down the notion that Black's committee was the first to investigate the problem.

Indeed, he shows it came at the end of almost two decades of growing unease about the unequal distribution of NHS resources and the growing realisation that the machinery of the welfare state was failing to have its expected impact on inequality.

Meanwhile, the report of a 'witness seminar, at the London School of Hygiene and Tropical Medicine in 1999, shows that the four committee members had difficulty agreeing on the data before them and how to resource their recommendations.

More interestingly, the witness seminar shows that they were under pressure from civil servants to produce something quickly, before the political world changed.

Dr Elizabeth Shore, deputy medical officer at the time of the report, told the seminar: 'I was metaphorically jumping up and down on the sidelines, saying, 'Can't we have some quick and dirty general recommendations to get going on?'' Mr Jenkin also attempts to 'dispel some myths' about the report's reception and publication. For example, he says the report was sent to 100 newspapers, specialist journals and broadcast media - most of which initially ignored it.

The former health secretary's defence does not convince, because his government was plainly hostile to the Black report's recommendations and because he must know how the British press works.

Few national newspaper journalists read reports - most work from press conferences and briefings. The currency of journalism is launches, splits and rows; with no launch, the Black report was perfect material for a row.

Yet Sir Douglas's assertion that the report has lasted because of that row is also doubtful.

The Black report undoubtedly triggered research interest in health inequalities and is, indeed, much quoted. But its remedies - a war on poverty, punitive taxation to fund benefit increases, massive state welfare and food programmes - are not on the agenda.

The history of poverty reduction and public health in this country might have been very different if the committee had dealt in the 'art of the possible.' Instead, the focus of public health policy has shifted to the individual and the areas in which poor individuals are now concentrated.

Poor Health is fascinating. But it will not change the received view of the Black report. It is too useful as popular history and as an embodiment of the idea that Labour cares and the Tories do not - even if time is starting to tell us that life is not that simple.