Infant mortality rates are falling more slowly in poorer areas than in less deprived ones, according to a Department of Health report.

The DoH report names 43 areas, many in deprived regions, which had at least 20 infant deaths affecting families in routine and manual occupations over a three-year period.

The review of the target to reduce health inequalities by 10 per cent by 2010 as measured by infant mortality and life expectancy at birth found that infant mortality has reduced since 1997. But the rate of decline is slower for those in less advantaged social groups. The gap between the 'routine and manual' group and the population as a whole has widened to 19 per cent from the 1997-99 baseline of 13 per cent.

However, Association of Directors of Public Health president Tim Crayford blamed demographic changes, rather than health policies, for the problem.

He said: 'Rates are at historically low levels and they are still continuing to reduce. The issue is that they're declining a little less quickly in the routine and manual group, so the gap has widened a little. As society generally becomes more affluent, so the number of people in the lower social classes falls.'

He added: 'A widening differential may be an expected consequence of this.'

The review also criticised what it called a 'lack of leadership on health inequalities'. It found that the infant mortality target was often not known or understood by chief executives, senior staff and professionals interviewed. In addition, there was 'a lack of performance management indicators' and 'no accountability' for the target in many areas.

Sandwell priamry care trust public health director Dr John Middleton argued that local NHS managers need greater support from central government to reduce inequalities.

He said: 'The government has told us to be committed to this and then funding has been withdrawn to be put back into high spending hospitals in wealthy areas.'

Public health minister Caroline Flint said: 'We are reminding people that infant mortality is there so that they put resources in to tackle it.'