Social policy 'must focus on inequalities'

Speaking at the Royal College of Physicians last week, former chief medical officer Sir Donald Acheson argued that policies designed to improve health 'on average' might not affect inequalities - and could increase them.

Anti-smoking campaigns were an example of this, he said.

'The biggest reductions in prevalence have been in the better off, while in the least well off there has been comparatively little benefit,' he said. The same trend could be seen in breastfeeding campaigns and immunisation and screening programmes.

The inquiry report, which 'has just gone to the printers', will call for a radical rethink of government decision making, Sir Donald said.

'It will be necessary for inequalities to be identified and then narrowed down... for all social policies likely to have an impact on health... including education, employment and income.'

Sir Donald said the report would include policy recommendations ranging from the 'key but complex area of public and private transport' to 'a stringent set of proposals directed at further reductions in smoking among the less well off'.

He added that the inquiry was concerned about disadvantaged mothers' nutrition: 'The tendency to out-of-town supermarkets has led to 'food deserts'. Hunger is prevalent in some groups in Britain today, particularly single mothers.'

The inquiry also found:

evidence that in both general practice and hospitals more still needs to be done to ensure equitable service;

evidence of an 'inverse prevention law' in primary care; those communities most at risk of ill health experience the poorest access to preventive services;

that in international terms the NHS offers an exemplary degree of equity.

'We hope our recommendations will ensure this reputation is not taken for granted and provide a basis for further improvement,' said Sir Donald.

Health secretary Frank Dobson appointed Sir Donald to lead the inquiry into health inequalities - the sixth in 20 years - shortly after the general election.