The government will spend an additional £34 million to help local communities tackle health inequalities in 2008-9, and National Health Service spending in England will increase from just over £90 billion in 2007-08 to almost £110 billion in 2010-11 in order to meet the “challenging” Public Service Agreement (PSA) target for Health Inequalities, which is, by 2010, to reduce inequalities in health outcomes by 10%, as measured by infant mortality and life expectancy at birth.

“Health in the most disadvantaged parts of the country is improving rapidly, but the relative gap is growing and we will do more to reduce it. Inequalities in health go down to the root of where people are born and live, and it’s time we set that right,” said Health Secretary Alan Johnson, announcing the new initiatives in a speech to the Institute for Public Policy Research on June 9.

The Health Secretary also launched the government’s Progress and Next Steps report, which examines achievements in reducing health inequalities since the NHS was established 60 years ago. The report states that, today, the nation has never been healthier and that nationally, life expectancy has improved year-on-year over the past decade.

However, it adds, the health of the most disadvantaged has not improved as quickly as that of the better-off, with health inequalities persisting and, in some cases, widening. Health inequalities are a reflection of wider issues, which are in turn linked to unequal opportunities and, to get to the root of the problem, the government will focus in future on: investing in early years and parenting; using work to improve health and well-being, promoting equality; developing mental health services further; and co-coordinating action both nationally and locally.

Mr Johnson emphasises that helping people make healthier choices in many different aspects of their lives does not detract from personal responsibility or impose a nanny state. “I believe there is a middle way, where we acknowledge that some people live in circumstances that make it much harder for them to choose healthy lifestyles. We can’t ignore the facts – people living in deprived areas are more likely to smoke, to eat less nutritional meals, take less physical exercise and be more susceptible to drugs and alcohol abuse. We want to ensure better health for everyone irrespective of social class. But the most disadvantaged are the least assertive and are experiencing the worst health outcomes. They require more help,” he said.

The extra £34 million for programmes in 2008-9 will include: - £19 million to support local communities in disadvantaged areas working to improve life expectancy and reduce infant mortality quickly in support of the national PSA target; and - £15 million focussed on people with the greatest needs, including children, those living and working in disadvantaged communities and people living with mental health issues. This will also include additional money to provide support for healthier lives.

Further initiatives will include: - a revised Health Inequalities National Intervention Tool to help all areas identify local health inequalities and ways to tackle them with specific actions; - establishment of a new National Support Team for Alcohol, with further support for areas which have the biggest problems with alcohol-related hospital admissions; and - the development, with the Department for Children, Schools and Families, of a Child Health Strategy, to be published later this year, which will provide a long-term vision for improving health services and outcomes for children and young people.

Also later this year, the government will publish its response to Professor Dame Carol Black’s report Working for a Healthier Tomorrow and develop her recommendation to create a new Fit for Work service. This will be piloted in less well-off areas, where there is the most significant potential to prevent worklessness arising from ill-health.

- The House of Commons Health Select Committee's current enquiry into health inequalities has been told by witnesses that health promotion and disease prevention initiatives are not the same as tackling health inequalities, and that in fact many such initiatives worsen inequalities, because the socially-advantaged and better-educated are the first people to take advantage of them.

“There may well be a trade-off between raising the average health of the population and widening health inequalities,” Professor Julian Le Grand, chairman of Health England, told the panel last month, adding that it is “a mistake” to focus on health inequalities. Rather, the focus should be “targeting the absolute health of the poor, trying to drive on programmes that will improve the health of the poor,” and not worrying if, as a result of those programmes, the health of the rich gets even better. “We ought not to worry too much if we do get a widening of health inequalities, but we need to be sure that we are raising the level at the bottom,” Prof Le Grand told the Committee.