It is “simply too early” to say if steps being being taken through the UK government’s National Programme for Action to reduce health inequalities and infant mortality and to improve life expectancy in England have yet had any effect, according to Professor Sir Michael Marmot, chairman of the Scientific Reference Group on Health Inequalities.

The target set by the Programme, which commenced in 2003, is to reduce inequalities in health outcomes by 10%, as measured by infant mortality and life expectancy at birth, by 2010. There is, as yet, no evidence that such inequalities are being reduced, although there are improvements in the overall health of the nation, says Sir Michael, writing in the Programme’s third and final status report, which has just been published by the Department of Health.

These have shown “a very welcome improvement in life expectancy for all social groups, including disadvantaged groups,” plus “encouraging signs of a reduction in health inequalities in the two big killers of cancer and heart disease,” he writes.

The status report also shows that the gap in infant mortality is narrowing and that life expectancy in the most deprived areas has increased by two and a half years for men and one and a half years for women over the last ten years. However, the gap between the life expectancy of women in the most deprived areas is still widening, compared to the rest of the country.

The Programme’s policies for narrowing the health gap include:

- tackling the “big killers” of cancer and cardiovascular disease: the status report says there have been improvements in death rates from these diseases, including among people living in the most disadvantaged areas. However, there has also been a widening in inequalities, in relative terms, for circulatory diseases, although no significant change in relative terms has been found for cancer;

- improving primary care services: there have been improvements in the number of GPs per 100,000 population in England since September 2002, including in the most deprived areas. However, there has not been any significant narrowing of inequalities and, indeed, there are signs that these have widened since September 2006. The number of deprived Primary Care Trusts which are more than 10% below the average number of full-time GPs per 100,000 population in England has gone up since September 2002;

- flu vaccinations: the percentage uptake of flu vaccinations by older people increased during 2002-5, including in the most disadvantaged areas, and there was a slight narrowing of inequalities, which continued into 2006; and

- smoking: since 1998, smoking prevalence among all adults has fallen, but there has been no significan change in inequalities for manual workers compared to other groups or all adults, and there are some signs of inequalities widening in relative terms. Between 2000 and 2005, the overall prevalence of smoking throughout pregnancy decreased slightly.

The Programme contains other healthy living initiatives aimed at increasing families’ consumption of fruit and vegetables, and it also includes social policies designed to reduce the numbers of poor children, teenage pregnancies, homeless families and road accident casualties and to improve housing, educational attainment, physical education and school sport.

Good progress
The report concludes that there has been good progress in four areas – reducing child poverty and narrowing inequalities in housing quality, educational attainments and uptake of flu vaccinations. There has also been a narrowing of inequalities in absolute (but not relative) terms in circulatory disease and cancer mortality, child road accident casualties and teenage conceptions. Other areas, like smoking, show a general reduction in prevalence but no narrowing of the gap between social groups.

The study also emphasizes that health inequalities are “persistent, stubborn and difficult to change,” pointing out that the time lag between interventions and the achievement of results means that it is difficult to assess the short-term contribution of individual programmes towards the target. These are likely to be most visible towards the end of the decade, it adds.

Commenting on the report’s findings, Public Health Minister Dawn Primarolo said the government will be publishing a long-term strategy to continue to tackle UK health inequalities later in the year. “We’ve set ourselves an ambitious target and we’re the only country in the world to have a plan to reduce health inequalities. We are determined to make a difference,” she added.