Experts' 10 steps to health equality

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THE 10 best ways of closing the health gap between the rich and the poor, highlighted as a priority by ministers, have been drawn up by an expert committee.

The list includes providing nicotine gum and patches free on the National Health Service to help smokers give up, fluoridation of drinking water to prevent tooth decay, and adding the mineral folate to flour to prevent birth defects and, possibly, heart and Alzheimer's disease.

The findings, based on the best available evidence of policies proved to work, have been presented to the government inquiry into health inequalities chaired by Sir Donald Acheson, whose report is due to be published at the end of the month.

Sir Donald, a former chief medical officer, was appointed last year by Frank Dobson, the Secretary of State for Health, to examine what could be done to close the health gap, which widened during the 17 years of Tory rule.

Figures show that over the past 20 years death rates have fallen 40 per cent among social classes one and two, but only 10 per cent in class five. The difference in illness rates between the classes has also widened.

The expert group that drew up the list included the editors of Britain's two leading medical journals, The Lancet and the British Medical Journal, who assessed a range of studies on health inequalities and ranked the measures they recommended according to their chances of success.

Their findings were revealed in a speech by Richard Smith, editor of the BMJ, in Manchester last night. Giving the annual Edwin Chadwick lecture, marking the 150th anniversary of the Public Health Act introduced by the 19th-century social reformer, Dr Smith said many of the papers produced by experts on health inequalities were "opinionated" and "biased" and few of their recommendations were based on hard evidence.

The committee assessed a range of options covering 16 areas, including mother and child health, housing, nutrition, education and mental health.

Using a complex formula to assess the strength of the evidence, the scale of the likely benefit, the fit with government policy and the ease and cost of implementation, they derived a list of the 10 interventions most likely to help the poor more than the rich (and thus close the health gap between them) and unlikely to do harm.

Dr Smith said the group's recommendations could be criticised for concentrating on relatively small, medical interventions - rather than macro changes, such as adjustments to the tax and benefits system - but that was where the evidence was strongest. "We were assessing the quality of the evidence produced. Our recommendations are quite medical because those are the sort that tend to have evidence behind them."

But he rejected charges that nothing on the list was new. "Newness is not an advantage here. It is better to have some evidence that an intervention works before you launch into it in a big way. You don't want to launch into something because it's new," he said.

Health Gap Remedies

1 Nicotine gum and patches free on the NHS. They double the chances of stopping smoking.

2 Pre-school education and child care. Strong evidence that it improves long-term prospects for children.

3 Fluoridation of drinking water. Cuts tooth decay.

4 Accident prevention - eg, fit cars with soft bumpers. Accidents are the principal cause of deaths among young people.

5 Drugs education in schools. Prevents pupils becoming hooked.

6 Support around childbirth to promote breastfeeding and mental health. Good evidence of long-term benefits.

7 Improved access to NHS for ethnic minorities - eg, by appointing link workers.

8 Adding folate to flour. Prevents spina bifida in babies; early evidence suggests it may prevent heart disease and Alzheimer's.

9 Free school milk.

10 Free smoke alarms. Good evidence they save lives.