Four goals for a healthier Britain that could save 15,000 lives

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Four targets for creating a healthier Britain were set out yesterday by the Government. But there are none to reduce the health gap between rich and poor, says Jeremy Laurance, Health Editor.

A total of 15,300 lives will be saved in 2010 if the national targets for reductions in deaths from heart disease, cancer and suicide set out by the Government yesterday are achieved.

The goals, published in a Green Paper, Our Healthier Nation, represent a 17 per cent cut in the 90,000 deaths a year that now occur among the under 65s, the target group. But this is more modest than expected, reflecting the difficulty ministers see in changing individual habits, social pressures and environmental influences. A fourth target is to cut accidents requiring a hospital visit from 10 million to 8 million a year.

The Green Paper sets out the Government's plans for replacing the Tories' Health of the Nation strategy, launched in 1992. That set 27 targets for improving health and although a majority have been or are about to be achieved, some will be badly missed including those on obesity, teenage pregnancy and teenage smoking.

Ministers say that by reducing the targets to four, efforts can be concentrated where they matter most. "If everything is to be a priority then nothing will be a priority," the document says.

There is no goal set for teenage pregnancies..

No national aim is set for reducing health inequalities and discussion of the problem is confined to three paragraphs. The Tories' Health of the Nation strategy, which was attacked for failing to make the link between poverty and ill-health, is criticised here for its "limited vision" and its "reluctance to acknowledge the social, economic and environmental causes of ill-health".

There is also no target set for reducing smoking, which is to be the subject of a separate White Paper in the spring.

The Green Paper acknowledges the influence of poverty, education, employment, transport and social services on health but insists that the Government cannot do everything. It rejects "individual victim blaming" and "nanny state social engineering" and says there is a third way - a national contract of better health. This involves a partnership between government, local communities and individuals with twin goals: to improve the health of the population as a whole and to improve the health of the worst off to narrow the health gap.

The task of tackling the health gap will fall to local health authorities which will be required to establish health improvement programmes focused on neighbourhoods or groups which suffer the worst health. However, ministers are waiting for the independent inquiry into health inequalities, chaired by Sir Donald Acheson, which is due to report in the spring, before deciding whether to include national targets.

The absence of targets for reducing health inequalities drew the strongest criticism from health organisations last night. Karen Caines, director of the Institute of Health Services Management, said: "[Ministers] have peered over the precipice and drawn back a step or two. On this most crucial issue they have bottled out. Without measurable targets, even over a long timescale there will be less pressure for change."

Responses to the Green Paper are invited up to 30 April.

health targets

l Heart disease/stroke - reduce the death-rate among people under 65 by one-third by 2010, saving 8,500 lives a year.

l Accidents - reduce accidents in the home, on the roads and at work by a fifth by 2010, averting 2 million accidents a year.

l Cancer - reduce the death-rate from all cancers among people under 65 by a fifth by 2010, saving 6,000 lives a year.

l Mental health - reduce the death-rate from suicide and undetermined injury by a sixth by 2010, saving 800 lives a year.