Ministers have been shocked by evidence showing that although the overall health of the nation is improving, the gap in death rates between rich and poor has widened. They have asked Sir Donald Acheson, former government chief medical officer, to produce an updated version of the Black report, setting out the scientific case on which policies to tackle health inequalities might be based.
The original Black report, commissioned by the last Labour government from consultant physician Sir Douglas Black and published in 1980, controversially linked deprivation with ill health and made a series of costly recommendations for alleviating poverty, improving housing and targeting NHS resources at the most needy.
In spite of efforts by the Conservative government to bury it, it has continued to provoke fierce debate since it was published.
On Monday Sir Donald met Frank Dobson, the health secretary, Tessa Jowell, the minister for public health, and Sir Kenneth Calman, chief medical officer, to discuss terms of the review, expected by Christmas. Final details are still to be worked out and an announcement is not expected until next month.
Revival of the Black report is an ambitious venture fraught with political risk. Tackling health inequalities will require the co-operation of all government departments and could incur high costs. Ministers are anxious to limit the review to proposals that have a realistic chance of being implemented. The original Black report's recommendations were costed at pounds 2bn at 1979 prices, equivalent to pounds 5.4bn today.
Ministers have accepted that there is limited scope for change in the NHS and that abolishing the internal market will take years rather than months. The arena of public health is seen as the most fertile ground for innovation of the kind that the public has come to expect of the new Government.
Tessa Jowell said yesterday: "Tackling inequalities is what the health department should be about. We have asked Sir Donald to give us a very clear steer on the basis of the scientific evidence about where we can take effective action to improve people's health. We will then decide what measures to take."
She said the initiative was "not about empty rhetoric or developing wish lists" and would form a central part of the Government's strategy on public health which will be formally launched at a health department conference on 7 July. "We are not going to raise expectations that we cannot fulfil. We would rather under-promise than over-deliver."
The reason public health had been marginalised in the past was because the agenda seemed so vast and the inequalities so pervasive that the prospect of doing anything overwhelmed the government. "We want to identify key measures across government departments that we can act on," she said.
The original Black report highlighted the fact that the death rate in infancy was twice as high among social class V as social class I and that similar differences persisted through life. In 1994, research published in the British Medical Journal showed that death rates in the poorest parts of northern England were rising for men aged 15 to 44 for the first time since the 1930s.
Experts welcomed the review of the Black report but warned that action to remedy the problem was needed, not a new diagnosis of the causes.
Ken Judge, director of the Kings Fund Health Policy Institute, said: "What we don't want is another description of the problem. We need a careful analysis of the causes and an evaluation of policy options. My worry is that Sir Donald may pay more attention to the causes than the options."
Julian Le Grand, professor of health policy at the London School of Economics, said: "The real question is how much muscle the initiative will have behind it. Without a budget, it looks as if Tessa Jowell as the new minister of public health will have to rely on persuasion.
"However, after 18 years in which the focus has been on organisational issues in the NHS, the switch to a focus on health rather than health care would be welcome."
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