Letter: NHS managers do not deserve to be reviled

Sir: Hamish McRae does the medical profession a disservice when he says that our only response to the debate about inequalities of health is to call for more money to be put into the NHS ('Personally healthy and socially secure', 14 July). In fact, he goes on to undermine his own assertion by detailing all the measures that are being taken by, among others, the medical profession with little or no extra money attached.

He quite rightly points to anti- smoking campaigns as an important contribution to reducing heart disease, but he fails to identify that those campaigns will become increasingly more difficult because we are now reaching the hardened smokers - many of whom fit perfectly into the description 'poor' when we are talking about inequalities of health. The reality for all concerned with the health of the nation - when considering the gap between the rich and the poor - is that more resources will help, but so will a clear recognition by everyone, including the Government, that poverty and ill-health are linked.

A small chink of light emerged earlier this year when the Deputy Chief Medical Officer revealed at a BMA conference that the Department of Health is re-examining those links.

What is necessary is a cross- governmental approach that leads society into debates on health that involve more than one secretary of state. Employment, housing, transport, environment and, of course, the Treasury all have a role to play in aiming for the kind of 'oneness' that Hamish McRae talks about. What he really means is that society must take equal responsibility for its own health. That means recognising the need and giving it the highest priority.

Yours faithfully,

ANDREW VALLANCE-OWEN

Head of Policy Research

British Medical Association

London, WC1