Five areas targeted to cut death and disease: The White Paper on health defines government aims and strategies up to 2010. Celia Hall reports

THE GOVERMENT'S first health strategy for England aims to reduce death and disease in five 'key areas' over the next 2 to 18 years by a process of health education, task forces, new local alliances, monitoring and research.

A Cabinet committee representing 11 government departments will oversee progress.

An unexpected proposal is a survey of the nation's mental health.

Targets have been set for each of the key areas, which are: heart disease and strokes; cancers; mental illness; Aids, HIV and sexual health; and accidents. In addition, the White Paper, The Health of the Nation, sets targets for a second line of attack. These are 'risk factor' targets.

They are aimed at changing behaviour in smoking, diet and nutrition, HIV and Aids and, in addition, lowering blood pressure in adults.

Heart disease causes 26 per cent of deaths in England, making it both the biggest single cause of death and the biggest single cause of premature death. The White Paper aims for a reduction in the death rate from coronary heart disease and stroke of 'at least' 40 per cent by 2000.

This is tougher than the target proposed in the Green Paper last year, which was 30 per cent. However, deaths from both causes have anyway been falling and the lower percentage reduction is likely to have occurred without extra efforts.

A 40 per cent reduction would bring deaths from heart disease down from 58 per 100,000 people in 1990 to 35 per 100,000 in 2000, and deaths from strokes down from 12.5 per 100,000 to no more than 7.5.

The White Paper proposes a new research liaison committee to pursue the most cost-effective ways of tackling both diseases.

To achieve the target it proposes to reduce smoking among adults from 35 per cent of men and 29 per cent of women to 31 per cent and 28 per cent respectively. This would produce by 2000 a population in which no more than 20 per cent of adults smoked.

It aims to reduce smoking in 11- to 15-year-olds by 33 per cent by 1994 and to reduce by a third the number of pregnant women who smoke.

But the Government has resolutely set its face against banning tobacco advertising and sponsorship. Some experts say that maintenance of a high price and an effective ban would reduce smoking by 10 per cent.

Instead, the Government will stick to its voluntary agreement with the tobacco industry. The White Paper undertakes, however, to keep tobacco prices up by maintaining the real level of taxes on tobacco products.

The Government accepts that smoking is an addiction and promises a new strategy to help people stop and to stop children starting, headed by an new inter-departmental task force.

It promotes smoke-free public and work places and transport, will legislate 'if necessary' to protect non-smokers and announces that the Department of Transport plans to amend legislation so that taxi-drivers can ban smoking in cabs. Currently they can only request passengers not to smoke.

On diet and nutrition, the White Paper again does not require food or farming industries to act but promises to liaise with industry, with the intention of reducing saturated fats, salt and sugar 'as far as practicable'.

The nutrition targets are to reduce from 40 per cent to 35 per cent the total amount of food energy derived from all fat in the diet by 2000; similarly it seeks a lowering of energy derived from saturated fat, found in animals, from 17 per cent to 11 per cent by 2000.

At the same time it sets obesity targets looking, in the same time span, for a reduction by 25 per cent and 33 per cent of the numbers of men and women respectively who are overweight. This is one of the toughest targets, as people are getting heavier.

The White Paper does not set targets for blood cholesterol levels but promises guidance in an awaited report.

A reduction in the numbers drinking above recommended limits is also sought - by 10 per cent in men and 5 per cent in women.

The White Paper says that health will be a key factor when the Chancellor decides the levels of alcohol taxes. Family health services will be asked to do more to identify and treat problem drinkers.

The target reduction for breast cancer for women being screened in the mammography programme is 25 per cent by 2000, a reduction of 95.1 per 100,000 to 71.3 per 100,000 women. For cervical cancer the target is to reduce incidence of the disease from 15 per 100,000 to 12 per 100,000 by 2000, and for skin cancer, a complete halt to the year-on-year increase.

The White Paper sets no direct target for Aids and HIV infection but wants to halve the number of intravenous drug users who share needles - from 20 per cent to 10 per cent by 1997 and to 5 per cent by 2000.

It wants to reduce pregnancies in girls aged 13 to 15 from 9.5 per 1,000 to no more than 4.8, and to reduce the incidence of gonorrhoea by 20 per cent.

The most difficult targets will be those for mental health. The paper sets out plans for a huge survey of mental health and seeks a reduction in the suicide rate by at least 15 per cent by 2000.