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*Tackling Health Inequalities* Update March 2002 This update is available in . For convenience the text is reproduced below. [Original report: Tackling Health Inequalities: a consultation document ]

Tackling Health Inequalities: a consultation document - update March 2002

Targets and Indicators

The reformulation of the two national targets is underway. This will take account of the changes to NHS structures and the revised system of social classification. Discussions are also underway on the basket of indicators.
Both of these developments are expected to feature in the strategy document later in the year.
Latest from ONS

New data are available on life expectancy and infant mortality up to the year 2000, just before the national targets were set.

Infant Mortality

	the overall infant mortality rate for England and Wales fell to 5.6 deaths per 1,000 live births in 2000, from 5.8 in 1999
	the gap between infant mortality rate among manual social classes and the general population showed little change – a slight widening, by 0.5 per cent – between 1997-99 and 1998-00 (published by ONS 08 November)

Life Expectancy

	the overall life expectancy for England in 1998-2000 is 80.2 years for women and 75.4 years for men
	the gap between the lowest fifth of areas and the national average did not change but
	the gap between ‘best’ (Kensington, Chelsea and Westminster) and ‘worst’ (Manchester) widened to 7.7 years for men and 6.6 years for women (published by ONS 28 February)

Next Steps

The Tackling Health Inequalities consultation exercise ended on 9 November with almost 600 written responses received. An earlier series of regional Consultation conferences and related events had attracted around 1,000 participants. A full report will be available in the spring.

The consultation strongly endorsed the six themes of the consultation document (see below).

Examples of good practice at local level were also identified. The responses emphasised that the Government’s recognition of the importance of health inequalities was welcome, but long overdue.

Respondents urged the strategy to look beyond the NHS to the influence of the wider determinants of health. The Treasury-led cross cutting spending review (CCSR) is seen as a crucial factor in widening action on health inequalities.

The responses made it clear that serious challenges face the development of the strategy. Not least, the ability to translate this new priority for health inequalities into a sustained commitment across Government, both nationally and locally, and with proper funding.

A Two Stage Approach

The health inequalities strategy will be developed in two stages. This will enable the strategy to take account of:

• the points raised in the consultation, and

• the conclusions of the CCSR

It will also help keep health inequalities in the public eye over the year ahead.

The first stage will be a report on the responses to the consultation to be published in the spring. This report will set out the overall approach for delivering the health inequalities strategy.

The second stage will be the publication of the health inequalities strategy later in the year. This will be after the Spending Review announcement – which will include the main CCSR findings - due in the summer.

The consultation and the CCSR are complementary, and will both feed into this strategy. The strategy will look both at the role of the NHS, and at the wider determinants. Another key issue will be the building of links between these aspects, and encouraging more effective crossboundary working both nationally and locally.

The Document
The aim of the Tackling Health Inequalities consultation document was to invite views on the delivery of the new national health inequalities targets on infant mortality and life expectancy.

Much is already being done across different sectors but it identified six emerging priorities:

THE SIX PRIORITIES

Providing a sure foundation through a healthy pregnancy and early childhood
Improving opportunity for children and young people
Improving primary care services
Tackling the major killers: CHD and cancer
Strengthening disadvantaged communities
Tackling the wider determinants of health inequalities

The Conferences

Ten regional consultation workshops were held across the country - from Durham to Dawlish - to support the consultation and elicit examples of good practice.

The 1,000 participants were drawn from the NHS, local government and other statutory and voluntary agencies.

Each event combined contributions from NHS Regional Offices and the Regional Government Offices to reflect the cross-Government approach needed to tackle the targets.

Several events adopted a joint format with regional social exclusion teams and health inequalities teams, to lay the basis for future collaboration.

Emerging Issues

These included:

	promoting a long-term vision (on a joined up basis) for working to reduce health inequalities, which will inform resource allocation and funding priorities
	empowering communities in disadvantaged areas, and developing partnerships between communities, service providers and health practitioners
	reflecting the needs of black and minority ethnic and other groups in the strategy, such as older people and those in rural areas, as well as groups such as travellers, asylum seekers and prisoners
	getting appropriate Primary Care Trust (PCT) arrangements in place for dealing with inequalities and public health. There is an opportunity to shape the way PCTs address these issues and to get inequalities embedded in PCT thinking. PCTs are also crucial to the building of effective local partnerships with others, particularly local Government
	improving access to primary care and other services (including mental health) in disadvantaged communities through PCT (and national) leadership
	promoting Local Strategic Partnerships as a model for partnership and cross-sectoral working on inequalities. It is vital that the NHS plays its full part in these and other partnerships

These themes also featured in the many written responses. The conclusions of the conferences and the written responses will provide the focus of the spring document.

Building A Strategy

This document will pave the way for the strategy later in the year.

The strategy will also take account of the conclusions of the CCSR, the continuing work within Government, the NHS and across Departmental boundaries. This includes the recently published Local Government White Paper and the DfES Green Paper Extending Opportunities and Raising Standards.

In the NHS, the Shifting the Balance changes are being introduced from 1 April with a high priority being given to the inequalities and public health, notably by the appointment of Board level Directors of Public Health for each PCT.

The possibilities of working across different boundaries will be highlighted by the results of the CCSR. They will be exploited in practical terms by the co-location of regional directors of health teams in Government offices around the regions from April.

KEEP UPDATED and watch this space...

For the latest information check the DH health inequalities website: www.doh.gov.uk/healthinequalities

Additional copies of this newsletter can be obtained from the Health Inequalities Unit, 502A
Skipton House, 80 London Rd,
London SE1 6LH.

March 2002