Doctors warn of a return of past plagues

Public-health system slipping back into 19th century, BMA says

Britain is returning to the nineteenth century in terms of public health, with problems such as dirty water, contaminated food and old infectious diseases re-emerging, the British Medical Association said yesterday.

Sandy Macara, the association's chairman, said: "We have slipped backwards. The public- health legislation of the nineteenth century put Britain ahead of other countries by addressing the issues of contaminated water and food.

"Yet we still have all these problems today in an affluent society. These lessons were acted on by governments long before there was universal suffrage. But now we have become careless.

"We assume that these problems will not happen and if we get ill we can just pop along to our friendly GP, who will give us some antibiotics," he added.

Dr Macara was outlining the BMA's manifesto for the general election.

Although it suited both main political parties to keep health out of the news, health care was the number-one election issue for most of the public, he said.

"The politicians would love health issues to go to sleep, because they have not got a coherent strategy for tackling them."

The association wants to see both parties promote health rather than "tinker with the NHS".

It issued six challenges to all political parties, demanding new targets for helping the disadvantaged, reducing the hazards of tobacco, dealing with the problems of young people and developing environmental, housing and transport policies.

Any incoming government would have to tackle the question of poverty and inequalities in health, he said.

"What concerns us is that the gap between rich and poor is demonstrably growing," he added.

Mac Armstrong, the association's secretary, said: "It is 20 years ago this year that Sir Douglas Black set up his committee to look at inequalities of health. It demonstrated unequivocally that there was a link between poverty and ill-health, and that such a link was not just a piece of dogma. Since that time, the evidence has been gathering.

"The evidence that Professor Michael Marmott has been gathering at University College London shows that even in the Civil Service, the gap has widened between rich and poor. By not tackling the preventable causes of ill- health, we are wasting resources.

"Look at the resources which went into tackling the E. coli outbreak in Scotland, which was entirely preventable. We forget, at our peril, that we are living in a hostile environment. This is a dynamic situation. There is no such thing as a conquered bug. You only have to look at the spread of MRSA [multi-resistant staphylococcus aureus] and drug-resistant strains of tuberculosis to realise that. Doctors are fire-fighting all over the place, and that is a waste of resources," Dr Armstrong added.

The King's Fund, Britain's leading independent think-tank, outlining its election strategy, yesterday, listed the four most important issues in health care as: inequalities in health and access to health care; the future of the NHS; the lack of a democratic voice in the health service, and community care.

Ken Judge, director of the King's Fund Policy Institute, said: "There is a fundamental difference between the Conservative and Labour parties in their approach to inequality. In 1980, the Government did the most in its power to suppress the Black Report on inequalities in health. Most of the Labour Party documents emphasise the importance of inequalities.

"The Government has belatedly acknowledged that social variations in health exist and taken some initiatives to tackle them. But we regret the fact that they have not taken a broad social and economic approach to health inequalities."

Robert Maxwell, secretary of the King's Fund, said any incoming government would need to consider the rationing of health care.

"It is not good enough to have people struggling at the local level as to what is within the NHS and what is not. The question of whether such services as in-vitro fertilisation are provided on the NHS or not, are national, not local issues."