Rising chance of early death for the poorest

Death rates among the poorest appear to be rising for the first time in at least 50 years, the country's leading health research institute said yesterday as it called for urgent action to tackle widening health inequalities.

The report by the King's Fund Institute led by Sir Donald Acheson, the Government's former Chief Medical Officer, calls on ministers to launch an Aids-style assault on the issue.

In his first domestic intervention since retiring from the post in 1991, Sir Donald said a standing Royal Commission, modelled on the lines of the Royal Commission on Environment Pollution, should be created to provide standing advice on how to reduce health inequalities.

Speaking at the launch of an Institute report recommending specific policies, Sir Donald said that mortality between the social classes had been widening since at least the 1920s but against the background of a general overall fall in death rates.

Following two recent studies in the North of England and Scotland, however, "it looks as if something new happened in the 1980s among the very poor - mortality stopped going down and began to go up".

That finding, said Ken Judge, the King's Fund director, was "a striking and alarming new feature". Although further research was needed to confirm the trend, the dramatic widening in inequality in Britain in the 1980s made it likely that the two were linked. "Social divisions have accelerated at a rate not matched for such a sustained period by any other rich industrialised country," the report said.

The institute said more help was needed for the poorest through both tax and benefits - notably by boosting the rates paid for children in families on means-tested income support and family credit. Grants should replace social fund loans, and the threat of disconnection for heating, light and water should be lifted.

Tobacco advertising should be banned and tobacco taxes raised, linked to the anti-poverty strategy.

Improvements to the worst housing and new low-rent housing were urgently needed, along with a new benefit to help low-income families with mortgages. That package could be paid for by phasing out the remainder of mortgage interest tax relief while transferring public housing to local housing companies which could raise private capital.

Improvements to benefits would be funded by increasing national insurance contributions for those earning above £22,800, restricting all the main tax allowances to 20 per cent, raising higher rate tax and reversing the shift from direct to indirect taxes.

9 Tackling Health Inequalities; An Agenda for Action. King's Fund; £14.95