Helen Linklater, Sheffield

Plans to tackle the United Kingdom’s “four killers”—cancer, ischaemic heart disease, accidents, and mental illness—emerged in New Labour’s latest white paper, Saving Lives: Our Healthier Nation, published in July. Child health issues are absent from the list of major targets, however, suggesting waning momentum in the wake of Prime Minister Tony Blair’s pledge last March to eliminate child poverty within 20 years.

Mr Blair was reacting to the release of stark Treasury figures on child poverty: 40% of British children are born into poor households, defined in the EU as those with a total income below half that of average households. Standing at 4 million children in 1995, this represents triple the number 20 years ago. The findings, from a 6 month research study into the causes and scale of poverty in the United Kingdom, have a clear long term impact: a hopeless 25% of children never escape poverty. Among the risks facing children in lower socio-economic groups are higher infant mortality, decreased breastfeeding rates, greater prevalence of maternal smoking during pregnancy, and poorer overall nutrition.

The unique plight of children was highlighted last November with the publication of the independent inquiry into inequalities in health by a former Chief Medical Officer, Sir Donald Acheson. He recommended the targeting of resources to help those most in need, with a focus on children, expectant mothers, and women of childbearing age, in recognition of the fact that “poverty falls disproportionately on children.” Child healthcare issues arising from his report focused on provision of equal access to health facilities, health promotion programmes, and social support from health visitors to young families.

Chancellor Gordon Brown responded with specific moves in this year’s budget to help children: the flagship £540m SureStart programme, delivering integrated services for children aged under 4 years in the United Kingdom in areas of greatest need, and an increase in child benefit for eldest children by £2.50. These moves were welcomed by Dr David Elliman, consultant paediatrician and convener for the British Association for Child Health (BACH). However, he remained concerned about the health of older children: “School nurses, though not part of primary care will have a major part to play ... I would hope to see more involvement with [adolescents] who are not in school—a major component of the socially excluded at this age.”

Concerns remain that Treasury purse strings are still too tight. The BMA, in its June report Growing up in Britain: ensuring a healthy future for our children, put forward a “radical agenda,” warning against cuts in lone parent benefit and encouraging tax measures to tackle social exclusion. A spokesperson for Child Poverty Action Group (CPAG), a charity providing information to help people combat poverty, echoed this with a suggestion to reverse the planned cut of 1p to basic rate tax: “The £2.8bn [the government] would lose in revenue should instead be invested in tackling child poverty including health inequalities.”

Saving Lives: Our Healthier Nation aims to prevent up to 300 000 deaths by the year 2010, combining a cash injection of £21bn for public health measures, including patient health education programmes and a new generation of community based public health agencies. “Tougher but attainable targets” include the slashing of mortality from ischaemic heart disease, by almost half, to 40%; cancer deaths in people aged under 75 years and deaths from mental illness by 20%, and accident fatalities by 10%. There is an additional focus on a constellation of lifestyle problems, ranging from sexually transmitted disease and teenage pregnancy, alcohol and drug misuse, to more mundane issues of food safety and water fluoridation. Progress on these targets will be reviewed after the next general election, in 2002.