Ethical Inequalities

Pasteurization, declared Dr Edith Summerskill in 1949 as she introduced one of the great public health reforms, had been blocked by ignorance, prejudice and selfishness. The ignorance was that of consumers; the prejudice was against the exercise of state power; and the selfishness was landowners' refusal to bear the cost of a life-saving reform. Perhaps as many as 40,000 people died from drinking milk infected by bovine TB after it was known that it could be eradicated by pasteurization. Yet similar resistance has not weakened in the intervening 60 years. In the next fortnight MPs will debate the health and social care bill, another measure containing, in the fruit-for-pregnant-mothers grant, the merest nod at improving the nation's health as well as its health care.

Creating and maintaining the conditions that enable and encourage citizens to live healthy lives is always harder to do than to discuss. Yet last week the Nuffield Council on Bioethics dropped a gift in the government's lap: a cogently argued case for large-scale public involvement in the protection and promotion of the nation's health - and a potent argument for doing it. Tackling health inequalities is a priority for the health secretary, Alan Johnson, and the prime minister. The ethicists say public-health programs should be focused on achieving it. For 10 years labor ministers have worried over health inequalities, only to be distracted by the NHS. It is five years since the Department of Health was told to prevent inequalities from worsening, and two since it had to admit it had failed. A baby boy born in Liverpool can now expect to live 10 years less than one born in affluent Kensington and Chelsea. Infant mortality is nearly twice the rate among "routine and manual" groups compared with "managerial and professional". Poorer people smoke more, eat less healthily and take less exercise than richer people - and nothing the government has done so far has changed it.

The picture is not entirely bleak: fewer children in poverty, better housing and school meals and better GCSE results are all vital to better public health. But the chief medical officer warned last year that public health has become a soft target for cash-strapped trusts. A recent King's Fund report found that of all health specialties, it was the only one where the number of consultants had fallen. The Nuffield ethicists acknowledge the complexities of tackling such inequalities. Yet this mild-mannered body also suggested, alongside some well-received observations on government policy and alcohol abuse, that it might, in extreme circumstances, be justifiable to take an obese child into care. There has been no public furore. Now is the time for the government to be equally bold.