Class: you either have it or you don’t

John Major’s call for a classless society is one which we can welcome warmly, and for two good reasons.

First, because it signals an encouraging policy U-turn by the new regime: there is to be such a thing as society, after all. What a relief it is to find that we do, at last, seem to live on the same planet as our leader. This is common ground which we should build on right away.

Second, because Mr Major implicitly recognises that our society (if it exists) shares out all kinds of essentials — most crucially wealth and health — unequally according to social class. This recognition is fundemental to our own understanding of health and illness — though where Mr Major might speak only of inequality, we would emphasise injustice.

But let’s not be churlish. To find one area of common ground with the prime minister could be regarded as good fortune. To find two looks like nothing short of a miracle.

Class inequalities in health have, of course, been known to exist for many years, but attained notoriety only with the attempted suppression of the Black Report in 1980. Less widely known is that, in the decade since Sir Douglas Black’s working party reported, inequalities in health between rich and poor have continued to increase — despite the much-vaunted success of our hi-tech, share owning, enterprise culture.

We should not look to the NHS, old or new, to improve the situation. The the health service has many strengths, preventing illness in the most disadvantaged sectors of society is not one of them, and nor could be expect it to be.

At root, the widening health divide of the last decade is the result of the widening health divide which this government has actively promoted — though we have yet to hear from Mr Major whether poverty, like society, is a word we shall be allowed to use again.

A new analysis of official statistics by the Child Poverty Action Group demonstrates that poverty increased faster in the UK between 1975 and 1985 than in any other EC state. Income inequalities across the working population are wider than at any time since records began in 1886. Benefits have been squeezed by tax cuts which have made the rich richer. Unemployment is rising once more.

So, 11 years after the Black report, what has the government done to reduce health inequalities? The record is a shaming one. The report called for a comprehensive anti-poverty strategy, with the elimination of child poverty as a national goal for the 1980s.

It recommended increases in child benefit and the maternity grant, the introduction of an infant care allowance, national targets for childcare provision, a comprehensive disability allowance, minimum standards for pay and conditions of work, increased local authority spending on housing, and a coordination of effort, at the highest level of government, to improve health.

None of these have been acted upon — and indeed, on many of these issues, national policy has been quite the opposite. Despite this, the government has been happy to display a breathtaking hypocrisy by signing both the WHO Health for All charter, and the European charter on Environment and Health.

Mr Major hopes to build a society ‘willing to make the changes necessary to provide a better quality of life for all our citizens’. In this, he has been given a clear lead by his own Chief Medical Officer, Sir Donald Acheson, who recently called for ‘a continuing diligent search for the origins of ill health in the structure of contemporary society’.

Mr Major must now demonstrate his commitment to a classless society in health terms. He should look again at the Black report and act on its recommendations.