Colin Guthrie (Letters, December 30) puts his finger on the key challenge for health policy. Research over the last two decades has shown that the bulk of the higher rates of sickness, accidents and deaths experienced by the poor is caused by obscene wealth gaps and the adverse psycho-social conditions that go with them. Japan, with relatively low gaps between rich and poor, has strikingly high life expectancy. It is not a waste of the additional funds and heroic staff efforts to pit the chronically underfunded health service against the toll of extra disease and accidents. But the underlying causes need addressing urgently. Mainly, this calls for action outside the NHS. The good news is that the policies needed to make progress in public health in relation to inequalities and environmental problems are broadly in harmony with the need to shift towards green policies and to address the root causes rather than the symptoms of crime. Many churches and humanist groups are already battling away, as well as the Greens.
Internationally, there is a wealth of policy development to build on, but most of the transnational corporations and their mouthpiece, the US government, will still be fighting vital change. It is not just electoral procedures that the US needs to modernise in 2001. Public health and environmentalism present challenges that reach beyond national boundaries and pre-ecological ideology.
Dr Peter Draper
London
peter.draper@btinternet.com
• Your leader (January 1) notes that 2001 may be an election year and rightly asks if things have got better since 1997. Are the poor poorer? Is the divide growing? Is our nation healthier? We shall be asking the political parties what they think and what they will do about it, and hope they will join in making 2001 the start of a popular movement for public health. Health - for all - should be the first paragraph of every manifesto.
John Nicholson
UK Public Health Association
• The government's plans to abolish community health councils (Report, December 28) will remove important civil liberties from individuals and communities. Patients who have suffered lapses of care in the NHS seek the help of CHCs to challenge the hospital staff responsible and seek redress. It is inconceivable that the hospital-employed advocates proposed to replace CHCs would be able to act for patients or bereaved relatives with the fearless determination of the CHCs.
It is not just the erosion of patients' rights to independent representation that causes concern. At the core of the government's plan is its determination to abolish independent monitoring of the NHS and in particular the monthly exposure through Casualty Watch of the government's failure to solve the embarrassing problem of 20-30 hour waits in casualty departments.
The government's plan to suppress public monitoring and criticism of the NHS by closing CHCs will lead to poorer and less sensitive care and treatment, and will hurt the most vulnerable patients.
Malcolm Alexander
Chief officer, Southwark community health council
maiexa49@aol.com
