10 July 1997

Sir Donald Acheson
International Centre for Health & Society
University College, London
1-19 Torrington Place
LONDON WC1 6BT

Review of inequalities in health

I thought it might be helpful to follow up our most useful conversation last Friday in order to confirm both where we had got to and the outstanding action on which you agreed to come back to me.

We have now agreed slightly revised terms of reference as follows:
"1. To moderate a Department of Health review of the latest available information on inequalities of health, using data from the Office for National Statistics, the Department of Health and elsewhere. The data review would summarise the evidence of inequalities of health and expectation of life in England and identify trends.
2. In the light of that evidence, to conduct - within the broad framework of the Government's overall financial strategy - an independent review to identify priority areas for future policy development, which scientific and expert evidence indicates are likely to offer opportunities for Government to develop beneficial, cost effective and affordable interventions to reduce health inequalities.
3. The review will report to the Secretary of State for Health. The report will be published and its conclusions, based on evidence, will contribute to the development of a new strategy for health."

We discussed the timing of your report. You were very concerned that a credible and reputable piece of work covering such a broad spectrum of issues could not be completed by January 1998 as we had originally hoped. However, you undertook to produce that part of your report which related to the work of the NHS by January 1998. You will then seek to produce by the end of March 1998 such further work as you are able to do properly in the time available. Any outstanding sections would form part of the final report to be delivered by the end of June.

However, proceeding on that basis makes it all the more important that the Department, whether through the CMO or the Secretariat, are kept in very close touch with your emerging findings so that these can be taken into account in the drafting of the Health Strategy White Paper which I intend to publish in the middle of next year. As I said, I recognise the time pressure which my overall timetable imposes on you but I do think it is vital to ensure that your work is relevant to the development of my new strategy for health.

Finally, we discussed the size and composition of the group of experts who you would like to assist you. As I said, I am concerned that the current proposals would create too large and unmanageable a group and you kindly undertook to consider how to reduce its size whilst covering all the major interests. I am most grateful to you for agreeing to consider these points further and to come back to me in due course. On further reflection, given the scientific basis of the evidence you intend to produce, scientists are clearly your essential resource for further advice.

The Secretary of State and I are both delighted that you and I have now been able to reach agreement on the basis on which you will carry out your review and I am sure it will prove a most important contribution to the development of health and social policy. I am extremely grateful to you for agreeing to take this on and hope we can keep in touch from time to time in the months ahead.

TESSA JOWELL