Milburn plans to cut death rate of poor

Alan Milburn, the health secretary, will today signal a historic shift in NHS policy when he announces a 10-year plan to reduce infant mortality and premature adult deaths in the poorest parts of England.

In a speech that is meant to unveil the "big idea" for Labour's general election manifesto on health, he will announce the first government targets to reduce the most flagrant examples of health inequalities that are blighting the lives of the poor.

Unlike previous targets for reducing NHS waiting lists and increasing the input of re sources flowing into the service, the new targets will focus on health outcomes.

The first will be to save the lives of at least 3,000 children a year by bringing infant mortality rates in the poorest areas closer to the national average.

The second will be to reduce the gap in life expectancy that causes people in the poorest areas to die about seven years earlier than their contemporaries in more prosperous areas. Similar targets are expected in the manifestos for Scotland and Wales.

"For too long the health debate in this country has been focused on the state of the nation's health service and not on the state of the nation's health," Mr Milburn will say in a speech in London to the Long Term Medical Conditions Alliance, a group of patients' organisations.

"The progress we have made in our first term allows us to set a new ambition for the second term. It is to undertake the biggest assault our country has ever seen in health disadvantage - to start to break the link between poverty and ill health ... to improve the health of the poorest fastest."

The drive against infant mortality was triggered by government figures showing six children in every thousand died before their first birthday in poor areas, compared with a national average of 5.5. Mr Milburn will pledge to reduce the gap by at least 10% by 2010.

He will set a similar target to reduce inequalities in the adult death rate. Figures from the office of national statistics show life expectancy for men in England ranged from 70.1 to 78.4 years and for women from 76.8 to 83.5 years.

Mr Milburn will say it is unacceptable that a boy from the most disadvantaged social group will live nine years less than a boy from the most disadvantaged. A boy born in Manchester can expect to die seven years earlier than a boy from Oxfordshire.

Policies to close the inequality gap would initially be directed at health authorities where the problem is greatest.

These areas will get a larger share of the growth in the NHS budget. Policies will include extension of the Sure Start programme to help pregnant women and their partners, better health education in schools and an intensive drive to cut smoking and reduce coronary heart disease. There will be a new health poverty index to measure health inequalities more accurately.

As a first step, Mr Milburn will today start to provide 80,000 children aged four to six with free fruit during every school day. It was being billed by the Department of Health last night as the biggest health promotion initiative in schools since the start of free school milk in 1948.