Despite an overall improvement in infant mortality in the United Kingdom, inequalities between different social and ethnic groups are widening, says a Department of Health report published this week.
A department spokesman said, “Infant mortality is at an all time low, and the rate continues to fall. However, there remains a gap between the routine and manual classes and the general population.
“Our target is to reduce the infant mortality gap by at least 10% by 2010. We are not complacent. This remains a challenging target.”
Previous research has shown that people in routine and manual occupations—such as porters and cleaners—and in ethnic minorities show consistently poorer health outcomes than the general population.
The government introduced targets in 2003 to reduce the gap in infant mortality across social groups, as well as to raise life expectancy in the most disadvantaged areas. By 2010 the target is to reduce inequalities between routine and manual occupations and the general population—as measured by life expectancy at birth and by infant mortality—by 10%.
A total of 9132 infant deaths were recorded in England and Wales between 2002 and 2004, almost half of which were caused by ill defined conditions, predominantly sudden unexpected deaths in infancy. The new report says that 40% of these deaths were recorded among parents who reported being in routine and manual occupations. In this group there were 5.9 deaths per 1000 live births, whereas the national average was 4.9 deaths per 1000 live births. The figures vary considerably across the country. Infant mortality was higher than the national average in 46 (66%) of the 70 “spearhead” local authority areas—those areas the government has identified as being particularly deprived.
Importantly, the gap between infant mortality in routine and manual occupations and that in the population as a whole has widened in recent years. Whereas in 1997-9 mortality among families who did routine and manual work was 13% higher than that in the general population, by 2002-4 this had risen to 19%.
Inequalities across ethnic and migrant groups were also found. For example, the number of deaths of infants of women who were born in Pakistan (10.2 per 1000 live births) is now double the national average.
The report highlights major shortfalls in the way local NHS services have so far responded to the 2010 target. In many cases service providers and management lacked knowledge and understanding of the target. The report noted a lack of leadership, poor handling of data, and gaps in the evidence base.
The report says that an additional reduction of around 800 to 900 deaths during 2009-11 will be needed to reduce infant mortality sufficiently to achieve the 2010 target. The data indicate that reductions in infant mortality in ethnic minority groups could have a greater effect in the routine and manual occupational groups than in the population as a whole.
Richard Congdon, chief executive at the Confidential Enquiry into Maternal and Child Health, London, said that although he supported the report's recommendations on further reducing infant mortality, this measure needed to be considered alongside maternal mortality and stillbirths.
He said, “There does not appear to be an overall improvement in rates [for maternal mortality and stillbirths] matching that reported in this report for infant mortality. Major risk factors include social exclusion and ethnicity, and continuing and increased effort will be needed to address these inequalities.”
Moyra Rushby, from the health charity Medact, London, said that the report's findings were relevant to broader discussions about the ability of people from ethnic minorities to access appropriate and timely health care.
“The recent tightening up and expansion of NHS systems to identify and charge non-eligible migrants, at maternity services in particular, means vulnerable individuals will increasingly be less likely to present to services, or will present late, which could impact on both maternal and child health status,” she said. She added that the Department of Health must do more research to explore the experiences of people from ethnic minorities in the UK health services.
Review of the Health Inequalities Infant Mortality PSA Target is available at www.dh.gov.uk.
