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Editor—In 1994 Sheffield had the highest infant mortality rate in England and Wales.1 The impact of neonatal care in Sheffield immediately came under the spotlight. An investigation led by the Public Health Department of Sheffield Health took place to establish the reasons for the high infant mortality rate.2
It is well known that factors affecting infant mortality and morbidity may operate in the antenatal, as well as the postnatal period.3 The Sheffield Health led investigation consequently included the antenatal period. Similar to Spenceret al, the investigation found that increased social deprivation as indicated by the Townsend Deprivation Index was related to a higher proportion of very low birth weight (less than 1500 g) infants.4 Furthermore, a higher proportion of very low birth weight (less than 1500 g) infants was related to a higher infant mortality rate. The investigation found that the infant mortality rate in Sheffield was not significantly different to other areas of England and Wales with a similar level of social deprivation. Neonatal care in Sheffield was not found to be substandard.
The investigation highlights the hazards of interpreting annual mortality rates as league tables of clinical performance.5In the Sheffield Health investigation, the most important factor on infant mortality was the level of social deprivation.
Spencer et al conclude that the differences in birth weight in their study may have major implications for later life. The investigation carried out in Sheffield, shows that differences in birthweight will certainly have major implications for later life.
The Government's commitment to reducing inequalities is to be welcomed, and we wait with interest to see what impact new policy initiatives in maternal and child health will have on the health of the most disadvantaged children in our society. The issue for Sheffield, and indeed the rest of the United Kingdom, is that if we are to be serious about reducing health inequalities, we must be serious in reducing social deprivation.