The Observer  09 September 2007 [Tam Fry]

All expectant mothers are to be given a one-off payment of around £120 that they will be encouraged to spend on fresh fruit and vegetables as a way of protecting their children from diseases and incurable conditions later in life. 

The plan for a 'health in pregnancy' grant will be outlined by Health Secretary Alan Johnson this week in his first major speech outlining how the government plans to tackle the yawning health divide between the richest and poorest in England and Wales.

The payment - the first by a government that is allied to a specific health target - would be given to women when they are seven months pregnant. It would be linked to them receiving professional health advice on how to maintain a proper balanced diet, and give up drinking and smoking. The move comes as the government's record on improving public health will come under fresh scrutiny this week when Sir Derek Wanless, a former government adviser on the NHS, publishes a major report that will criticise lack of progress on tackling increasingly unhealthy lifestyles which have led to Britain's obesity epidemic. The report is expected to highlight poor eating habits, people's increasingly sedentary routines and the growing number of overweight people as areas where more determined action needs to be taken.

The pregnancy measure, to be introduced in 2009, is likely to prove highly controversial as women will be free to spend the money on drink or cigarettes. Sources told The Observer that the government accepts that some of the 630,000 women who become pregnant each year may choose not to spend the money on healthy food. There is also little published research to show that a financial incentive, combined with nutritional advice, is sufficient to persuade mothers from the most deprived areas to change their lifestyle.

It was decided it would be too complex, and possibly unfair, to means-test the payment and give it only to the poorest women. It is likely to be given as an extra child benefit, regardless of income. The proposals, currently being scrutinised by the Treasury, are expected to cost between £70m and £80m a year. Health economists have argued that if women do buy good food, it would save the health service far more than that amount by preventing chronic diseases such as diabetes.

In his speech on Thursday, Johnson will lay out his vision for an NHS where preventative measures play a far greater role. He will point out that just under one in 12 children in England and Wales is born underweight - less than 5.5lbs. They are not only at greater risk of dying in infancy, but face long-term difficulties such as heart disease, diabetes, lung conditions and impaired cognitive development because their growth has been retarded in the womb by a lack of essential nutrients.

Another problem driving the high number of underweight babies is the fact that Britain has Europe's highest rate of teenage births, with an average of 26 children born to every 1,000 women aged between 15 and 19, more than four times the rate in Cyprus, Slovenia, Sweden or Denmark.

Brushing aside concerns about being seen as a 'nanny state', Gordon Brown has sanctioned his Cabinet to take a more interventionist approach when it comes to narrowing the life chances between rich and poor. This will include sending more nurses into deprived communities to support women who need the most NHS help but are most likely not to ask for it. A scheme pioneered in America is being trialled in Somerset under which nurses regularly help mothers who are struggling to cope. 

Tam Fry said: ' We know that women who are well educated and with disposable income take their diet seriously during pregnancy and eat well, but for those lower on the social scale, without the education or the money or the help, it's tough. It's a sensitive issue to address, but it matters because the weight of a baby at birth can have a profound effect on their health further down the line.  By the time a woman falls pregnant, she already needs to be eating well to give her baby the best chance. Tackling it halfway through the pregnancy is really a bit late, though it is very good that the government is waking up to the scale of the problem.' 

One big health divide opening up is over tobacco, as women from deprived communities are four times more likely to smoke during pregnancy. Johnson will publish a health inequality strategy next summer which will launch a radical programme to try to lower the divide.