High rates of cancer and heart disease among the working classes will be tackled under government plans to narrow the 'health gap' between the rich and the poor.
While deaths from the two major killers have been falling, the trend has been driven largely by rapidly improving health among middle class patients, who are less likely to smoke, have a better diet and consult their doctors more readily.
Health Secretary John Reid is concerned that the NHS too often fails to understand the reasons why poorer people take risks with their health and wants spending to be better targeted.
The Treasury's spending review, to be unveiled in the next few weeks, is expected to include for the first time targets to prevent premature deaths among the poorest patients, forcing the NHS to rethink the way it tackles risky behaviour among the group.
One Whitehall source said: 'We know deaths are coming down but not at an even rate. This is about challenging health professionals to do things differently.
'We know for instance that catching cancers early increases survival, yet people in the lowest social classes will put up with pain and present to health professionals later. If you can get them to change their attitudes and present earlier that should have an impact.'
While the government has already set an overall target to reduce premature deaths from heart disease and cancer by 20 per cent, the new objectives will mean this cannot be achieved simply by making the relatively healthy middle class even more healthy.
Reid hinted at the change in emphasis during a speech to health specialists in Edinburgh earlier this month, warning that 'not everyone will find it as easy as everyone else to achieve change'.
He said efforts to tackle obesity must recognise that poor families struggle to eat lots of fresh fruit and vegetables, while 'straitened circumstances' could make it harder to kick drink and drug habits.
Although the Department of Health has already received its financial settlement from the Treasury, the review will still set new so-called Public Service Agreement targets, designed to measure how much bang the Treasury gets for its buck.
Reid has argued these should reflect class differences. Working-class men die seven years younger than their peers in high-income brackets, with the major contributor being higher rates of smoking.
