| Previous Section | Home Page |
Column 1321
"the widespread dissemination of advice and information" in the context of the national health service.In welcoming the increasing emphasis on preventive medicine I commend the excellent work of the Maddison clinic at Teddington in my constituency. It was founded by the late Dr. Maddison to enable elderly people to have regular health checks and be given information about, among other things, what to eat to protect their health. It is a highly popular institution which is widely patronised.
There are occasional rumours about the clinic closing. Such rumours were circulating seven years ago. We conducted a great campaign, and it was saved. There have been rumours in the past few months to the effect that it might close, but I am glad to say that the general manager of the Richmond, Twickenham and Roehampton district health authority has confirmed to me that the clinic will remain open. I hope that the Minister will note what I have said about the valuable work done by that clinic and what the district health authority has said about it not closing. I emphasise that because some local general practitioners have shown a noticeable lack of enthusiasm for the clinic ; they prefer patients to receive all the health checks from the GPs and not from the clinic. I repeat that the clinic is extremely valuable, and I hope and believe that it will long remain to serve this and future generations of elderly people resident in my constituency.
The concept of preventive medicine contains a large proportion of what can be done to reduce the incidence of premature death. I would not object to an element of compulsion, as occurred with seat belts, or as would be the case with water fluoridation. We need more discipline in preventive medicine, as well as compulsion, and we need more incentives. We should pay doctors more to achieve a high target of immunisation of babies against diphtheria and smallpox. That is part of the purpose of recent legislation, which we were right to pass, because it should be compulsory for babies to be immunised in that way. Parents who are so ignorant as to seek to prevent immunisation should be overridden by the law, as in the case of seat belts.
Mrs. Wise : Is the hon. Gentleman aware that vaccination against smallpox no longer takes place?
Mr. Jessel : Well then it ought to take place, and so should the immunisation against diphtheria because one never knows when such things will break out again. There should also be other vaccinations.
I can tell the hon. Member for Preston (Mrs. Wise) of the greatest episode of compulsory immunisation in recent times when I was on a delegation in 1971, 10 million refugees went from Bangladesh to India because they were being ill-treated by the Pakistan army, based in West Pakistan. A massive number of refugees had to live in the most appalling conditions, in the ditches and fields in the open, when they went into India. The Indian Government wanted to feed those 10 million people, look after them and protect their health until they were able to get back into their own territory of East Bengal. But there was a terrible threat of a cholera epidemic. The Indian Government insisted that every one of those refugees was injected against cholera and produce a certificate of inoculation before being entitled to receive a food ration card. That must sound tough, but it was toughness based on the motive of compassion. It forced everyone to have an inoculation against cholera before
Column 1322
they could get food. That was done and in that way, the number of deaths from cholera was kept down to 3,000 out of 10 million refugees. Without that policy, probably hundreds of thousands of people would have died of cholera. That is what I mean by compulsion in preventive medicine. The Indian Government were right, and that episode made a great impression upon me. Ever since, I have believed that there is little place for freedom in preventive medicine, and there should be more compulsion, discipline and inoculations where necessary.Mr. Arbuthnot : I am listening to my hon. Friend with increasing nervousness. About two centuries ago, if my hon. Friend's philosophy were followed, it would have been compulsory to have cupping and blood-letting of everyone as a matter of course. Medical science moves on, and from time to time things that are thought to be good are later thought to be bad. If such progress can be achieved through encouragement and incentive, that is all to the good, but doing it through compulsion makes me wary.
Mr. Jessel : I am sure that if my hon. Friend had been a Member of the House in the late 1970s and early 1980s, he would have voted against the compulsory wearing of seat belts. We had passionate debates on that subject when people who thought like my hon. Friend thought that it would be a monstrous interference with individual liberty for people to be compelled to wear seat belts and people should make their own decision about it. The other argument prevailed, and we are saving 600 or 700 lives a year, preventing 10,000 serious injuries a year and saving the National Health Service £8 million or £9 million a year from treating people who would have been severely injured on the roads and might, in some cases, have been human cabbages and taken up beds in national health service wards, which are now available, instead, to other people who need the treatment. I am, at heart, as much of a libertarian as my hon. Friend, except in health matters. That may sound inconsistent, but my hon. Friend should remember the wise words of Emerson :
"A foolish consistency is the hob-goblin of little minds," and
"Speak what you think to-day in words as hard as cannon balls, and to- morrow speak what to-morrow thinks in hard words again, though it contradict everything you said to-day."
It is a most barren and foolish form of politics for people constantly to try to look for remarks, quotations or attitudes that are in conflict with what someone has said or thought in a different context or at a different time. We have to say what we believe is right at any particular time. It seems monstrous that young babies should not be protected against the risk of diphtheria because they happen to have a misguided mother. It is better to make a few mistakes than to make a lot.
I remind the House that a few years ago we were constantly being told that there were 2,000 deaths a year from cervical cancer in women and being asked why the Government and the House of Commons were not doing more about it. People said that something must be done about it. We have done something about it in the recent legislation. We have introduced targets for general practitioners to ensure that a certain percentage of women have checks, cervical smears and screening against cervical cancer. Now, those same people who were saying that we
Column 1323
must do something about it are beefing and complaining, whining and whingeing--the usual lobby--saying that it is an interference with their professional liberty. We should disregard that sort of lobby and get on with what we believe to be right. It is wrong to pay too much attention to people who complain in that way. In public life, sometimes we must lead public opinion and not just follow it. It is right to do so in this matter.My hon. Friend the Member for Chislehurst, who introduced the debate, was one of the supporters of compulsory seat belts, as was my hon. Friend the Member for Acton. If I may say so, I was also active in that. That was the right philosophy and I regard the prevention of accidents as part of preventive medicine.
Much of the speech of my hon. Friend the Member for Chislehurst was devoted to smoking. He is famous for the lead that he has given in that subject. He should have more backing from the House as a whole and from within my party. In an intervention in his speech, I mentioned that it is more difficult to book a non-smoking seat in a crowded aircraft than a smoking seat. I suggested that he should invite the Minister of State for Health to make representations to Ministers with responsibility for transport that there should be international co-operation among Transport Ministers from different countries to remind airlines that they should keep ahead of the public demand for that instead of lagging behind it, and ensure that there are more non-smoking seats available to meet that public demand in view of the decreasing proportion of people who habitually smoke when travelling.
There should be higher taxation on cigarettes. The tax on cigarettes should go up in every Budget systematically and regularly so that over a period of five or 10 years cigarettes become at least relatively twice as expensive as they are. Whenever they have gone up a little, due to tax changes introduced by successive Chancellors of the Exchequer, there have been complaints from tobacconists in my constituency, but never by more than three or four of them. People quickly settle down to a 5p or 10p increase in the price of cigarettes. The Government then have the extra revenue to spend on the health service or whatever they and the House believe to be right. I should like the tax to be increased progressively, year by year, until cigarettes become much more expensive. I agree with my hon. Friend the Member for Chislehurst that cigarettes should not be included in the cost of living index.
I am greatly concerned about the number of children who smoke, and particularly about girls at school, who seem to smoke more than the boys. I do not know why that is and I would be grateful if anyone could throw any light on it, but it is a worrying trend. I am glad to have heard from my hon. Friend the Member for Acton that the Home Office intends to tighten up its regime for the prosecution of shopkeepers who sell cigarettes to minors.
Cancer remains a major cause of death, and within the total figures there has been no significant reduction in the number of deaths from lung cancer. There were 35,000 in 1988, compared with 34,000 in 1981. That remains a great cause for concern because it is preventable to a large extent.
I turn now to heart disease. We are all told these days that we must cut down the proportion of cholesterol in our diets. My hon. Friend's motion refers to
"the widespread dissemination of advice and information."
Column 1324
But in some respects there is not yet enough information about diet. I could not help noticing when there was anxiety about beef three months ago and about eggs 18 months ago-- [Interruption.] I must ask my hon. Friend the Member for Billericay (Mrs. Gorman) to whisper a little more quietly as I find her distracting, too--Mr. Irvine Patnick (Sheffield, Hallam) : That is a sexist attack.
Mr. Jessel : It is not. I am always interested to hear what my hon. Friend has to say--
Madam Deputy Speaker (Miss Betty Boothroyd) : But the hon. Gentleman would prefer to hear it when the hon. Lady takes the Floor and makes her own speech.
Mr. Jessel : Absolutely, Madam Deputy Speaker, and I am grateful for your assistance.
I could not help noticing when we heard so much about eggs in the winter 18 months ago or about beef in the spring of this year that hardly anyone mentioned that eggs and beef contain a high proportion of cholesterol, which enters into people's diets.
Fish are another area of diet. We are all told to eat more fish, but there is little reference to shellfish. It is far from clear whether a healthy diet includes shellfish in the same way as it includes flat fish, white fish or oily fish. At least one eminent heart specialist, who is a fellow of the Royal College of Physicians, has written that shellfish are just as healthy as white fish and that there is no reason why we should not all eat a large amount of them. But that is not reflected in the information put out by the societies that advise on diet, so there is a conflict of information. We should remember that if we are told to reduce our intake of milk, cream, butter, cheese, eggs and meat, there is not much left that does not contain those foods. We cannot live all the time on kippers, cabbage and aspirins. If people could include a substantial proportion of shellfish in their diets that would add to the variety of what they can feel free to eat.
There are two main classes of shellfish : crustaceans and molluscs. Crustaceans are crabs, lobsters, shrimps, prawns and crayfish. Molluscs include winkles, whelks--which are described as sea snails on menus in France--clams, mussels, cockles and oysters. It is sometimes suggested that shellfish, whether crustaceans or molluscs, are luxuries, but I see the hon. Member for Peckham in her place, and I hope that she will not mind my mentioning that in 1964 I was the Conservative candidate for Peckham ; indeed, I had been the prospective candidate there since 1960, which may well be before she was born. When I was there I had a drink in every pub in Peckham. They then numbered 117, and at least 20 of them had shellfish stalls outside. Peckham is not one of the richest areas in the country, as I am sure the hon. Lady would not deny. The consumption and enjoyment of shellfish was widespread throughout the whole of society in Peckham.
Of course there can be tremendous changes in relative food prices. We all know that salmon has come down in price. I was told by the main fishmonger in Twickenham, Mr. Ray Sandys, that the price of salmon last week was lower than the price of cod. That is absolutely astonishing : no one 10 years ago would have believed it possible. We all know that chicken is now much cheaper than beef, and 50 years ago it was the other way around. The same applies to certain shellfish.
Column 1325
When Lewis Carroll wrote "The Walrus and the Carpenter" in the 1880s, the oysters which feature prominately in that poem were a dish regularly and frequently eaten by working men in London. It would not have been surprising in those days for carpenters to eat oysters ; these days, oysters are more likely to be consumed by yuppies. I believe that the wheel will turn full circle because, owing to improved fish-farming methods in Brittany and all along the west coast of France-- methods which I hope will be extended to include places like Whitstable and Colchester in this country--the price of oysters has gone down. One can now buy 12 big ones at a fishmonger in Brittany for 20 francs, which is £2. I believe that it will not be long before some enterprising business man finds a way of importing oysters into Britain far more cheaply, so that their dissemination can be much more widely enjoyed among the population as a whole. In the context of preventive medicine, it is all the more important that we should know whether oysters are good for health and ought to be enjoyed as much as possible.Next, I turn to eels. When we are told by health experts that we all have to eat more oily fish, they invariably mention herrings and kippers, but they make little mention of eels. Jellied eels are a traditional British dish, and they can be bought outside pubs in Peckham and outside a few pubs in Twickenham, which I have the honour to represent.
We should be told whether the consumption of eels ought to be encouraged to promote health, as well as that of kippers and herrings. They are high in calories--that is known--but they are a delicacy that is enjoyed less and less often than used to be the case, because so many people have a snobbish attitude towards eels. They think jellied eels in particular a proletarian dish, although smoked eels are considered more smart--or eels in a green sauce, as one would eat them in Belgium or Holland. I want my hon. Friend the Minister for Health to obtain departmental advice, and to let me know in writing whether eels are as healthy as herrings and kippers. I shall make the result of this inquiry known in my constituency. I now turn to lobsters. I spoke of food farming in relation to oysters which could make them much cheaper here. Recently I was on a visit to Canada, where I was representing the Council of Europe at a conference in Ottawa on global warming and the ozone layer. I flew back via Toronto. There is in the heart of Toronto a restaurant where one can eat as much lobster as one likes for 24 Canadian dollars, which is about £13. It is analogous to the carvery that one might come upon in a British restaurant, where people can eat as much pork or beef as they want for a certain sum.
I went into this place, and I must confess to the House that I ate seven lobsters for 24 Canadian dollars. I had never had more than half a lobster in my life before, so it was a tremendous treat to eat seven lobsters. They told me in that restaurant that the record was 35 lobsters. I did not aspire to emulate that ; I might have expired if I had.
I have never felt better than I felt on that occasion. Lobsters have become much cheaper in Canada because there is farming of lobster taking place, either in Hudson bay or Newfoundland--I do not know where exactly. If it takes place there, presumably it can take place around the coast of Scotland and I think that lobster will become much cheaper here in future years. We should be told whether lobsters are a healthy diet so that in future we know, because if we are not told, we shall not know.
Column 1326
Mr. Arbuthnot : My hon. Friend has several times mentioned fish farming, but I wonder whether this is the best route to healthy eating. Some of the fish farming in Scotland produces, for example, salmon that are fatty because they do not have the proper lifestyle of wild salmon. They do not taste nearly as good, and presumably they are not nearly as healthy for us as wild salmon. I should have thought that the same would apply to lobsters. While I am sure that one and even two lobsters would be a healthy part of one's diet, 35 are probably not.
Mr. Jessel : I did not eat 35, I ate seven. I am grateful to my hon. Friend for his intervention because he raises an important point to do with whether farmed salmon are a healthy part of a diet in terms of preventive medicine. As I said earlier, the country has been advised by the Department of Health and oily and fatty fish are good for health, and it mentioned herrings and kippers. I asked my hon. Friend the Minister for advice about eels, but now my hon. Friend the Member for Wanstead and Woodford (Mr. Arbuthnot) asks about fatty salmon. He believes that salmon that are farmed are more fatty than salmon caught in the wild on the River Tay. In view of the fact that the price of salmon fell last week below the price of cod, the public should be told whether salmon, albeit slightly fatty salmon, is as healthy as other types of salmon or other fatty fish such as herrings, kippers or, dare I say it, eel.
I think that I have said enough about fish and I now turn to the important subject of back pain. The national headquarters of the Back Pain Association is at Teddington, in my constituency, where it was founded by Mr. Stanley Grundy CBE, who happens to be the patron of my constituency Conservative association. He is an industrialist, and he is extremely fit. The Back Pain Association has been running for about 15 years. This is a subject in which my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) takes a great interest, because he has the Anglo-European College of Chiropractic in his constituency.
I believe that much more can be done to relieve the country of the scourge of back pain, by preventive health measures. People do not usually do anything about back pain until they are hurt and afflicted by it. If only people learnt to bend in the right way when picking up heavy articles, and were trained at an earlier age in physical recreation and physical training classes at school, the incidence of back pain would be greatly reduced. Much can be done to prevent it. For example, far too many nurses--I mention them in particular because this has to do with the national health service- -suffer from back pain because, when they are lifting patients, they do not follow the instructions that they have been given on how to stand or bend their knees when lifting patients or turning stroke patients in bed. Back pain is not a glamour cause in the health service or in the charitable sector, but it afflicts a great many people, and I should like the Government to devote more of their time and resources, and more of their share of the preventive medicine budget, to the prevention of back pain.
Earlier I mentioned fluoride. I used to represent the Greater London council on the Metropolitan water board--when it was the forerunner for Thames Water. I took an interest in the fluoridation of water. I ask my hon. Friend the Minister to report to the House, either now or at some convenient time, what progress is being made. The great
Column 1327
law suit in Strathclyde three or four years ago--a case to end all cases, which lasted for many months and took massive medical evidence--clearly established that fluoridation is not only safe but is the most effective measure that can be taken to protect children's teeth. Unfortunately, we are making rather slow progress. I hope that the whole process will be bucked up and that my hon. Friend will give us some information about it. I did not give her notice that I intended to raise the matter, so I should be content to accept a letter from her if it is not convenient for her to reply now.Mr. Ian Taylor (Esher) : I am grateful to my hon. Friend and neighbour. Is he aware that the chairman of the anti-fluoridation campaign lives in my constituency? I listened with interest to what my hon. Friend said and I wonder whether he would like to receive correspondence from my constituent, rather than my constituent writing to me.
Mr. Jessel : No, I would not. I have had correspondence from the person in question for some 20 years.
Mr. Jessel : Indeed we have. I admire the gentleman's tenacity, but he never seems to learn anything. He just churns out the same old stuff, and I see no point in reading it again. I do not want to hear from him. Indeed, I once had to threaten to sue him. I hope that the process of fluoridation will now proceed more rapidly.
I was pleased to hear the hon. and learned Member for Montgomery refer to water, because water is the basic foundation of health. A year ago, when water was still nationalised, some horrible green midges appeared in the pools of water waiting to go into the water supply at the waterworks at Hampton. Since water was privatised, those green weevils have not reappeared. That is an argument in favour of the privatisation of water.
I have one complaint about the water administration, and it is that the water pumping station--
Mr. Alex Carlile : Does the hon. Gentleman believe that there is a cause and effect relationship between the privatisation of water and the disappearance of those monsters? If so, can he explain why quantities of green algae have now appeared in water sources in Wales?
Mr. Jessel : The green things that appeared in my constituency were not algae ; they were midge larvae. They wriggled, they were shown on television and they alarmed a great many people, even though they were perfectly harmless. I do not know whether the algae are harmless, but I am sure that they do not wriggle. They are therefore less likely to bring about fear, anxiety and despondency, and so are a less worrying matter.
I want the waterworks in my constituency to stop sounding a hooter at 9 am. It is a Victorian relic summoning people to work and it annoys those of my constituents who are still asleep--and there are a few. I hope that the chairman of Thames Water will stop the hooter noise forthwith, after which I shall cease complaining about it.
Column 1328
12.49 pmMs. Harriet Harman (Peckham) : It is a challenge to follow the hon. Member for Twickenham (Mr. Jessel), who has much in common with the green things that he found in his water supply : he too is perfectly harmless but frightens many people.
I am grateful to the hon. Member for Chislehurst (Mr. Sims) for taking the opportunity provided by his success in the ballot to debate such an important topic, and for drafting a motion with which I and many other right hon. and hon. Members agree. His speech was wide ranging and struck the balance interestingly between private and Government responsibility.
Every individual has a responsibility to take care of themselves, and it is the responsibility of every parent to care for the health of their children. The Government also bear a major responsibility in caring for the nation's health--to promote good health and to prevent ill health--but they are failing to meet it. There has been progress in cutting deaths from preventable disease, but it has been too slow. Heart and liver disease and lung cancer are still major killers, but many deaths from them could be prevented.
We know much more now about the causes of disease and of accidents, and about their prevention. We know of the link between alcohol and liver disease, smoking and lung cancer, poverty and ill health. That knowledge places a moral obligation on the Government, which they should discharge by setting targets for preventive medicine and formulating strategies that will meet them. They should also monitor progress. That will not happen by itself, so the Government must take the lead.
Of course there must be a partnership between individuals, local authorities, health authorities, industry, and the Government, but they must take the lead. The reason they are failing to do so is that all their health initiative and enterprise is bogged down and tied up with their efforts to press ahead with national health service reforms that the public do not want. If one goes to any district health authority or family practitioner committee, one finds it discussing not public health strategy but how it can manage to make ends meet and to implement the Government's ludicrous reforms. A further obstacle to the Government being the real champion of preventive medicine and good health promotion is their hostility to planning and regulation, which, as other hon. Members have remarked, are a vital element in maintaining public health. Nor are the Government prepared to invest the resources necessary to improve it. I shall mention some of the aspects involved, though I am afraid that I shall not range as widely as the hon. Member for Twickenham. I hope to shed more light on family planning than he was able to do, but I cannot compete with the hon. Gentleman when it comes to the price of lobsters in Toronto.
Lung cancer, which is caused by smoking, is a major killer. We know that smoking is also a major cause of disability and premature death. Recently, I visited a hospital in my constituency whose patients included those who had just undergone amputations as a result of circulation problems caused by smoking. I went from ward to ward seeing babies born prematurely because their mothers smoked, and adults struggling to breathe as they
Column 1329
tried to talk to me about smoking. The toll that that habit takes on public health is intolerable. The facts and figures, as the hon. Member for Chislehurst said, are appalling.We did not always appreciate how dangerous smoking can be, but we do now. I remember an advertisement from the 1950s which was shown recently on television. It was a public information advertisement to encourage people to go to see their general practitioner. A woman was invited into the GP's surgery but one could hardly see the GP for the cloud of smoke from the fag he was puffing on. He invited her to sit down and, in order to show how to take it easy in a GP's surgery, and how a GP can set patients at their ease, he offered her a fag, she lit up and the cloud of smoke deepened.
One of the people I met in hospital who had had an amputation said that he was given cigarettes as part of his rations in the armed services. He said that he had not chosen to be a smoker but had become addicted to smoking at a time when information about the link between smoking and ill health was not known.
Now that we have information about the effects of smoking and ill health, we must have clear and unambiguous policies to cut down smoking and prevent ill health. The facts are appalling. In its strategy document for 1990-95 entitled "Strategic Plan", the Health Education Authority says :
"Cigarette smoking is the greatest cause of preventable death and disability in this country. It is estimated that some 110,000 deaths each year in the United Kingdom are attributable to tobacco products. This is the equivalent of one million years of life lost annually." It is the equivalent of 300 people dying every day from smoking. Smoking causes 90 per cent. of deaths from lung cancer, 90 per cent. of deaths from chronic bronchitis and emphysema and 20 to 25 per cent. of deaths from heart disease.
Smoking rates are still much too high. A total of 32 per cent. of the British adult population are regular cigarette smokers. Worryingly, at the age of 15, 22 per cent. of girls--more than one in five--and 17 per cent. of boys are regular cigarette smokers. We have to act decisively on this issue.
We have to have a target. That target should be to reduce by the end of the century the number of adult smokers from 32 per cent. to 20 per cent. We should aim to cut to 5 per cent. or less the number of children under 16 who smoke. That would be a realistic target. I too support the Parents Against Tobacco initiative which is looking at new ways to deter children from smoking.
We need to have regular increases in the price of tobacco. We should have an advertising levy on tobacco promotion which could be used for health education. Really, we should abolish advertising for tobacco and tobacco products. We know that smoking kills. Why do we still allow advertisements for a product that causes major ill health and death? We should have a total ban on advertising and sponsorship. It is horrifying to see in toy shops toy cars with the name of cigarette companies all over them and during motor racing on television the cars whizz past with highly visible adverts. Cigarette sponsorship runs throughout sport.
Mr. Arbuthnot : Will the hon. Lady say the same about alcohol advertising? Is she saying that a Labour Government would ban advertising of both products?
Column 1330
Ms. Harman : I shall come to alcohol advertising shortly. If the hon. Gentleman reads "Looking to the Future", our policy document, which was quoted by my hon. Friend the Member for Preston (Mrs. Wise), he will see that we are committed to a total ban on advertising and sponsorship. We must be clear about that.
The ceiling for permitted tar yields must be reduced and there should be no Government subsidies, through any Department, for the production, import or manufacture of tobacco products. That will be hard, because the tobacco industry, including the manufacture, importing, sale and supply of tobacco products, accounts for many jobs in this country. However, the Department of Health should not have to pick up the pieces of illness caused by smoking while the Department of Trade and Industry is subsidising the tobacco industry in this country.
Mr. Jeremy Corbyn (Islington, North) : Does my hon. Friend agree that one of the most distressing problems at the moment concerns the export of high-tar tobacco products to poorer countries and the promotion by British companies of tobacco in Third world countries? Does she agree that those companies should be rapidly encouraged to adopt product diversification instead of promoting the sale of those dangerous tobacco products to poorer people in poorer countries?
Ms. Harman : I agree with my hon. Friend. The Government should have an honest and coherent approach to smoking across all Departments. Smoking cannot be dangerous in this country but safe in the third world. Different Departments should not be pulling in different directions.
There should be more resources for health education targeted at smokers and to prevent people from taking up smoking. We need more training in the risks of smoking for health professionals, and smokers who are trying to give up should be supported and receive counselling.
We also need legislation to control all public and workplace smoking, because that smoking involves a twofold problem. First, non-smokers are smoking passively and that is a problem for everyone, but particularly for people with respiratory diseases and for children. Secondly, workplace and public smoking seems to create the idea that smoking in public is somehow acceptable and that we can expect to see people on buses, in restaurants or at work smoking. Smoking should not be allowed in day rooms in hospitals. It is an amazing irony that a mother who has given birth prematurely to a low birth weight baby with a health risk as a result of smoking can go and have a fag in the day room. We must have a public health strategy in which the Government take a lead in their role as an employer and provider of facilities and services. Cigarettes should not be sold on health service premises. Selling them there is a contradiction in terms.
The hon. Member for Ealing, Acton (Sir G. Young) made an interesting point about the sale of cigarettes bearing the House of Commons insignia. I would be interested to hear what the Minister for Health thinks about that.
The Minister for Health (Mrs. Virginia Bottomley) indicated dissent.
Column 1331
Ms. Harman : The Minister is shaking her head. It seems that she is going to try to avoid that point. However, I hope that she will consider the matter.There must be a named individual in each health and local authority to co- ordinate action. Smoking control plans should be part of every local and health authority's strategy.
There has been a great advance in child immunisation, as several hon. Members have said. However, there should be more stringent checks to discover whether children have had the correct immunisations. Those checks should be made when children enter school, because if children have missed out on immunisation before then, they can be caught and their parents can be encouraged to have their children immunised.
The Government must back that kind of service with resources. The Government took up on the excellent MMR vaccination campaign. Obviously, we should aim to stamp out rubella ; it can have a terrible effect on a child if its mother had rubella when she was pregnant. That illness is entirely preventable. However, it is ironic that, when the advertising campaign for MMR was at its height, district health authorities were rationing the vaccine because they could not afford it. Parents were told to bring their children back on a different day because there was not enough vaccine available. They were told that, although their children were eligible for vaccination, they were not in the main target group and therefore they should bring their childern back on another occasion. We should take every oportunity to ensure that children have received their immunisations and vaccinations.
More and more stress is being placed on health visitors yet their posts are being frozen as a result of cuts and difficulties with health budgets. Health visitors play a vital role in promoting public health and in encouraging women to have cervical smears and to take their children for vaccinations. They must be an important part of any health promotion strategy. Their posts should not be frozen because health authorities are having financial difficulties. I should like the Minister to respond to my next point, about vaccine-damaged children and their eligibility for compensation. As I understand it, a child is eligible for compensation only if he or she has suffered 80 per cent. disability. As the compensation scheme does not cost very much in any case--because vaccine damage is rare- -it seems unfair that children who have been vaccine-damaged should not be eligible for campensation unless they cross the threshold of 80 per cent. disability.
We know that health inequalities relating to income are as deep as ever. The map of the variations in health and disease patterns shows that the picture remains largely unchanged since the Black report. Our health strategy and our targets for health promotion should focus not only on certain diseases, such as those caused by smoking or alcohol, but on the ill health that exists in different regions and individual cities. We need to set targets for cities and to encourage healthy city projects such as those in Liverpool and Sandwell, and the one that I have visited in Oxford. We need public health profiles so that the agencies concerned and the local community can join in setting and achieving targets to improve the health of their region or city.
Many hon. Members have referred to food safety. Our discussion has ranged across salmonella, botulism, listeria and the problems of a contaminated drinking water
Column 1332
supply. Our knowledge of food safety and of the link between poorly stored food and ill health is growing as food science is becoming more developed and microbiology is telling us more.The Government should not lag behind. They should see the research as an opportunity. They should not bring in controls reluctantly, only when everybody is screaming and shouting ; they should look closely at what science can now tell us about food and ill health, which it could not previously, and be poised to cut the incidence of ill health caused by food.
The Government should not be dragged kicking and screaming to introduce new regulations. As my hon. Friend the Member for Preston has said, we need a sufficient number of environmental health officers to enforce the regulations, because regulations by themselves have only a limited value if there are insufficient environmental health officers to police them. No local authority has sufficient environmental health officers to ensure that the current law is being complied with, let alone to make the improvements in the regulations that we are seeking.
While I am dealing with food and nutrition, I must emphasise that the low level of breast feeding in this country is a scandal. All the evidence shows that the best food for a child when it is born is its mother's breast milk. However, the companies that produce artificial milk are still giving out free samples of their products in hospital maternity wards. Although that is against the regulations, it is still happening because the milk manufacturers have been clever and have recognised that maternity wards no longer give out packs to new mothers.
In the past, a new mother could take a nappy, some baby lotion or vaseline and some talcum powder from the hospital supplies. The national health service used to provide such things, when it was not so strapped for cash. That is one of the cuts that has taken place. Therefore, milk suppliers provide what are called "bounty boxes" for expectant mothers. In the bounty box there is stacks of commecial advertising material for artificial milk.
Despite the increase in the number of babies being born, the number of maternity beds has been cut. That has led to mothers being discharged sooner after they have their babies. The amount of time that women spend in hospital after having a baby is rapidly decreasing. One of the casualties of that is that women return home with a new baby without having established breast feeding with the support of the midwives in the hospital. The community support of the midwives is the hospital. The community midwife service is too stretched to enable mothers who have nothing wrong with them to establish breast feeding.
Mr. Arbuthnot : Will the hon. Lady give way?
Ms. Harman : We have an expert on breast feeding ; I shall give way.
Mr. Arbuthnot : As the hon. Lady will understand, I am not an experienced breast feeder. Would she cope with the problem by banning the advertising of babies' milk?
Ms. Harman : A Department of Health regulation states that hospitals should not advertise babies' milk. I simply argue that that regulation should be enforced. I am sorry if I did not make myself clear. The Minister will confirm that it is already Government policy that milk should not
Column 1333
be advertised in hospitals but that the regulation is not enforced. The milk companies encourage hospitals to break the regulation by offering free samples which hospitals stretched for cash take up.Mrs. Wise : I agree entirely with my hon. Friend's point. Does she agree that the community midwife service needs to be strengthened and that it would be a good thing if new mothers were again given a home help so that they could rest more and give more attention to the baby? That would help in the establishment of breast feeding.
Ms. Harman : I absolutely agree with my hon. Friend. The home help service was introduced to assist mothers with new babies, but it is now almost entirely devoted to the elderly and people with disabilities.
I wish to touch briefly on maternity services. We must increase pre- conceptual care and promote understanding of the issues behind it, but we must also increase the number of women who come forward for ante-natal assistance and screening.
There is still an appallingly high toll from industrial illness and accidents at work. Many of those accidents simply should not happen. There is an unacceptable level of accidents among employees of cowboy builders. My hon. Friend the Member for Preston mentioned repetitive strain injury. Ill-health and disease is caused in the chemical and nuclear industries. Farmworkers are affected by chemicals and machinery used in agriculture.
We need a combination of openness, so that people know and assess the hazards in their workplace, and good inspection by the Government which is properly resourced, so that employers know that, if they breach regulations, there is a substantial chance that they will be discovered and fined. We need unionisation so that management can negotiate with strong unions acting in the interests of their members to ensure their safety.
I wish to touch briefly on ill health caused by poverty. A severe winter always brings an epidemic of hypothermia, which is preventable. The Scandinavian countries, which have far harsher climates, do not experience the increase in deaths by hypothermia that we have in Britain. If people had a decent income, if there were good incentives for insulation and if the cost of fuel was lower, we would not have that unacceptable Dickensian epidemic of death by hypothermia that arises every time that there is a cold winter. We have too many accidents in the home. We need to have better regulations to ensure that unsafe toys and electrical goods do not reach the market. My hon. Friend the Member for Preston mentioned the safety of people in bed-and-breakfast accommodation. In her previous incarnation as a social worker, she will have visited families in bed-and-breakfast accommodation. Such accommodation lacks cooking facilities. The electric kettle is inevitably without a table because there is no space between the beds, and its wire snakes across the floor. That is of particular danger to children. Several families share the same toilet and inadequate washing facilities. They are prone to infectious diseases, such as gastroenteritis. It is a contradiction in terms to claim an interest in public health promotion when so many families live in these squalid, unhealthy hostels for the homeless.
As I came here today, I went down Haygate street in SE17 and saw a touching shrine of a little dog made up of flowers. Obviously, a child has been killed there recently.
| Next Section
| Home Page |