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Mr. Michael Colvin (Romsey and Waterside): I should like to pay tribute to the speech we have just heard from the hon. Member for Eccles (Miss Lestor), in which she
displayed the social conscience that she has shown whenever she has spoken in the House. The subject of her speech is dear to her heart, and has a local bearing, but during her time on the Opposition Front Bench she has spoken robustly in favour of assistance for countries overseas that are not as well provided for as we are. In doing so, she has displayed her social conscience and fought her corner with a robustness which sometimes has not received the recognition it deserves. I am sure that the House will be much diminished following her departure, and I wish to use this opportunity on behalf of Conservative Members to pay tribute to the work that she has done as an honourable Member of this House.7.7 pm
The Parliamentary Under-Secretary of State for Health (Mr. Simon Burns): I join my hon. Friend the Member for Romsey and Waterside (Mr. Colvin) in paying tribute to the hon. Member for Eccles. She said that she wanted to go out on a high note because of her continued commitment to children, both in this country and overseas. I would like to pay tribute to her for her work over the past 20 years, and for the passion of her views. Obviously, she will not be surprised to learn that I do not share her concluding views, and she was unduly harsh on the Government. As she has wide experience in this House, she would not expect me to necessarily agree with everything that she said in a well thought out, detailed and knowledgeable speech.
The vast majority of households are better off as a result of the Government's policies: average income has risen by more than a third--by 37 per cent.--between 1979 and 1993-94, and those rises are not confined to a few top earners. Average income is up for all family types throughout the country.
It is a fallacy to claim that there are more children living below the poverty line than ever before. Such a claim, which rests on equating the poverty line with the income support level, would imply that any increase in benefit levels brings about an apparent increase in poverty, and that, conversely, by cutting benefit levels we could reduce the numbers on low incomes.
The facts are that those usually thought of as poor have also seen their income increased in the past 18 years. For example, a typical unemployed couple with two children, receiving income support, is 20 per cent. per week better off in real terms than in 1979. The less well-off, the bottom 10 per cent., now possess more consumer durables. The possession of such items as telephones and central heating is up by more than a half, and half those people now have cars and video recorders.
We have continued to concentrate help where it is most needed, on low-income families, less well-off pensioners and sick and disabled people on low incomes. Extra help is available to low-income families through income-related benefits worth about £1.4 billion a year more, in real terms, than in 1988. More than 706,000 families benefit every week from family credit payments.
Family credit, a benefit introduced by the Government, plays an important part in helping families with children to break out of the poverty trap, making easier the jump from the state benefit system back into work by raising their incomes through the early stages of their return to work. That is an important help, which has enabled 706,000 families to get back into work and enhance their standard of living.
The biggest cause of low income is unemployment, which has fallen by 1.1 million since December 1992. We are building on that, as recent unemployment figures have shown. I cannot anticipate what the figures will show tomorrow, but I have no reason to doubt the continuing economic recovery of this country. We have an economy that is the envy of our European partners, and that should continue to develop and strengthen in a stable and excellent way, bringing benefits to both individuals and their families, and to manufacturing, the retail sector and others.
About 750,000 people a year will benefit from a range of innovative measures announced by my right hon. and learned Friend the Chancellor in his 1994 Budget to help people to move into and stay in work. From April this year, the parent plus initiative will offer help to up to 100,000 lone parents on income support to get back to work: £20 million will be invested in the scheme and supporting initiatives. It will be piloted for three years in 12 Benefits Agency districts, covering almost one tenth of Britain.
Of course we acknowledge that there is an association between health and socio-economic status: that is not unique to this country, but is seen throughout the developed world. There are also variations in health between different areas and social and ethnic groups, and between men and women. The experts agree that there are likely to be many factors at work: living and working conditions, resources, individual preferences and social relationships.
The Government are determined to work towards improving the health of the nation and breaking down the barriers between the different factors that can have an adverse impact on individuals' health, be they adults or children. Through the "Health of the Nation" initiative, we have set targets for improving health. We are the first Government to do so. Within those targets, we have asked health authorities to work with others to concentrate efforts on those whose needs are greatest. That means that we can focus on those who face poorer health than others, whether because of low income, gender, ethnicity or geography.
I want now to concentrate on the more narrow and focused area of children's health and nutritional requirements. The hon. Member for Eccles mentioned a number of issues relating to children's health, on which I am afraid that I cannot agree with her conclusions.
We know that children of all ages and in all population groups are taller and heavier than before. No group shows the signs of faltering growth that could result from under-nutrition. Indeed, Government surveys of food, nutrition and diet over the past 20 years have shown consistently that there is no evidence of malnutrition in British children. The average intake of nutrients for all groups surveyed is above the appropriate dietary reference value. The exceptions are for iron in women and girls, and calcium in some adolescent girls, but those exceptions cut across all socio-economic groups.
It is important at this stage to define a healthy diet, because I believe that there is a great deal of confusion on the subject among too many people. A healthy diet, as the hon. Member for Eccles will know, is a well-balanced and varied diet. It should consist of foods in the following groups: bread, other cereals, potatoes, fruit and vegetables, milk and dairy foods, meat, fish and alternatives.
It is important for people to understand the fundamental basis of a healthy diet. The diet of British schoolchildren is important. The growth of primary school children between the ages of five and 11 in England and Scotland was monitored between 1972 and 1994 by the national study of health and growth, which was funded by the old Department of Health and Social Security and the current Department of Health.
In 1995, the health survey for England took over that responsibility. The NSHG has demonstrated consistently over the years that children of all ages, in all population groups, including low-income, inner-city and ethnic-minority groups, are growing taller and heavier than before. That is significant, because it suggests that there is no evidence of under-nutrition among young people and children in this country.
A summary of the results of the survey, "Trends in Growth in England and Scotland", was published in a scientific journal on 11 March and generated much media attention, as it claimed to show that, although children in all groups studied had grown on average taller and heavier year on year, that was not wholly good news, because fatness among the children had also increased markedly. It was speculated that that was due to increasingly inactive life styles over the period.
The heights and weights of children were measured by the national diet and nutrition survey, which was published in 1995. It showed that children in all groups had heights and weights at or above the national standard--again, no sign of the faltering growth that may be due to under-nutrition. It is important to have that on the record, so that people do not misunderstand the results of the expert research.
There is no recent representative study of children in secondary school, but the Department of Health and Social Security survey of the diets of British schoolchildren carried out in 1982-83 found that both 10 to 11-year-olds and 14 to 15-year-olds were growing taller and heavier than ever before. That reflected the evidence of the research I mentioned earlier, on the younger age group. The field work suggests that there is no evidence of under-nutrition. A survey of the diets of more than 3,000 children aged 10 to 11 and 14 to 15 carried out in 1982-83 showed that, for intakes of all nutrients, children were above recommended levels. That adds weight to the argument that there is no under-nutrition.
Some recent surveys claim to show that a significant proportion of women on income support are seriously deficient in several essential vitamins and minerals, causing low birth weights and a high rate of infant mortality. However, our records show that infant deaths--deaths of babies under one year--which is accepted internationally as an indicator of general health, are at their lowest rate ever.
In social classes IV and V, infant death rates have fallen by more than half over the past 15 years. Infant death rates in social class V are better than those of social class I only 15 years ago. The trend is towards steadily improving health. I am sure that the hon. Lady welcomes that, because it is a great step forward for the infant mortality rate to drop so dramatically over a relatively short period.
The hon. Lady mentioned reports on nutrition-related diseases. The claim that children are living in poverty on inadequate diets concerns us all and cannot be lightly
dismissed, even if we are not prepared to agree that there is evidence from proper research to back up that claim. In recent years, several reports have claimed exactly that. As she said--they are her words, not mine--they claim that we are returning to 19th-century levels of illness, with rickets and iron deficiency on the increase. Those claims are not borne out by the facts. I repeat that, because it is important: the claims are not borne out by the facts.
Let us take, for example, rickets. There is no reliable evidence that rickets, which is caused by vitamin D deficiency, is on the increase. In fact, there is good evidence that rickets, which used to be especially prevalent among Asian communities, is no longer a significant problem for those groups.
We know of occasional cases of rickets associated with extreme diets. Every effort is being made to identify their causes, with a view to reducing even those isolated cases by, for example, making available vitamin drops containing vitamin D for pregnant and lactating women, and for children under five. They are available free to families on income support, income-related jobseeker's allowance or family credit. They are available at low cost through child health clinics to the rest of population.
I caution against relying on anecdotal reports of rickets in the medical literature on extreme diets. As I have said, there is no reliable evidence that rickets is on the increase, and we have evidence to show that it is declining. The Committee on Medical Aspects of Food and Nutrition Policy has established an expert working group to consider the nutritional aspects of bone health in the UK population. A report from the group is expected in 1998.
On 2 January, field work for the national diet and nutritional survey of young people aged four to 18 years started. That will measure all aspects of the diet and nutritional status of young people, and will be an important enhancement of our knowledge and understanding, based on scientific and medical research.
The hon. Lady mentioned tuberculosis, which is also worrying. I agree that no one should downgrade or dismiss the problems, suffering and misery associated with it. However, the UK has an excellent record of TB control, and we are determined that that should continue. TB notification in England and Wales has reached the low level of fewer than 6,000 cases a year, compared with around 50,000 a year in 1950, only 47 years ago. She will agree that that is a dramatic drop over a relatively short period in the history of medical science.
Our success has been achieved against the background of a worldwide resurgence of TB, which is having a small but important impact on UK trends. The Government are responding positively to adverse developments abroad by strengthening our policies to protect the health of the nation against TB. Notifications of TB tend to be higher in more deprived, inner-city areas, but that does not mean that poverty and TB go hand in hand. That is down to the co-existence of some key risk factors, including a high proportion of ethnic minority groups, higher levels of HIV infection, and homelessness. We are working to deal with the specific needs of those groups by the following measures.
We are considering how to improve screening procedures for immigrants from countries with a high incidence of TB, which will allow us to treat them more
effectively. A working group on TB set up by the Department of Health to recommend further improvements in TB prevention and control published two reports last summer. One, entitled, "Tuberculosis and Homeless People", considers in detail the special needs of homeless people. We are acting on its recommendations.
Finally, and most importantly, our BCG immunisation programme to protect against TB is continuing. BCG immunisation is routinely recommended for all schoolchildren aged between 10 and 14. In addition, immunisation of high-risk groups and babies continues. That wide-ranging package should allow us to continue our proud record of TB control. I hope that the hon. Lady is reassured by those Government actions.
I hope that the hon. Lady will forgive for me dealing with anaemia, which is an important problem associated with children, but one that she did not mention. Anaemia is the clinical manifestation of iron deficiency. Its prevalence among young children has been monitored by the national diet and nutrition survey of children aged one and a half to four and a half years, which was published 1995. Seven per cent. of males and 9 per cent. of females in that age group had haemoglobin levels below the 11 g/dl World Health Organisation level which is considered indicative of anaemia.
On 2 January 1997, field work for the national diet and nutrition survey of young people aged four to 18 years started. It will include measures of iron status. The joint Department of Health/Medical Research Council nutrition research programme will fund research to help develop better measures of iron status. The Committee on Medical Aspects of Food and Nutrition Policy has agreed to convene an expert group to assess the iron status of the population. Although the group has not yet started work, it will do in due course.
Related to anaemia and iron deficiency is the question of healthy eating, which is important for everyone. Research shows that many young people could eat a better balanced diet that was less rich in fat. The hon. Lady devoted a significant proportion of her speech to the problems associated with the quality of the diet given to children by their parents. With the advent of fast food, that is a problem, because young children and teenagers are attracted to hamburgers, beefburgers and fried chicken rather than to what nutritionists consider a more responsible, sensible and healthy diet.
May I briefly explain the background to school food? As the hon. Lady will know, under sections 512 and 534 of the Education Act 1996, local education authorities and grant-maintained schools were given the responsibility for the presentation, content and cost of school meals. They must provide free meals to children whose parents receive income support or income-based jobseeker's allowance. They are not obliged to provide meals for other pupils, but in practice most schools do. The price of meals can be subsidised by LEAs and schools.
The development of practical national guidance for the school catering sector was taken on by the nutrition task force's catering working group, which set up a sub-group consisting of representatives from the catering world, the health education world, school meals providers and local authorities. The guidance is based on detailed nutritional guidelines for school meals, drawn up by the Caroline Walker Trust.
The project team has developed voluntary guidance in three parts. The first is aimed at head teachers and governors; the second at LEAs and grant-maintained schools; and the third at school caterers. There are no plans to introduce compulsory nutritional guidelines, and the guidance makes no reference to recent food scares, but it provides guidance which should have a positive and beneficial effect on the balance of the diet of school children.
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