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12.43 am

The Minister for Public Health (Ms Tessa Jowell): I congratulate my hon. Friend the Member for Romford (Mrs. Gordon) on introducing tonight's debate, and on the extremely eloquent and informed way in which she addressed the issue. She highlighted the problem of children and young people with back pain. I appreciate, as do other hon. Members, how debilitating back pain can be, and the effect that it can have not only on the general health of sufferers, but on their social, economic and psychological well-being as well as that of their families.

As my hon. Friend said, back pain can be costly to employers and, if it is not properly treated, to the national health service. There are, however, fairly strict regulations for adult workers. It is the responsibility of the Health and Safety Executive to formulate guidance and to oversee the implementation of European and United Kingdom regulations.

We do not think it necessary to legislate for how people should go about their everyday tasks or how schoolchildren should carry their books or other possessions. However, I take the point, which my hon. Friend made so forcefully, that we need to take account of the damage that many young people may be inflicting on themselves. Certainly we should do well to remember that the child with back pain today may be the adult with a chronic disability tomorrow.

Nearly a third of the population will suffer some back pain at some time in the year; possibly half that number will consult their general practitioners about it. For a

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small proportion--about 3 to 5 per cent.--of people, back pain will be a chronic condition, which will, in many cases, prevent them from working and require them to rely on disability benefits or to claim compensation through their employers or insurance companies, with all the difficulties that that involves.

Back pain in adults can be serious, although it is generally short-lived. There are clinical guidelines on treatment and programmes of rehabilitation. Moreover, there are a number of research projects and, thanks to organisations such as the National Back Pain Association, to which my hon. Friend paid tribute, there are good sources of advice and information, including information on self-help, as she made clear.

Back pain in children brings with it different considerations, such as the effect it can have on educational development and the carry-over of problems into adulthood. The Department of Health has noted reports of an increasing number of children being referred for treatment of back pain. Although the design and weight of school bags may play a part in that, other factors--such as physical fitness, good posture and healthy life styles--are also important.

The reported increase in back pain is a matter of considerable concern for both the Department of Health and the Department for Education and Employment. For children to realise their full educational potential, they must be both physically fit and mentally receptive, as both Departments fully recognise--we have been working together on a number of initiatives aimed at achieving precisely that objective in schools.

The Department for Education and Employment's White Paper "Excellence in schools" identified the importance of a good education for all children, especially those who were likely already to be disadvantaged because of their social background. The Government's consultation paper "Our Healthier Nation" has continued that theme, stressing the importance of the link between educational achievement and some of the social problems that teenagers, in particular, may face.

When the Under-Secretary of State for Education and Employment, my hon. Friend the Member for Birmingham, Yardley (Ms Morris), and I launched the initiative on healthy schools in May, we were both aware of the need to promote better recognition of the link between health and education and to encourage schools to lay down foundations on which children could go on to lead healthy, active and productive adult lives. The problem of back pain is only one aspect of that, although it is important and of growing significance.

I fully appreciate my hon. Friend's concerns about the problems that pupils may experience in carrying heavy bags and the possible effects in later life. The National Back Pain Association has focused on the problem of heavy school bags and will, I understand, promote the sale of a specially designed school bag later this year.

We are pleased to welcome that practical development, but we should remember that some children's decisions are defined by fashion and culture rather than any thought for their future health. Many children regard the odd twinge as a price worth paying to seem to their friends to be at the leading edge of fashion. There are clear parallels with parental battles over sensible footwear--not something to which a fashion-conscious 13-year-old will give a great deal of thought.

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There may be a number of other possible solutions, such as having lockers, desks, or at least safe places available for children to store their books in school; or limiting children's need to move to different classrooms during the day. Those are matters for the school authorities, which must also take into account other factors, such as security and practicability. It is also for the school to plan its timetable and decide where and when lessons take place.

It is important not to look at the problem of heavy school bags in isolation. The general health of children and young people will affect their susceptibility to back pain and other disorders, as will posture and life style.

Although we need to recognise the prevalence of, and to do something about, low back pain in both adults and children, we also need to put it in the wider context of public health. Exercise and physical activity are acknowledged to play an important part in maintaining good health and helping to prevent not only serious conditions such as coronary heart disease or stroke, but minor disabilities that can cause distress and affect a person's mental well-being.

In children and young people, in particular, physical activity is known to have multiple health benefits. Activities such as walking or cycling can improve the growth and development of bone and muscle, control blood pressure and promote the development of a healthy body weight.

We in the Department of Health are not simply preaching about those benefits. Indeed, preaching is likely to guarantee that the message will fall on deaf ears. We are working with the Department of the Environment, Transport and the Regions and the Department for Education and Employment to promote safe cycling and walking to and from school. We contributed to the DETR's White Paper on integrated transport, which aims to develop active modes of transport through, for example, dedicated cycle paths and better facilities for cycle parking at schools.

Last year, we funded through the Health Advisory Council a symposium of experts known as "Young and Active", which brought together specialists to agree new recommendations on the amount and type of physical activity that should be encouraged in order to benefit children's health. We have asked the council to produce recommendations that will help to inform future departmental strategy on physical activity and young people. I hope to be able to launch a report later this year.

That may seem to stray from the problem of children carrying around heavy bags of books, but I hope that hon. Members will recognise the need to see that problem in the wider context of healthy life styles for children and adults. People who are active tend to be those who were

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active in childhood, and children with prolonged back pain are likely to find the condition recurring when they are older. We must not forget the beneficial effect that physical activity can have on low self-esteem, particularly for children from disadvantaged groups and those with learning difficulties.

My hon. Friend's suggestion that legislation should limit the weight of children's bags is not likely to be the most practical or the best way to tackle the problem. Guidance to schools, parents and children is simpler and far more likely to be effective. The National Back Pain Association has produced guidelines for head teachers, and those have been welcomed. I should be happy to arrange for officials to meet the NBPA and other interested parties to discuss the most helpful way forward. That should be seen in the broad context of the Government's healthy schools initiative.

The Government fully recognise the seriousness of back pain. The Clinical Standards Advisory Group made a major advance in a 1994 report that highlighted the condition and made practical recommendations. One was that rehabilitation programmes should be set up for patients who had had back pain for more than three months. The report put particular emphasis on the need for an active rehabilitation programme provided in a multi-disciplinary setting with access to a wide range of professional skills and close links to other services and organisations. As well as medical supervision and physiotherapy, a programme might include education and training in back function, and the teaching of the type of relaxation and coping strategies referred to by my hon. Friend.

The findings of the advisory group were welcomed by both the professions concerned and the Department of Health. The report was distributed widely within the NHS, so that health authorities and trusts could consider action to improve services for people with back pain. As part of our plans to develop the new NHS, there will be greater emphasis on treatment and rehabilitation in the community. That should mean that most people with back pain can be seen earlier and closer to home, without the need for hospital treatment.

Back pain is a major cause of absence from work in the NHS itself. Methods of treatment must improve, but so must occupational health policies on the welfare and well-being of NHS staff. I believe that there is now more awareness of the need to give greater emphasis to promoting good back care and preventing avoidable injuries. There is a clear incentive for employers to reduce back injuries--the resultant days off work, and risks of litigation.

I reiterate my thanks to my hon. Friend for raising an important issue and for discussing prevention of injuries and the health of children.

Question put and agreed to.


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