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Mr. Win Griffiths: To ask the Secretary of State for Health what estimate he has made of the health costs of air pollution indicating the health problems of principal concern and the main source of the pollutants. 
Yvette Cooper: The Department's Committee on the Medical Effect of Air Pollutants (COMEAP) published a report in 1998 on 'Quantification of the Health Effects of Air Pollution on Health in the United Kingdom'. The report was based on levels of pollutants in 1995. It estimated that the deaths of between 12,000 and 24,000 vulnerable people (mainly those with heart or lung disease) may be brought forward and between 14,000 and 24,000 respiratory hospital admissions and readmissions may be associated with short term exposure to air pollution each year. There was insufficient information to allow quantification of other health effects of air pollution.
The main pollutants of concern were particles and ozone. Particle levels have decreased since 1995 but there is no clear downward trend for ozone. The main sources of particles are primary particles from combustion sources (mainly road traffic), secondary particles, mainly sulphate and nitrate formed by chemical reactions in the atmosphere and coarse particles such as dust and biological particles. Ozone arises from chemical reactions of pollutants in the atmosphere in the presence of sunlight. The precursor pollutants include nitrogen oxides and volatile organic compounds form traffic and industry.
Needle exchange facilities are generally provided directly through the National Health Service or through voluntary sector agencies under agreement with health authorities, or through community pharmacies. They are subject to the normal monitoring arrangements exercised by health authorities.
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The Department published revised "Drug Misuse and Dependence--Guidelines on Clinical Management" last April and sent these to all doctors. The guidelines include advice on blood-borne diseases and on injecting drug use.
During 2000-01 it is planned that guidance for professionals will be published, expanding on the information in the Department's clinical guidelines. Regional seminars are to be held for professionals to raise awareness of the guidance, and increase skills in delivering prevention messages.
Yvette Cooper: The Prison Service has a strategy for preventing the spread of hepatitis C, and other communicable diseases, in prisons. This includes training for staff, education and information for prisoners and measures to reduce the risk of transmission. Where clinically indicated, a prisoner who has tested positive for hepatitis C would be referred to a National Health Service specialist for expert advice on the clinical management of the case.
Yvette Cooper: The Department is continuing to raise awareness of hepatitis C by working with the voluntary sector and others to provide information and advice for the general public and for those groups most at risk, specifically injecting drug users.
Hepatitis C is spread primarily by contact with the blood of an infected person, and injecting drug users are at increased risk of infection. In this country, there is a robust approach to harm minimisation that includes widespread needle exchange schemes and substitute prescribing, both of which encourage people not to inject and not to share injecting drug equipment. We are currently improving the effectiveness and efficiency of these programmes through shared care schemes. Guidance on hepatitis C and strategies to minimise transmission is being developed and will be backed up by regionally based workshops and seminars.
The risk of transmission of hepatitis C via blood donations has been virtually eliminated by the screening of blood donors for antibodies to hepatitis C virus and the treatment of blood products. Organs and tissues for donation are also screened for hepatitis C. The risk of hepatitis C transmission in the clinical setting is minimised by adhering to universal infection control procedures. To emphasise this, guidance has been issued to the National Health Service on minimising the risk of occupationally acquired hepatitis C for health care workers. Guidance on the prevention and control of blood-borne virus infection in renal dialysis units, which includes advice on hepatitis C, is currently being finalised. The Advisory Group on Hepatitis C is currently reviewing its advice on hepatitis C infected health care workers.
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Yvette Cooper: Current information suggests that the prevalence (current level) of chronic carriage of hepatitis C may be around 0.5 per cent. of the general population. The incidence (new infection) of hepatitis C is not known as the virus is usually acquired without symptoms. Data from surveillance of antibody positive hepatitis C laboratory reports in the United Kingdom during the period 1995-99 are set out in the table. These laboratory reports do not distinguish between new and chronic infections, and reflect current laboratory testing patterns. They do not take into account under-reporting and under-ascertainment of cases.
|Year||England and Wales(51)||Scotland(52)||Northern Ireland(53)|
(51) Source: Public Health Laboratory Service
(52) Source: Scottish Centre for Infection and Environmental Health
(53) Source: Department of Health, Social Services and Public Safety, Northern Ireland.
(54) Provisional figures to week 36
(55) To date
Dr. Iddon: To ask the Secretary of State for Health if he will make a statement on the availability of harm reduction facilities, with special reference to needle exchange, in the last five years; and what assessment he has made of the effects of needle exchange facilities on the prevalence of hepatitis C among injecting drug users. 
Yvette Cooper: Our anti-drugs strategy is clear about the benefits of a policy that discourages drug use but also recognises that some people may still use illegal drugs. It is important to minimise the health risks and harm for those who do so.
Data from the drug action team template returns for 1999-2000 show a combined total of 322 statutory and voluntary sector providers of needle exchange services. The directory "Drug Problems: where to get help", published by the voluntary sector organisation Drugscope, lists 124 voluntary and statutory agencies which provide needle exchange facilities for injecting drug misusers. These data are not comparable due to their different methods of collection.
Other measures to minimise the spread of hepatitis C among drug misusers include the prescription of oral substitute medication, and health promotion literature. Guidance on harm reduction for injecting drug misusers, and current carriers of hepatitis C, are included in the Department's clinical guidelines "Drug Misuse and Dependence--Guidelines on Clinical Management", which were published last year and sent to all doctors.
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might not otherwise engage with services. It is generally acknowledged that the introduction of needle exchanges have been instrumental in averting an HIV epidemic among drug misusers. The latest report by the European Monitoring Centre for Drugs and Drug Addiction shows that the United Kingdom has the lowest rate of hepatitis C prevalence in the European Union.
Yvette Cooper: The Department will continue to raise awareness of hepatitis C by working with the voluntary sector and others to provide information and advice for the general public and for those groups most at risk, specifically injecting drug users.
Those who have been at risk of exposure to hepatitis C and who seek testing in the National Health Service should be offered well-informed advice and made aware of the implications of a positive test. Those who test positive will be referred to a specialist for confirmatory testing, further assessment and treatment, if appropriate.
Yvette Cooper: Our approach to hepatitis C is to develop a strategic national programme which involves co-ordination in areas such as public health work on prevention and surveillance; tackling drug misuse; prison healthcare; research; commissioning healthcare services and implementing the recommendations of the National Institute of Clinical Excellence.
Yvette Cooper: Our approach to hepatitis C is to develop a strategic programme which involves co-ordination in areas such as public health work on prevention and surveillance; tackling drug misuse; prison healthcare; research; commissioning healthcare services and implementing the recommendations of the National Institute of Clinical Excellence.
Yvette Cooper: There are no plans at present for the National Institute for Clinical Excellence to produce guidance on drugs for the treatment of HIV. NICE completed appraisals of ribavirin and alfa interferon for hepatitis C on 31 October 2000. This guidance and further information on the NICE work programme can be found on NICE's website at www.nice.org.uk.
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Yvette Cooper: Yes. We recently published the NHS Cancer Plan setting out a comprehensive strategy to tackle cancer and through a major programme of action linking prevention, diagnosis, treatment, care and research. The Plan pledges to cut the death rate from all cancers by one fifth by 2010, this includes the death rate from liver cell cancer secondary to hepatitis C.
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