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The Minister for Public Health (Yvette Cooper): The most recent evidence shows that smoking rates among children aged from 11 to 15 fell from 13 per cent. in 1996 to 9 per cent. in 1999, while adult smoking levels also fell. However, smoking rates among 16 to 19-year-olds rose between 1992 and 1998. That is why the Government have put in place a broad strategy to cut deaths from smoking, including the banning of tobacco advertising, which has a significant impact on smoking among children and young people.
Mr. Taylor: In the next 24 hours, 500 British teenagers will, on average, take a decade off their lives by taking up smoking. Is my hon. Friend convinced that we can reduce that dreadful toll by hitting the targets set out in the 1998 White Paper, "Smoking Kills"? Will she introduce a national scheme to provide children with proof-of-age cards, which have been successful in parts of Leicestershire and elsewhere in reducing under-age tobacco sales? Will she read the Hansard record for 24 April, when my ten-minute Bill will be debated, and take the opportunity to review those topics?
Yvette Cooper: My hon. Friend is right that smoking has a huge impact on health. We have already made progress on under-16s, but we have considerably more to do. He mentioned proof-of-age cards, which can play an important part in enforcement strategies to cut under-age sales. We are keen to encourage the sort of programme that has been initiated in Leicestershire, and we shall consider his proposals in detail.
Mr. Nick St. Aubyn (Guildford): Given the appalling increase since the Government came to power in the number of teenagers who smoke illegally imported tobacco, is not it one of the worst cases of Government mismanagement that they increase taxes on tobacco while failing to increase the services and Customs and Excise men to stop the smuggling? It is their fault that these teenagers are now smoking illegal cigarettes.
Yvette Cooper: I must point out that smuggling is a serious problem not only in this country, but in Italy, which has low duty rates. Smuggling is a problem of organised crime and not of duty rates. That is exactly why the
The Secretary of State for Health (Mr. Alan Milburn): Across the Government, there is a commitment to tackle health inequalities. For the first time, new national targets have been set to reduce the health gap among children and between geographical areas. We have backed that commitment with extra resources for the poorest parts of the country.
Mr. Benn: I am grateful to my right hon. Friend for that reply. Is he aware of the research published by Dr. Richard Mitchell and Professor Daniel Dorling of the university of Leeds, and Dr. Mary Shaw of the university of Bristol, which suggests that about 7,500 lives a year could be saved among people under the age of 65 if inequalities in wealth were to decrease? Does he therefore agree, unlike the previous Government, that reducing poverty has as big a part to play in reducing health inequalities as the improvements in primary health care to which he is committed?
Mr. Milburn: I agree with my hon. Friend. As all hon. Members know from their constituencies, there is a direct relationship between poverty, deprivation and ill health. That is irrefutably the case. We also know from the statistics that a child born today into the poorest family in the land will, on average, live 10 years less than a child born into the richest family in the land, which, for most people, is an unacceptable state of affairs that must change. We know what the attitude of previous Governments has been. The hon. Member for Woodspring (Dr. Fox) summed it up neatly when he said:
Sir Patrick Cormack (South Staffordshire): Is the right hon. Gentleman aware that many social inequalities are caused by variable waiting lists? Will he address the sort of problem that is faced by constituents of mine who have to wait significantly longer for their treatment at the New Cross hospital in Wolverhampton than those who live in Wolverhampton itself? That is a real social inequality, which needs addressing.
Mr. Eric Illsley (Barnsley, Central): Nowhere are social inequalities in health more apparent than in my constituency, mainly as a result of historical underfunding under the previous Government. Even now, because of the difficulties in my area, my local health authority faces yet another deficit in its health budget of about £3 million. I plead once again with my right hon. Friend to reconsider the funding of Barnsley health authority, whose funding is one of the lowest in the country, to try to alleviate some of those problems.
Mr. Milburn: As my hon. Friend is aware, not only Barnsley health authority but health authorities throughout the country will receive extra investment. He will also be aware that we are committed to changing the way in which cash is distributed within the NHS to ensure that it is much more geared to tackling such appalling health inequalities. In the meantime, we have made £130 million available to 50 or so health authorities with the highest incidence of early deaths and high morbidity from some of the diseases that we have been discussing today, including coronary heart disease and cancer.
We have a simple choice: we can either continue to do what has been done in the past and wring our hands at the dreadful facts around inequalities, regret those facts and say that, in the end, trickle-down economics will hit the poorest communities and the poorest people, or recognise, as the Government do, that we must learn from history that trickle-down economics have failed and have not benefited the poorest people in the poorest communities. We can then redouble our effort to do what Governments for many a generation should have done, which is to improve the nation's health overall and improve the health of the poorest people fastest.
Mr. David Chidgey (Eastleigh): Does the Minister share my worry about the social consequences in communities of CJD outbreaks? Is he aware that the national surveillance unit has just identified a number of clusters throughout the kingdom, including in my constituency, but its preliminary investigations have shown no strong links? I am anxious that there should be a detailed investigation into the causal links between the cases in my constituency. Does he agree that it is vital that such detailed investigations are carried out as quickly as possible, first to identify causal links and, secondly and most importantly, to allay the concerns of those in larger communities who are frightened by that terrifying disease?
Mr. Milburn: The hon. Gentleman is right to say that it is a terrifying disease. The national variant CJD surveillance unit does a good job and, where there are outbreaks or clusters, we must try to find out why. The hon. Gentleman is aware that, in Queniborough in Leicestershire, research was carried out into the background factors that led to a cluster of deaths from variant CJD. If there are other clusters, we shall want to consider background causes. We must do that because we
Mr. Lawrie Quinn (Scarborough and Whitby): Does my right hon. Friend recognise the inequalities in health provision in rural areas such as my constituency? Will he confirm that, in future, hospitals such as Whitby community hospital will be a focal point for dealing with inequalities in dentistry provision and eyesight problems, and that they will form a key plank in our strategy for tackling inequalities in rural areas?
Mr. Milburn: My hon. Friend makes a good point. All too often, we perceive health inequalities in terms of the concentration of poverty and deprivation in inner-city or urban areas such as those that my hon. Friend the Member for Barnsley, Central (Mr. Illsley) mentioned. However, as we all know from our constituencies, there are also large concentrations of poverty, deprivation and ill health in rural areas. I therefore give my hon. Friend the Member for Scarborough and Whitby (Mr. Quinn) a firm assurance that, when the new formula for distributing cash across the national health service is introduced in 2003, it will have a particular perspective on the way in which we recognise the needs of rural communities.