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North Nantymoel (Polling Station)

6.10 pm

Huw Irranca-Davies (Ogmore) (Lab): I am pleased to present to the House of Commons a petition on behalf of the residents of north Nantymoel and others that has been collected by Community Councillor Enid Lock.

The petition declares:

and Bridgend county borough council—

To lie upon the Table.

15 Mar 2005 : Column 227

Cholesterol and Disease Prevention

Motion made, and Question proposed, That this House do now adjourn.—[Vernon Coaker.]

6.11 pm

Dr. Howard Stoate (Dartford) (Lab): I welcome the public health White Paper and the Government's renewed commitment to promoting public health and investing in disease prevention. I pay tribute to Health Ministers, and in particular to the hard work done by my hon. Friend the Minister for Public Health, who has done a great deal to promote public health in the Government and to help to raise awareness of the importance of healthy living among the public and the media.

The White Paper and the measures that flow from it will help to enable the public to make more informed choices about their health and to take greater responsibility for their own health and well-being. That is of critical importance if we are to make sustained, long-term improvements in the health of this nation. Everyone, regardless of age, can do a great deal significantly to reduce their risk of developing diseases, such as heart disease, stroke and diabetes, as well as obesity. It is essential therefore, that disease prevention is placed at the heart of our public health strategy.

I am heartened by the positive steps that the Government, together with primary care providers and non-governmental organisations that operate in health care, have taken to raise the profile of disease prevention and to provide direct extra resources for preventive strategies. For example, the newly established National Obesity Institute, of which I am a trustee, has chosen to focus its activities on public health and healthy lifestyle promotion, in line with the ethos of prevention, in preference to the narrower issue of obesity and weight management. The institute looks forward to working with Departments and acting as a catalyst for the development of innovative strategies and disseminating best practice.

The challenges are formidable. It is clear both from the tenor of debate in Westminster and in the media that, as a society, we have yet to comprehend fully the importance of disease prevention. Four months on from the publication of the public health White Paper, the media are dominated by debates about MRSA and the performance of accident and emergency departments, rather than some of the fundamental primary care and public health issues that will influence the future of everyone in the nation.

Coronary heart disease remains the nation's biggest killer. In turn, raised cholesterol is the single greatest risk factor for heart disease. Statistics show that raised blood cholesterol is a factor in nearly half of all coronary heart disease cases—47 per cent.—and is more significant even than smoking, blood pressure problems or the lack of exercise. Moreover, high blood cholesterol levels in diabetics and obese individuals carry an even greater health risk than in normal weight, non-diabetic people.

Most people can help to lower and manage their cholesterol by changing their diet and lifestyle. Last year, for example, the "Winning the War on Heart Disease" progress report highlighted positive steps to
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prevent death from heart attacks. Statistics show that that is a continuing trend, which is obviously good news. However, statistics also show that more people are developing heart disease. We would like that trend to be reversed. Many people are effectively being ignored because health advice about diet and lifestyle changes is not reaching them. Ironically, those people are often those who are most at risk: those in lower socio-economic classes and those living in more impoverished circumstances. Those people are the heart patients of tomorrow, as are their children. We should give special priority to helping them through public health initiatives.

I share the worries of Cholesterol UK, which has been enormously helpful by providing briefings for the debate. It, along with other organisations, has actively supported moves to focus on cholesterol as the biggest single risk factor for heart disease. Diet and lifestyle changes are achievable to reduce cholesterol levels and they could contribute significantly to reducing the cost of treating heart disease patients.

At present, 70 per cent. of UK adults aged over 35 have a cholesterol level in excess of the recommended 5 millimoles per litre. As the Joint British Societies' guidelines are to be updated in 2005 with a lower recommended cholesterol level of less than 4 millimoles per litre, it is certain that the proportion of people with cholesterol above the recommended level will increase. However, less than 5 per cent. of the population recognise that cholesterol is the major risk factor for coronary heart disease. Most people still think that smoking is the major factor.

Studies have shown that a 5 per cent. reduction in the cholesterol of people aged 30 to 74 with raised cholesterol levels could reduce the number of people qualifying for treatment under the national service framework for coronary heart disease by 500,000. A 10 per cent. reduction in the cholesterol of those individuals could mean that almost 1 million people would no longer require treatment. Likewise, studies show that a 10 per cent. reduction in cholesterol in a 40-year-old male, which is achievable by changing diet and lifestyle, would lead to a 54 per cent. reduction in the risk of heart disease. The Health Development Agency recently published a report showing that reducing cholesterol levels by even a small amount would prevent approximately 25,000 premature deaths each year—that is quite possible.

Some 51 per cent. of the decline in recent years in deaths due to coronary heart disease in Scotland is attributable to the reduction of risk factors such as smoking, cholesterol levels and blood pressure, as well as improvements to social and economic circumstances. Even people with a family history of high cholesterol levels can enjoy improved health outcomes through changes to their diet and lifestyle.

Coronary heart disease costs the UK economy more than £7 billion each year. Through the national service framework for CHD, the Government have placed great emphasis on lowering cholesterol as part of secondary prevention strategies for those at high risk of CHD or those who have already had a coronary event. In particular, they have supported the introduction of statins in all coronary disease management guidelines and introduced the licensing of over-the-counter statins. However, that recognition has been omitted, in a
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broader primary prevention sense, from public health messages relating to diet and lifestyle approaches on lowering cholesterol.

The cost of treating heart disease will continue to rise. The Department of Health's annual spend on statins is £700 million and rising. It is said that the figure will reach £2.1 billion by 2010. Lipid-lowering drugs now cost the NHS more than any other class of drugs—they overtook ulcer-healing drugs in 2001. Between 2002 and 2003, 22 per cent. of the overall increase in the cost of drugs to the NHS was due to lipid-lowering drugs.

Many other diseases are linked to cholesterol. Raised cholesterol is a major risk factor in the 110,000 strokes suffered each year in the UK. Obesity and heart disease are inextricably linked because obesity increases the likelihood of high cholesterol, high blood pressure and diabetes, all of which are key risk factors for heart disease and stroke. Obesity also significantly increases the risk of cancer and affects mental health, with a rise in depression and suicide.

There is also some good news. A recent study involving patients with high cholesterol showed that through increased awareness of their cholesterol levels, individuals were more motivated to improve their diet and take more exercise. That had a positive effect on reducing their risk of heart disease and certain cancers, especially gastrointestinal cancers.

As I have already said, everyone can benefit from lowering their cholesterol and there is no lower limit on cholesterol reduction. Much of the focus to date has been on reducing smoking and salt intake and increasing the consumption of fruit and vegetables, all of which are welcome. However, cholesterol, as one of the major risk factors for heart disease and stroke, needs to be given an equivalent focus by the Department of Health in the public health strategy outlined in the White Paper. Moreover, although the White Paper rightly prioritises action for children and those in mid-life, I would welcome the Government implementing measures aimed at people aged between 15 and 55 to help them to make the lifestyle changes necessary to stay in good health and prevent disease.

Enabling that group, which the NHS has found hard to reach in the past, to take greater responsibility for their own health will not only help to reduce the incidence of chronic and debilitating disease but will minimise the growing financial cost to the NHS of managing chronic disease. There are concerns, however, in some quarters about the Government's ability to ensure implementation of the many good actions proposed in the White Paper. It states that the Government will issue a technical note to the NHS reinforcing the priorities that it sets out. I would like the Government to go further. If there is not a clear accountability structure for the implementation of the White Paper, it will not receive the local funding and prioritisation that it needs.

The White Paper states that the new contract for primary care "offers enormous potential". GPs and their teams are vital to successful public health strategies, and there should be a clearer commitment to action through the new contract. In particular, measurement of body mass index should be a target for GP practices with appropriate quality points attached.
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People with a raised BMI should have their lipids measured and there should be a follow-up to ensure that the effects are dealt with.

One well-known public health initiative took place in Finland, where the incidence of coronary heart disease was the highest in Europe. Community projects such as the north Karelia project have shown that a reduction in cholesterol levels significantly reduces heart disease, and that that can be achieved through diet and lifestyle. The   Finnish programmes focused on changing dietary habits through health education, cholesterol awareness campaigns, community participation programmes, national guidance by Government and heart associations, food and agriculture industry collaborations and so on. From 1972 to 1995, the heart disease mortality reduction was 65 per cent.—and that was prior to the introduction of statins. Professor Pekka Puska, who led the programme in north Karelia, will speak at the associate parliamentary food and health forum on 22 March. He will present the successful results achieved in Finland and outline the ongoing challenges to maintaining healthier lifestyles.

Informed choice is a significant part of the public health White Paper. Building on the success of the Food Standards Agency's recent campaign on salt, it would be prudent to address the other two main food groups—fat and sugar—as part of a comprehensive public health strategy. The positive results of the salt awareness campaign indicate that the public welcome greater information on how to lead healthier lives. The all-party parliamentary group on men's health, which I chair, and the men's health forum are attempting to ensure that such information is provided. Contrary to accepted wisdom, men are extremely concerned about health issues, but they are notoriously bad at seeking advice from conventional sources. We must therefore develop new strategies to reach them.

A public awareness campaign that highlights the role of good and bad fats and dispels the myths around fat would be a positive step in addressing ways of reducing cholesterol levels in the population and makes sound economic sense. The salt campaign was funded with a mere £4 million, and the cost savings of not having to treat people who might otherwise develop heart disease are enormous. It is encouraging that about one in four MPs signed early-day motion 1426 last summer in support of a national cholesterol awareness campaign.

A Cholesterol UK survey in 2004 showed that only 5 per cent. of the population realises that cholesterol is a major risk factor. It also revealed a clear lack of understanding of what constitutes a healthy diet. It is probably safe to say that there is considerable confusion about diet, and an awareness campaign that dispels misunderstandings would be a positive step in helping people to understand what they should be eating. The White Paper delivery plans outline a national obesity awareness campaign. As I have already discussed, at the very least that must include messages about cholesterol, and ways of reducing cholesterol levels and ensuring that comprehensive dietary advice is directed at people who need it. Likewise, the proposal for a communication and education programme for older people should include health messages to avert the risk of poor health in later life. That strategy should be extended to everyone, as the sooner people adopt healthier lifestyles and are given the tools and information to do so, the greater the benefit in preventing disease in future.
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There should be greater emphasis on primary screening. It is difficult to obtain a heart health check-up on the NHS, particularly for someone who does not have a family history of heart disease or has not reached middle age. Easier access to measurement of cholesterol, blood pressure, blood sugar, and body mass index or waist circumference measurement can provide the necessary motivation for people to take action to improve their health. That should not be an additional responsibility for GPs. Pharmacies could provide much of the service through appropriate contracts with primary care trusts.

One has only to look at the huge popularity of the free Boots cholesterol screening service to see that the UK population is interested in understanding the health risks. Lloyds Pharmacy last year introduced a trial of a coronary risk assessment programme in 31 pharmacies in Cardiff, Newport and Sheffield. Following a positive evaluation, which included written patient surveys and feedback from customer groups, an additional service was introduced in 10 further pharmacies, starting earlier this year.

We must continue to make more use of the expertise and enthusiasm of community pharmacists in the future. As well as being an ideal provider of cholesterol tests, blood pressure checks, sugar tests and body mass index, community pharmacists are well placed to help raise public awareness about cholesterol and the importance of eating and exercising healthily. A number of community pharmacists have received specialist training on cholesterol and the options available to manage it through lifestyle advice, smoking cessation and statins. We should be taking greater advantage of those skills.

The many measures to provide more training for health care professionals in public health are welcome. In particular, I am pleased to see that primary health care professionals including GPs, practice nurses, dieticians and pharmacists are becoming equipped fully to advise patients on diet and lifestyle changes. Many have made the effort to train, but some have not. That should be incentivised by inclusion in the relevant contracts. In addition, appropriate evidence-based information is the key.

The Government should take the lead in providing clear, simple, evidence-based guidelines. There is currently insufficient consensus among primary care professionals on which guidelines to use. Many are secondary care focused, rather than appropriate for primary prevention for the majority of individuals. As the public and non-high risk individuals increasingly seek advice from GPs, practice nurses, occupational and community-based nurses and pharmacists as well as dieticians and nutritionists, it is important that guidelines and information for health care professionals provide consistently simple, practical and user-friendly advice.

The new Joint British Societies' guidelines on the prevention of coronary heart disease in clinical practice and the current British Hypertension Society's guidelines for the management of hypertension offer an opportunity for a simple, condensed version of primary prevention sections to be developed and circulated to
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relevant primary care professionals, providing the latest evidence-based information in accessible form. This could be developed independently with Government funding and distributed through NHS organisations.

In summary, I reiterate my support for the ongoing strategies in public health in the UK. It is clear that there is a need and a demand for accurate and accessible information. It is important to include all levels of society in those strategies. Increased awareness of the dangers of unhealthy levels of cholesterol, greater access to heart health check-ups, including cholesterol tests to motivate individuals, and the development of practical guidelines for health care professionals to help individuals adopt a healthier lifestyle are all important elements of a public health strategy. These recommendations should not work in isolation, but should be part of an integrated approach to implementing the many positive steps outlined in the public health White Paper. I look forward to my hon. Friend the Minister's response.

6.27 pm

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