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The Parliamentary Under-Secretary of State for Health (Dr. Stephen Ladyman): I thank my hon. Friend the Member for Dartford (Dr. Stoate) for raising this important topic and for his tireless campaigning on this and other health issues. His zealousness extends to those rare occasions when I treat myself to fried egg and chips in the Tea Room, when he sits next to me looking like an abandoned puppy and tutting when I put salt on my chips. Like him, I believe the Government have done well on the issue, but we can always do more. I hope I can reassure him that the Government recognise the continuing importance of efforts to reduce cholesterol levels. Reducing the incidence of heart disease is a key priority, and as he rightly says, reducing cholesterol is the key to success.
Coronary heart disease, or CHD, remains a major cause of death and disability, and risk factors in addition to elevated blood cholesterol levels include age, sex, hypertension, smoking and diabetes. As my hon. Friend realises, the cornerstone of CHD prevention is lifestyle modification, particularly through dietary change, to modify both the quantity and the quality of the fat consumed and to increase levels of physical activity.
Although it is the total level of cholesterol in blood that is the main risk factor for CHD, there is good and bad cholesterol. Low-density lipoprotein cholesterol concentrations are directly associated with CHD risk, and reducing levels of LDL-C lowers CHD risk. Over the past 20 to 30 years, dietary intake of saturated fats—for example, animal fats—has been discouraged because they may raise cholesterol levels, and the replacement of saturated fat with oils rich in linoleic acid, such as sunflower oil, is encouraged as a means of reducing CHD risk. The consumption of complex carbohydrates as a replacement for saturated fat is also encouraged.
As my hon. Friend has pointed out, we cannot expect the public to be food chemists or dieticians, so it is important to translate the advice into a more usable form. The Government therefore provide practical guidance on how consumers can reduce the saturated fat in their diets through healthy eating advice. As part of a balanced diet, foods rich in saturated fat must be
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replaced with unsaturated fats, such as oil-rich fish and foods containing oils such as sunflower oil, rapeseed oil and olive oil.
The Department of Health also funds a range of non-governmental organisations to increase awareness of the benefits of eating a healthy diet and of having an active lifestyle. Replacement of saturated fats with monounsaturated oils, such as rapeseed oil and olive oil, also has beneficial effects on blood LDL-C levels, which are similar to polyunsaturated fatty acids in their effect. More recently, industry has been active in making available foods that contain phytostanols—for example, in the form of spreads—which can also help to reduce blood cholesterol. Those products may not be easily accessible to everyone because of their price, but they are a means of self-help for some.
Government activities to promote healthier eating have had some success. The latest national diet and nutrition survey of adults from the ages of 19 to 64 indicates that, on a population basis, average intake of total fat has now reached the level recommended by the Committee on Medical Aspects of Food and Nutrition Policy, which is 35 per cent. of food energy being derived from fat. In contrast, the intakes of saturated fat remain higher than the recommended level at 13 per cent. of food energy compared with the recommended level of 11 per cent.
Following the publication of the public health White Paper, we published a delivery plan last week that explains how the Government will put those plans into practice. It includes 45 big wins that evidence suggests will make the greatest impact on health, and it also covers the policies and programmes that will be developed and implemented, targets to improve health and partnerships between industry, the voluntary sector, professional groups, local authorities and the NHS.
There are two plans—the food and health action plan and the physical activity plan—that set our actions to deliver improvements in diet and physical activity. The food and health action plan aims to improve diet and nutrition in England. It concerns the food that people eat, which influences the risk of developing chronic diseases, such as cardiovascular diseases and some cancers. Recognising that a significant proportion of the population consumes more than the recommended amount of saturated fat and sugar and less than the recommended amount of fruit and vegetables, the plan prioritises nutrition to reduce the consumption of fat, saturated fat, sugar and salt, and to increase the consumption of fruit and vegetables in the population.
The food plan presents the action that the Government will take across a wide range of areas. It sets out how we can develop healthy eating in a consumer society and how information can be improved to enable healthier choices. We are developing nutrient criteria to help identify which foods can be promoted to children and to signpost foods to make healthy choices easier to make. It encourages healthy eating behaviours in children and young people through a whole-school approach to healthier eating; promotes opportunities for healthy eating in the communities in which we live through, for example, the five-a-day community initiatives; ensures that the NHS promotes healthy eating in all aspects of its work; promotes opportunities for healthy eating in the workplace and for ensuring that
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the public sector leads by example through, for example, developing guidance on good practice in food procurement in the NHS and across other public sector services; and it requires us to work with the food industry to increase the availability of and access to healthier foods that have reduced levels of fat, saturated fat, sugar and salt, to make healthy foods the norm rather than the exception.
The physical activity action plan brings together all the commitments relating to physical activity in "Choosing Health" as well as further activity across Government. That will contribute to increasing levels of physical activity. It sets out detailed action at national, regional and local levels to improve people's health through participation in physical activity. This represents the first truly cross-Government plan to co-ordinate action aimed at increasing levels of physical activity across the whole population, as recommended by the report, "Game Plan: a strategy for delivering Government's sport and physical activity objectives", in 2002.
Our action on physical activity will ensure high quality, well-targeted and attractive provision for walking and cycling; create and maintain a wide range of opportunities for activity through recreational activity and sport; encourage activity in early years, school, and further and higher education; develop services within the community health care system to provide ongoing support to achieve sustainable behaviour change; and encourage employers in the public, private and voluntary sectors to engage and motivate staff to be more active.
As already emphasised, it is important to maintain optimal levels of blood cholesterol, with the ideal being, as my hon. Friend said, 5 millimoles per litre. The UK average is well above that at 5.6 millimoles per litre, with nearly two thirds of men and women having raised levels of blood cholesterol. In many cases, elevated levels of cholesterol can be treated by adopting healthier lifestyles. The key is to avoid being overweight, exercise regularly and eat less saturated fat.
The first route to managing raised cholesterol levels is through dietary modification. If levels continue to be high, medication is required, usually in the form of statins, which my hon. Friend mentioned. In addition to changing the quality of fat in the diet by reducing saturated fat and eating a variety of at least five portions of fruit and vegetables a day, statins can help to prevent heart disease, stroke and some cancers. The five-a-day programme includes a communications programme to increase awareness of the benefits of eating five portions of fruit and vegetables a day, and to encourage increased consumption of fruit and vegetables. A recent study showed that each increase of one portion of fruit and vegetables a day can lower the risk of coronary heart disease by 4 per cent.
Alongside diet, I reiterate the importance of physical activity. There is considerable evidence that physical activity can help to improve blood cholesterol levels. The main benefit appears to be improved levels of the good high-density lipoprotein—HDL—cholesterol. A simple measure such as regular walking of at least 30 minutes a day can help to reduce the risk of heart disease. A low level of cardio-respiratory fitness is an independent risk factor for coronary heart disease. Increasing levels of cardio-respiratory fitness can lessen
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the harmful effects of other risk factors for coronary heart disease such as high cholesterol, smoking or blood pressure.
As my hon. Friend stated, heart disease remains the biggest killer, with the disadvantaged being more vulnerable. Tackling risk factors of heart disease, including elevated levels of blood cholesterol, is vital to the delivery of our public service agreement target, which not only focuses on heart disease but aims to reduce inequalities in health. The PSA target calls on us "to substantially reduce"—from the Our Healthier Nation baseline of 1995–97—
"mortality rates by 2010 from heart disease and stroke related diseases by at least 40 per cent. in people under 75, with at least a 40 per cent. reduction in the inequalities gap between the fifth of areas with the worst health and deprivation indicators and the population as a whole."
The Department of Health has explicitly signed up to deliver by 2010 a 40 per cent. narrowing of the gap between the country as a whole and the worst hit areas. The latest figures show that we are well on track to deliver that, with a 22 per cent. narrowing of the gap since 1997. The extra £500 million announced for the spearhead primary care trusts in the worst hit areas will be an important boost to that effort.
Primary care has a vital role to play in tackling the risk factors of heart disease. That is why we also have a priorities and performance framework, or PPF, which requires primary care practices to update practice-based registers so that patients with CHD and diabetes continue to receive appropriate advice and treatment in line with national service framework standards, including the recording of blood cholesterol levels and body mass index. Evidence from the primary care and CHD collaboratives suggests that the large majority of practices have registers.
Our second line of action on prevention is to resort to drug treatment—statins—as the last resort. Statins are lipid-lowering drugs, which are cost-effective in reducing heart attacks and deaths from CHD. They are potentially beneficial to a wide group of patients either with existing CHD or at risk of developing the disease. They are also one of the major cost drivers of the CHD national service framework—NSF. For that reason, the NSF recommended that the roll-out of statins prescribing should be staged, starting with people with diagnosed CHD, and progressing to those at risk.
That is now further reinforced in the quality indicators for the new general medical services contract, which include cholesterol management for patients with existing CHD. The number of statins prescribed continues to rise by around 30 per cent. a year. Nationally, approximately 1.5 million people currently receive them. That saves around 6,700 lives a year and prevents many more people from having heart attacks.
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The Wanless report suggested that statins should be prescribed for patients with lower levels of CHD risk than indicated in the NSF—a 15 per cent. risk over 10 years as opposed to 30 per cent. in the NSF—and that that would lead to a prescribing cost of £2.1 billion by 2010.
A statin—simvastatin—will soon be available over the counter for sale to people at moderate risk of CHD, to help them reduce their risk by lowering their cholesterol. The pharmaceutical company will undoubtedly conduct its campaign to raise awareness of those benefits to potential customers.
My hon. Friend raised the importance of promoting awareness of the risk of raised blood cholesterol, and I agree that it is important for people to be aware of their cholesterol levels. Although population-wide cholesterol testing is currently not feasible, primary care practices are encouraged to identify those at risk of heart disease.
Primary care trusts will have to set local targets in their local delivery plans to cover better management of blood cholesterol and blood pressure levels. We agree that increased awareness of one's health risks can be a motivating factor in making lasting lifestyle changes, so the Government are committed to supporting people by a new kind of personal health resource in the form of NHS health trainers drawn from local communities with an understanding of the day-to-day concerns and experiences of the people whom they support. Health trainers will work with individuals to develop personal health plans as a tool to identify their priorities for health and create tailored advice to make the necessary lifestyle changes. Health trainers will be accredited to provide general advice, and for those who need specialised help, they will help access the relevant NHS services.
I wish to reiterate that the Government's drive to reduce mortality from heart disease is to address all risk factors such as obesity, diet, physical activity, smoking and so on and, more important, raise awareness among people through clear and credible tailored information, helping people to take responsibility for their own health.
As I said at the beginning, I believe, like my hon. Friend, that the Government have done some excellent work on this. However, there is always more that we can do. I shall ensure that the Minister for Public Health studies my hon. Friend's comments to ascertain where we can improve on what we are already doing. However, I hope that I have reassured him that the Government do not take the issue lightly. We are determined to reduce coronary heart disease rates in this country, and we understand that the key to doing that is to reduce people's cholesterol levels and improve their lifestyles generally.
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