Select Committee on Health Written Evidence

Memorandum by The Maranatha Community (WP 45)

1.  INTRODUCTION

1.1  This Document

  This document has been prepared in response to the Consultation by the Health Committee on the Government's Public Health White Paper "Choosing Health" launched by The Secretary of State for Health.

  The submission has been prepared by the Maranatha Community together with the Council for Health and Wholeness. Representatives from both bodies would be happy to give oral evidence to the Committee.

1.2  The Maranatha Community

  The Maranatha Community is a Christian movement with many thousands of members throughout the country active in all the main churches. Its membership includes a substantial number of people involved in the health and caring professions and in a wide range of voluntary work. Since its formation 23 years ago, it has been deeply involved in work amongst children and young people, people with drug and alcohol problems, the disabled and disadvantaged. It has taken the initiative in a broad range of projects directly contributing to the health of the nation and it also has extensive international experience. The Trust is a registered charity number 327627.

1.3  The Council for Health and Wholeness

  The Council is a multi-disciplinary body embracing doctors drawn from a variety of specialisms, nurses and various medical auxiliaries, counsellors, chaplains and others. It has close links with the healing ministry of the Christian church and is involved in a broad range of research projects.

  The Council for Health and Wholeness is based in the offices of the Maranatha Community.

2.  SUMMARY WITH RECOMMENDATIONS

  2.1  The Maranatha Community and the Council for Health and Wholeness welcome this consultation. We believe that this is a timely opportunity to re-evaluate the current approach to public health. We recognise many excellent proposals in the White Paper, however are concerned at a large number of areas that have not been addressed which are major determinants of public health. We are therefore concerned that the beneficial impact of this White Paper will be much smaller than the Department of Health would have hoped for.

  2.2  We are convinced that the UK faces the greatest challenge to public health since the inception of the NHS. If current trends continue, we will not be able to fund the cost of treating the explosion of chronic diseases.

  2.3  The dramatic increase in family breakdown has led to a trail of casualties, especially among children. There has been a dramatic increase in family breakdown over the past 40 years: In 1961, 350,000 British people got married for the first time, 50,000 remarried, and 30,000 divorced. Forty years later, 180,000 married for the first time, 120,000 remarried, and 150,000 divorced. The proportion of children raised in single-parent households is higher in the UK than elsewhere in Europe. Could it be, that at the root of many of the concerns we have for children, such as the high rates of drinking, drug taking, teenage pregnancy and childhood poverty (all the highest or among the highest in Europe) is the high rate of family breakdown in the UK?

  2.4  There is a wealth of evidence linking family breakdown with many adverse health outcomes for children, such as higher mortality, emotional problems, poor school performance and poverty. Children from broken families are also more likely to become drug addicts, teenage parents and contract sexually transmitted diseases. They are more likely to engage in criminal activity and are over-represented in the prison population. Conversely, marriage confers many health benefits including lower mortality, less depression and less alcohol abuse and increased life expectancy. This is similar in men to the increased life expectancy of non-smokers. Cohabitation does not confer the same protective benefit that marriage does. While the White Paper obviously is concerned about the above mentioned problems such as childhood poverty, emotional problems in children, teenage pregnancy etc. the White Paper fails to recommend the most basic and in our view most effective strategy to address these issues, the strengthening of the marriage-based family.

  2.5  With the direct cost of family breakdown being estimated in the region of £15 billion per year—if one takes into account the indirect costs, then the total cost of family breakdown is likely to be in the region of £30 billion and rising—there is an urgent public health need to strengthen the family and marriage, supporting dysfunctional families and thoroughly reviewing legislation and policies that undermine marriage. We are concerned that the White Paper does not even mention marriage or family breakdown—even though a majority of the population consider the marriage-based family as the ideal for children to be brought up—but rather speaks of parents. The White Paper is concerned about childhood poverty but fails to recognize that one of the major contributing factor to childhood poverty is family breakdown, which leads to a significant reduction in the income available to families. Unfortunately, strengthening marriage and families dose not appear to be a political priority nor does it feature in the White Paper. Therefore, a major determinant for public health is not even addressed in the White Paper.

  2.6  The "safe(r) sex" experiment has failed. We face a public health crisis regarding sexual health. Sexually transmitted infections now are out of control. Most STIs have doubled over the past six years and chlamydia infection rates among young women have trebled over the past decade. Syphilis has increased by over 500% over the past six years. Teenage pregnancy rates are the highest in Western Europe. Some Genitourinary clinics turn hundreds of patients away a week and are unable to cope with the huge demand. GU-clinic attendances have doubled over the past decade.

  2.7  Official strategies such as the National Strategy for Sexual Health and HIV as well as the Teenage Pregnancy Strategy have singularly failed to address the underlying cause for the explosion in STIs and will continue to do so. Underlying this dramatic increase in STIs is a dramatic increase in casual sex, promiscuity including an increase in concurrent and sequential sexual relationships, earlier sexual activity and increasingly risky sexual behaviour. Casual sex may be casual in intent, but certainly not in outcome.

  2.8  The only evidence-based definition of "safe sex" is—apart from abstinence—mutual monogamy with an uninfected partner. This is in essence the meaning of marriage. However it is a sad truth that sexual abstinence until marriage is not even mentioned as a possibility in the UK sexual health strategy. The most important risk factor for contracting a STI is the number of sexual partners a person has. Condoms are not as "safe" as they have been promoted to be and many, especially young people, are stunned to find that they have contracted an STI, often incurable, despite using condoms. Condoms may be effective in reducing the risk of contracting HIV ("always condom use" reduces the risk of HIV transmission by 85%), however the risk reduction is far less for essentially all non-HIV STIs, such as chlamydia, gonorrhoea, syphilis, genital warts etc, where the risk reduction, even with "always condom use" is more in the region of 50% or less. The "faith in the condom" is misplaced.

  2.9  The widespread adoption of the ABC approach in Uganda has led to a 70% decrease in HIV over the past decade. This contrasts with a more than 100% increase of most STIs in the UK over the same period. Abstinence until marriage needs to be actively promoted from a public health point of view. Opponents of this approach frequently state that this equals to "moralising" or "preaching". However, to promote sexual abstinence is as much "moralising" or "preaching" as it is to encourage a smoker to quit smoking. Both are public health interventions aimed at reducing a lifestyle, sexual promiscuity or smoking, that have very adverse effects on the health of the nation. As the White Paper fails to address the real reasons for the explosion of STIs, we are not convinced that the chosen strategy will be effective and predict further increase in the number of STIs diagnosed.

  2.10  Illicit drug misuse in the UK is out of control.The UK has probably the worst drug problem in Europe. British young people have higher rates of drug misuse, including cannabis, cocaine, ecstasy and amphetamines than most other young Europeans. Over 4 million of the population use an illicit drug and 1 million use class A drugs such as heroin, cocaine, crack or ecstasy. The economic, social and health costs of Class A drugs alone is conservatively estimated to be up to £17 billion per year. The Home office estimates the total cost of the UK drug problem to be in the region of £20 billion per annum.  This translates to just under £800 per household per year. The number of drug-related deaths exceeds 3,500 per year.

  2.11  Across Europe, countries with a high level of cannabis misuse, for example the UK, also have high levels of "hard drug" misuse such as cocaine and ecstasy. Countries with low levels of cannabis misuse such as Sweden have low levels of other "hard drug" use. Indeed, Sweden has among the lowest, possibly the lowest, rates of drug misuse of any European country.

  2.12  Sweden appears to be the only European country with the goal to create a drug-free society. Drug misuse, especially cannabis misuse is strongly discouraged. There is a very strong consensus in society against drugs and parents, teachers, police and politicians are all strongly supportive of a restrictive drug policy. The basis of the Swedish drug policy is the recognition that the only indispensable part of the drug problem is the drug user and therefore primary prevention of drug misuse—demand reduction—is given the highest priority.

  2.13  The Swedish approach contrasts greatly with the UK approach where increasingly drug policy appears to be based on the very dubious concept of "harm reduction". "Harm-reduction" essentially portrays drug misuse as inevitable, based on the wrong assumption that "young people are going to use drugs anyway so we might as well teach them how to do it safely".

  2.14  It is interesting that a "harm-reduction" approach is used regarding illegal drugs but not regarding any other illegal activity. No-one would teach young people how to speed or to steal safely, the clear message instead is "speeding is dangerous and illegal". Harm-reduction accommodates and normalises, rather than prevents, drug misuse. There are examples of harm-reduction drug education material being used in UK schools which aim to teach pupils the skills of "safe drug use". This is a contradiction in itself, since there are no safe ways of taking drugs. This type of educational material encourages rather than discourages drug misuse. It should not be used in schools or in any health education context.

  2.15  Significantly, the Swedish Drug policy was liberal in the 1960s, essentially using a "harm-reduction" approach. Following this, drug misuse escalated to very high levels in Sweden and in the 1970s, the goal to create a drug-free society was adopted with all the above mentioned policies based on demand reduction and primary prevention. Subsequently, there was a very significant drop in drug misuse in Sweden. There is no good reason why this could not happen in the UK. We deplore the downgrading of cannabis as misguided and are concerned that there is no coherent political message focussing on drug prevention and demand reduction. Furthermore, the high rate of family breakdown in the UK contributes to the drug problem. However, this issue is not addressed by the White Paper. For these reasons, we are not convinced that the currently adopted drug strategy will be successful.

  2.16  There is an urgent public need to identify and, wherever possible, to avoid toxic substances. We are at risk of being poisoned in a variety of different ways, through contaminated water, contaminated nutrition, through outdoor and indoor pollution, possibly also low-level radiation and electromagnetic fields. Perhaps the most worrying issue is our obvious ignorance of the long-term effects of many of the toxic substances to which we are exposed. There is legitimate and growing concern that a large proportion of our entire population are being placed at risk.

  2.17  It is impossible to even give an accurate overview of the effects of toxic substances on human health and public health. We therefore want to limit our submission to a few examples of the devastating effect toxicity has on public health, especially on children.

  2.18  Children are exposed to potentially carcinogenic pesticides from many sources of contamination. Childhood malignancies linked to pesticides include leukemia, neuroblastoma, Wilms' tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, and cancers of the brain, colorectum, and testes. There has been a significant increase in childhood cancer over past decades, including non-Hodgkin Lymphoma. Could it be that toxicity from pesticides and other sources plays a significant role in this increase?

  2.19  It is estimated that every year there are 8,100 deaths from particulate matter and 3,500 deaths because of sulphur dioxide in urban areas of Great Britain. The numbers of deaths by ozone in both urban and rural areas of Great Britain during summer ranges between 700 and 12,500. Particulate pollution therefore costs many lives, far more than the number of deaths from road accidents.

  2.20  There has been a dramatic increase in childhood conditions such as learning difficulties, ADHD and autism. There are many, sometimes controversial, theories on the causation of these conditions. However we are concerned that there appears to be little awareness—even in professional circles—of the contribution of neurotoxins such as lead, mercury, cadmium, dioxins, organophosphates and other toxins to those conditions.

  2.21  While there has been some research—not all of it independent of industry—into the health effects of toxic substances such as pesticides entering the food chain we are concerned that much of the safety data relates to adults. It is therefore very likely that official "safe" thresholds are by no means safe for developing bodies, especially the developing brains, of children. Furthermore, there seems to be only very little research looking at the adverse health effects of toxic substances in combination.

  2.22  We call for the establishment of a Royal Commission—totally independent of the chemical industries—to assess the full impact of toxic substances on public health, especially on children. We furthermore are convinced that there should be a national screening programme for the most common toxins that adversely affect children such as lead, mercury, cadmium, dioxins, organophosphates and others. Again, we are concerned that the issue of toxicity is not given prominence in the White Paper which we believe to be a major omission.

  2.23  Alcohol misuse has a huge toll on the population. Over 5,500 people die a year due to direct effect of alcohol, however the total number of deaths where alcohol plays a part may be in excess of 30,000 a year. The number of alcohol-related deaths has increased dramatically over the past five years. One person in 13 is dependent on alcohol in Britain. British adolescents are among the worst in international comparisons regarding alcohol consumption, drunkenness and binge drinking. Alcohol misuse costs the UK in excess of £10 billion a year in health and social costs. We therefore call for the urgent development of a coherent Alcohol strategy in the UK.

  2.24  It is likely that many of the diseases that place the main burden on the NHS are due to changes in our diet and lifestyle. The dominating illnesses in modernised societies are new, or have become newly prominent, in the past 100-150 years. Some of these are increasing dramatically. These conditions include cardiovascular diseases such as ischaemic heart disease, hypertension and stroke, respiratory diseases such as asthma, metabolic diseases such as obesity and diabetes, malignancies such as major types of cancer including cancers of the breast, prostate and colon, allergies, gastrointestinal conditions such as appendicitis, inflammatory bowel diseases, irritable bowel syndrome and coeliac disease and behavioural disorders especially in children such as childhood hyperactivity and "autism".

  2.25  While it is possible that some of the above conditions are due to a "westernised lifestyle", part of the "westernised lifestyle" comprises a "western diet" which in itself consists of increased intake of processed foods, including increased intake of fats, sugars, salt and an increased intake of total calories. The WHO finds that worldwide 60% of all deaths are "clearly related to changes in dietary patterns and increased consumption of processed fatty, salty and sugar foods". Obviously, other factors also contribute to a "western lifestyle" such as reduced physical activity and increased exposure to toxic substances through for example pollution.

  2.26  The medical treatment of many chronic diseases such as ischaemic heart disease, hypertension, stroke, diabetes, asthma and cancer uses up most of the resources of the health service including drug budgets. The cost of diabetes to the NHS is estimated at £5 billion per year. The economic cost of being obese or overweight is estimated in the region of £7 billion a year. The social, economic and health costs of heart disease is estimated to be another £7 billion per year. In addition to those costs, the social and economic cost due to incapacity, disability and death caused by these diseases can hardly be overestimated. The anticipated increase in these conditions, especially obesity, diabetes and cancer is likely to financially crush the NHS. Currently, among the highest prescribing drug costs in UK General Practice are cholesterol-lowering statins. However, antihypertensives and inhalers for asthma/COPD also contribute very significantly to drug costs. Statins are currently prescribed to about 1.8 million people in the UK, at a cost of £700 million a year. This is expected to rise to more than £2 billion a year by the year 2010.

  2.27  The nutritional treatment of many chronic diseases is relatively cheap compared to drug costs. For example, one strategy for the secondary prevention of ischaemic heart disease (IHD) used a Mediterranean-style diet. This intervention led within three years to a 70% reduction in overall mortality rate, compared with the far more expensive statin treatment, which, over a five-year period led to at most 30% reduction in overall mortality. Another study examined the impact of eating two or three portions of fatty fish per week on the survival of men with a previous heart attack. Within two years of the commencement of this simple diet change, a significant reduction in all-cause mortality was observed. This mortality reduction was similar to the reduction achieved in trials using statins for a period of over five years.

  2.28  Statin treatment is expensive. It costs in the range of £4,000-9,000 per year to save one life with statins in patients who already have established IHD. This contrasts with Mediterranean diet, which, at a cost of around £300 per life-year saved, is only a fraction as expensive as statin treatment. Some dietary changes in the secondary prevention of IHD appear to reduce mortality twice as much as statin treatment. We are convinced that the currently adopted strategy of combating IHD with statins while neglecting more beneficial dietary interventions both for prevention and treatment is a grave misallocation of scarce public funds.

  2.29  There is strong evidence that several dietary strategies are effective in preventing the development of IHD. A recent review from Harvard University concluded: "Substantial evidence indicates that diets using non-hydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids can offer significant protection against coronary heart disease. Such diets, together with regular physical activity, avoidance of smoking, and maintenance of a healthy body weight, may prevent the majority of cardiovascular disease in Western populations."

  2.30  Unfortunately, while commonsense teaches that nutrition is essential for health and well-being, nutritional medicine as a medical and public health specialty is, in our view, a neglected area. There appears to be comparatively little research done in this field, compared, for example, with the research into drug treatment of chronic diseases funded by drug companies. There is however a case for a UK-wide integrated nutritional medicine strategy, especially for the prevention and treatment of chronic diseases such as heart disease, stroke, asthma, high blood pressure, diabetes, obesity, cancer and other chronic conditions. We welcome the suggestions in the White Paper, however believe that these suggestions do not go far enough.

  2.31  A highly controversial area is the health impact of processed and refined foods and of food additives including colourings, preservatives, trans-fats and others. We therefore call for the establishment of a Royal Commission, independent of the food industry, to examine the short and long-term public health effects of processed foods and food additives. We are concerned that political pressure from the food industry prevents the Government to independently examine the effect of processed foods. We are convinced that the health impact of processed foods is very significant. Unfortunately, this issue is not addressed in the White Paper.

  2.32  Exposure to media, including watching TV, playing video games, listening to radio and reading magazines has a very powerful formative impact on children and young people, including their physical, emotional and spiritual health. Time spent watching TV and playing computer games exceeds the time spent on physical activity for most children and for many children exceeds the time spent with parents. Time spent watching television or playing computer games takes away from important activities such as social interaction and development, especially time spent with the family, physical activity, including playing, but also reading and school work. British children spend on average five hours per day using media—far more than in any other European country.

  2.33  Because children have high levels of media exposure, more so than in previous generations, the media have greater access and time now to shape young people's attitudes, values and behaviour than do parents or teachers. The media therefore replaces parents and teachers as educators, role models, and the primary sources of information about the world. In this context we disagree with the statement by OFCOM quoted in the White Paper, that a ban on childhood food advertising on TV would not be effective. If TV food advertising had no effect, why would food manufacturers spend millions on food advertising? We consider advertising of food products to children on TV essentially unethical and call upon the Government to follow the lead of other countries such as Sweden and Norway and ban TV advertising of food products to children completely. We urge the Government to without delay implement regulation of advertising of unhealthy products, especially those with high levels of sugar, salt and fat, just as the advertising of cigarettes has been regulated.

  2.34  There is significant evidence linking time spent watching TV with the prevalence rates of obesity. Obesity measurably increases for every hour spent watching TV. Reducing the time watching TV reduces childhood obesity rates. While the White Paper makes a link between time spent watching TV and childhood obesity we consider that more action could be taken to reduce the time that children watch TV.

  2.35  There has been a steady increase in the amount of sex in the media, especially TV but also glossy magazines and an increase in the explicitness of these portrayals. There appears to be a fairly consistent sexual message: most portrayals of sex depict or imply heterosexual intercourse between unmarried adults portraying promiscuity as the norm, with little reference to sexually transmitted infections, pregnancy, or use of contraception. There is evidence that young people aged 12-17 who watch far more TV are up to twice as likely to engage in sexual activity as those who watch far less. References in TV regarding possible adverse consequences of precocious sexual activity can delay early sexual activity.

  2.36  The sexually explicit messages daily portrayed by the media have a formative influence on children's and adolescent's sexual behaviour, possibly more so than the influence of parents and the educational system. We are therefore particularly concerned about misleading, inaccurate and unrealistic information about sex which may be taken as "fact" by young people. For example, how many people in soap operas—in contrast to "real life"—contract an STI or become pregnant following casual sex? We therefore are concerned that the White Paper does not call for a significant reduction in the sexual explicit content on TV. We would not be surprised if a significant reduction in sexually explicit content on TV coupled with portrayals and information on potential adverse effects of precocious sexual activity will have more impact in reducing early sexual activity in adolescents than "traditional" approaches such as school sex education.

  2.37  Viewing media/TV violence can lead to increased antisocial or aggressive behaviour, desensitisation to violence or increased fear of becoming a victim of violence. Exposure to media violence results in many physical and mental health problems for children and adolescents, including aggressive behaviour, desensitisation to violence, fear, depression, nightmares, and sleep disturbances. Furthermore, prolonged exposure to violent media portrayals results in increased acceptance of violence as an appropriate means of solving problems and achieving one's goals. All this has a direct bearing on society and the NHS.

  2.38  Many studies show that young children under eight years of age are developmentally unable to understand the intent of advertisements and, in fact, accept advertising claims as inherently true. The youngest viewers, up to age eight, cannot distinguish advertising from regular television programming.

  2.39  We believe that there needs to be an urgent Public Health Summit involving representation from the Government, OFCOM, representation from professional organisations, the media including TV, magazines and advertising companies. This should assess the impact of the media on young people's health including the possibility of legislative control. The areas that need to be examined include: advertising to children, impact of violence and sex depicted on TV and the impact of electronic media on eating patterns as well as their impact on health and physical activity of young people.

  2.40  The spiritual dimension of life is a fundamental part of the healing process. Modern western medicine acknowledges the contribution of body, mind and emotions in disease and healing but fails to recognise, and totally lacks understanding of, the spiritual dimension of health and sickness. We deplore the complete absence of an understanding of the spiritual roots of sickness. We consider these very significant contributors to ill health, perhaps comparable to the contribution of nutrition both to ill health and to healing.

  2.41  Spirituality refers to the relationship between man and God. Spirituality is the means, both for the individual and society, to bring a sense of meaning to "being human". The spiritual component of the healing process enables patients to have a sense of identity and self-worth, belonging and purpose, even in sickness. In comparatively recent times there has been a quite irrational trend towards the dismissal of the central role of spirituality both in causing disease and in the healing process.

  2.42  Faith significantly reduces the risk of depression and suicide, and reduces the risk of alcohol, nicotine and drug misuse. Adolescents who report that religion is important to them are much less likely to engage in binge drinking, smoking, or using cannabis. They are more likely to eat in a healthy fashion and to exercise regularly. Among adults, spirituality is associated with increased physical exercise, lower rates of smoking and alcohol abuse, improved mental health including reduced depression, and maintaining marital stability. Furthermore, spirituality can positively help patients dealing with recovery from surgery, or with severe or chronic medical or emotional illness including cancer. Faith can play a central role in the lives of those who are terminally ill and allows them to "die well".

  2.43  It is therefore not surprising that faith is linked with significantly increased life expectancy. The beneficial effect of spirituality on life expectancy is comparable to the effect of not smoking or taking regular exercise.

  2.44  There is very substantial evidence that Christian experience and belief has a powerful and some times dominant influence on the healing process. We are today seeing the emergence of a large number of Christian healing centres in which there is a partnership between ordained priests and ministers and health professionals.

  2.45  As a Christian community, the Maranatha community has extensive experience in all aspects of the Christian Healing ministry and over many years we have experienced many healings—sometimes quite dramatic healings—through prayers. Perhaps one of the most relevant aspects of spirituality in terms of the healing process is the message of forgiveness, especially in the Christian faith, whether we call it reconciliation, restoration, offering new hope, affirming acceptance etc. Experience has shown that the giving and receiving of forgiveness, personal, individual and corporate, is pivotal to many aspects of healing.

  2.46  Whereas the Department of Health must clearly meet the needs of the minority religions, sight should not be lost of the fact that in the last national census, 72% of the population of the United Kingdom claimed to have a Christian faith. It is important that the majority of the population should not in any way be deprived of the benefits of Christian prayer within hospitals and clinics, especially as there is very clear evidence supporting the benefits of spirituality in recovery from illness. It needs to be recognised that a very substantial proportion of all patients are in a real emotional and spiritual need and this should not be disregarded.

  2.47  As a Christian community, we would like to introduce the biblical term "righteousness" into the discussion on public health. Righteousness means "right relationships" between man and God. Furthermore, it means a right relationship to myself (Jesus' command is to love your neighbour as your self—there is the command to have a right relationship with others and with oneself) right relationships with others and right relationships with nature and the environment. The right relationship of the individual with God leads to a meaningful life and to healing through experiencing God's love. The right relationship with oneself leads to a healthy lifestyle, including healthy nutrition, a healthy self-image which is neither corrupted by self-aggrandizement nor self-denigration and no need for drug or alcohol dependencies. The right relationship with others leads to peace and healthy communities. The right relationship with the environment leads to a respect for nature and the environment, reducing pollution and preserving species. We believe that if this concept of righteousness were followed, it would lead to a healing of the individual, of society and of the environment.

  2.48  There is a need for greater consideration to be given within the NHS to the spiritual dimension of healing and it is suggested that the church's experience of the healing process should be shared more widely with the National Health Service. It is, therefore, proposed that there should be a consultation between the Department of Health and representatives of churches and experienced specialist Christian bodies. Consideration should be given to the carrying out joint studies with doctors and those experienced in the Christian Healing ministry, to explore ways and means of achieving a deeper understanding of the spiritual aspects of the healing process in the interest of public health. Put simply, God cannot be dismissed from the healing process.

  2.49  We are convinced that the healing process must be seen as far more than attending to physical ailments. It must embrace the broader moral, spiritual, emotional and societal factors, which govern health and wholeness, both personal and social.

  2.50  In this Submission, we focus on some of those areas where our nation can choose health rather than disease. We are concerned that, as a society, we are increasingly choosing disease rather than health. We are concerned that the individual choices based on "rights" rather than "responsibilities" have a deleterious impact on public health and the NHS. We deplore the widespread assumption that "what I do with my body is my choice and only affects me". This is inherently selfish and ignores the fact that individual choices have a profound impact on society as a whole.

  2.51  We conclude that far higher priority should be given to public policies, clinical practices and educational procedures which focus on the prevention of disease in comparison with treatment. We recognise that the White Paper is attempting to do this. However, we are concerned that many areas that have a major impact on public health are not being addressed, perhaps out of concern to appear "politically incorrect" (as in the area of family breakdown and marriage support), perhaps because of influences of the food industry (food advertising, impact of processed foods, food colourings etc.) or influence of the pharmaceutical industry (in the area of nutritional prevention of chronic diseases). There is an immediate need for political and social leaders, both nationally and locally, to face up to what is, in effect, a public health crisis in the nation. In our opinion the National Health Service will soon be overwhelmed, unable to provide adequate treatment and be crushed by the huge burdens placed upon it by the increases in "lifestyle diseases" such as diabetes, obesity, sexually transmitted infections, to name but a few. Furthermore, society as a whole will be unable to fund the dramatic costs of lifestyle choices such as widespread drug misuse, unstable relationships and family breakdown with all the adverse effects on children. Catastrophic trends need to be admitted and the need for radical change honestly accepted. We are not convinced that the "White Paper" is going far enough in analysis and recommendations. For this reason, we are not convinced that it will have only a fairly limited positive impact on the health of the nation.

3.  MARRIAGE

Its positive contribution to public health

  3.1  Discussions about public health usually fail to mention the positive contribution that marriage has for public health. For example, the health benefit of being married for men is similar to the health benefit gained from not smoking. While we see a very strong campaign to try to get smokers to quit, we do not see any campaign aimed at supporting marriage.

  3.2  Recent legislation has sought to undermine marriage. Furthermore, the UK tax system is less favourable to marriage than the tax systems of France and Germany. Significantly, both France and Germany have a lower rate of family breakdown.

  3.3  Much of the guidance for teachers of sex and relationship education (SRE) in schools emphasises the importance of a "value-free" approach to relationships. As part of SRE, different family constellations should be discussed as being equally valid and acceptable. In a sex education pack intended for primary schools, beginning with key stage one, the teacher is encouraged to discuss different family arrangements, for example children living with married or unmarried parents, single parents, lesbian, gay and bisexual parents, grandparents etc. Teachers are instructed that "it is important not to try to `promote' a particular type of home life as the norm or superior" (Julian Cohen. Primary School Sex and Relationships Education Pack, Healthwise 2001; p 22) Thus, children are not being taught that marriage is the most beneficial family structure, to be discarded at our peril.

  3.4  It is clear that marriage has significant health benefits according to published evidence. Why, therefore, are pupils not told this?

  3.5  It is clear that marriage reduces mortality. Married people, as opposed to divorced and separated individuals, have a lower mortality rate and are healthier. Marriage is associated with greater happiness, less depression and less alcohol abuse. It is interesting to note that cohabitation does not appear to confer the same protective benefit than marriage does.

  3.6  As a Christian Community, we are convinced that marriage is the basic building block of society and contributes massively to the wellbeing of the nation. If marriage is being abandoned to other forms of living together such as cohabitation and same-sex partnerships, our entire society and especially our children will suffer. Marriage is ordained as a covenant relationship by God and it therefore has a major positive contribution to physical, emotional and spiritual health of married couples, their children and society as a whole. Conversely, the adverse effects of marriage breakdown are devastating for the individuals concerned, especially children and society as a whole as we see in the next section on family breakdown. (See evidence in Annex A.) [Not printed.]

RECOMMENDATIONS

—  The promotion of marriage should, as a matter of urgency, be firmly placed on the curriculum of every school and at the centre of all sex and relationship education programmes.

—  There needs to be a thorough and co-ordinated review of legislation introduced during decades which have had a direct or indirect deleterious effect on the institution of marriage. This should include aspects of the taxation system which should be more favourable to marriage.

4.  FAMILY BREAKDOWN

Its negative contribution to public health

  4.1  There is a wealth of evidence linking family breakdown with many adverse health outcomes for children, such as ill health including higher mortality, emotional problems, poor school performance and poverty. Children from broken families are also more likely to have problems with substance misuse and poor sexual health including teenage pregnancy. Furthermore, they are more likely to be engaging in criminal activity and are disproportionally over-represented in the prison population. Finally, family breakdown is associated with an increased risk of being physically or sexually abused.[89]

  4.2  There has been a dramatic increase in family breakdown over the past 40 years: In 1961, 350,000 British people got married for the first time, 50,000 remarried, and 30,000 divorced. Forty years later, 180,000 married for the first time, 120,000 remarried, and 150,000 divorced. (Andrew Oswald, The economics of Love, May 2003).

  4.3  With the direct cost of family breakdown being estimated in the region of £15 billion per year—if one takes into account the indirect costs of family breakdown, then the total cost of family breakdown is likely to be in the region of £30 billion and rising—there is an urgent public health need to strengthen the family and marriage, supporting dysfunctional families and reviewing legislation and policies that undermine marriage.

  4.4  At the root of many of the problems we see in children and young adults—such as emotional and behavioural difficulties, poor school performance, substance misuse, precocious teenage sexuality including teenage pregnancy and juvenile delinquency—is the dramatic increase in family breakup and "relationship turnover" of parents, adversely affecting their children?

  4.5  Unfortunately, we do not detect any strong political leadership encouraging marriage, despite its many public health benefits, both to married couples, their children and society as a whole. We are convinced that reducing family breakdown will have a more significant and positive impact on many health problems seen in young people—such as substance misuse, poor sexual health including teenage pregnancy and others—than some of the official strategies currently adopted. These strategies, including drug and sex education, access to family planning clinics and others, usually fail to take into account the significant benefits gained for young people through a stable marriage of their parents. (See evidence in Annex B.) [Not printed.]

RECOMMENDATIONS

—  More resources should be devoted to helping dysfunctional families in order to avoid marriage breakup with all the adverse effects on public health.

—  Research needs to be carried out into the financial and social incentives and disincentives to marriage-based family life.

5.  SEXUALLY TRANSMITTED INFECTIONS: PREVENTION RATHER THAN JUST TREATMENT

  5.1  The UK faces an epidemic of sexual ill health. Sexually transmitted infections (STIs) are out of control, having doubled over the past six years, with some infections such as syphilis increasing by more than 500%. Over the past decade, the rate of chlamydia diagnoses in 16-19 year old girls nearly trebled. Britain's teenage pregnancy rate, the highest in Western Europe, has not substantially changed over the past 25 years, despite several government initiatives.

  5.2  The underlying cause for this is the high increase in promiscuity, risky sexual behaviour and earlier sexual activity. However, the UK sexual health strategy does not even address the underlying cause for the epidemic in sexual ill health. It is surprising to note that the National Strategy for Sexual Health and HIV fails to mention reduction in promiscuity, it also fails to mention marriage or sexual abstinence until marriage even as a remote possibility. Instead, the current approach to sexual health is based on the promotion of condoms and other contraception, access to family planning clinics and genitourinary clinics in a "value-free" and "non-judgmental" environment. However, record attendances at both GU clinics and family planning clinics together with an increase in condom use have failed to make a positive impact on the nation's sexual health. Indeed, the nation's sexual health continues to deteriorate at an alarming rate. Is it not time to re-evaluate the current approach to sexual health? Is it not time to assess the significance of powerful formative influences shaping sexual behaviour?

  5.3  The more than doubling of STIs in the UK over the past decade contrasts with a more than 70% reduction of HIV in Uganda over the same period of time. Uganda has adopted the ABC programme: Abstain from sex, Be faithful—Partner reduction, "zero grazing", monogamy—or if that fails use Condoms. The reduction in HIV was mainly due to behavioural change—essentially a reduction in casual sex. The promotion of condoms in Uganda had only a minor contribution to this fall in HIV. Other African countries that rely on condom promotion rather than behavioural changes, did not see significant HIV declines.

  5.4  While we are aware of cultural differences, we urge the Government to learn from the success of Uganda's balanced "ABC" approach to sexual health and urge this approach to be adopted throughout the UK. A public health campaign aimed at modifying behaviour, with a predominant emphasis on reduction of casual sex, is the only measure that will stop the epidemic of STIs in the UK. To combat STIs with the currently adopted strategy will inevitably mean continued failure.

  5.5  As a Christian community, we recognise that the guidance given to us by God, for example emphasising that marriage is a lifelong covenant relationship and discouraging sex outside of marriage, is very relevant to promote good physical, emotional and spiritual health for the individual but also for society as a whole. We are concerned, that the current approach to sexual health appears to discount the physical, emotional and spiritual consequences of promiscuity. (See evidence in Annex C.) [Not printed.]

RECOMMENDATIONS

—  There should be a complete overhaul of current sexual health strategies, questioning the fundamentally flawed assumptions of policies pursued in the past decades.

—  There needs to be a review of the allocation of public funds to the various clinics, sexual health "educators" and others who appear to be a fundamental part of the problem rather than its solution.

—  There needs to be a public health campaign warning both young people and adults of the risks involved in contracting especially non-HIV STIs, realistic information about the level of protection conferred by condoms, and a warning of the extremely dangerous consequences of abnormal sexual practices such as anal intercourse, which is both unnatural and disease prone.

6.  DRUG MISUSE

Prevention rather than just damage limitation

  6.1  The UK has one of the worst drug problems in Europe. Figures for the prevalence rates of illicit drugs, including cannabis, cocaine, ecstasy and amphetamines are among the highest, if not the highest in Europe. Over four million of the population use an illicit drug and one million use class A drugs such as heroin, cocaine, crack or ecstasy. The economic, social and health costs of Class A drugs alone is conservatively estimated to be up to £17 billion per year.

  6.2  Comparing data on the prevalence of drug misuse across Europe one trend is quite obvious: countries with a high level of cannabis misuse, for example the UK, also have high levels of "hard drug" misuse such as cocaine and ecstasy. Countries with low levels of cannabis misuse such as Sweden, have low levels of other "hard drug" use. Indeed, Sweden has among the lowest, possibly the lowest, rates of drug misuse of any European country.

  6.3  What are the lessons that the UK can learn from Sweden? Sweden appears to be the only European country with the goal to create a drug-free society. Drug misuse, especially cannabis misuse is strongly discouraged. There is a very strong consensus in society against drugs. Parents, teachers, police and politicians are all strongly supportive of a restrictive drug policy. The basis of the Swedish drug policy is the recognition that the only indispensable part of the drug problem is the drug user and therefore primary prevention of drug misuse ie demand-reduction, is given the highest priority. Furthermore, the Swedish drug policy is formulated around the gateway hypothesis, ie use of cannabis is associated with the use of harder drugs.

  6.4  While we are aware that the gateway hypothesis is controversial we would like to point out that it cannot be denied that essentially all heroin and other "hard drug" users started on cannabis as their first illicit drug. Furthermore, there have been several powerful studies recently supporting the "gateway" hypothesis. Cannabis is therefore considered to be a very serious problem in Sweden and Swedish drug education is very clear about its many dangers. Interestingly, the Swedish Criminal justice system is given the right to enforce drug testing and compulsory drug treatment. Significantly, the Swedish Drug policy was liberal in the 1960s, essentially using a "harm-reduction" approach. Following this, drug misuse escalated to very high levels and in the 1970s, the goal to create a drug-free society was adopted. Subsequently, there was a very significant drop in drug misuse in Sweden. There is no good reason why this could not happen in this country.

  6.5  The Swedish approach contrasts greatly with the UK approach where increasingly, drug policy appears to be based on the very problematic concept of "harm reduction". "Harm-reduction" essentially portrays drug misuse as inevitable, based on the wrong assumption that "young people are going to use drugs anyway so we might as well teach them how to do it safely". There are examples of drug education material used in the UK which aims to teach pupils the skills of "safe drug use", a contradiction in itself, since there are no safe ways of taking drugs. It is interesting that a "harm-reduction" approach is used regarding illegal drugs but not regarding any other illegal activity. No-one would teach young people how to speed or to steal safely, the clear message instead is "speeding is dangerous and illegal". Harm-reduction accommodates and normalises, rather than prevents, drug misuse. While "harm-reduction" may have its place once a person is addicted, for example some heroin addicts may benefit from methadone maintenance, it has no place as part of drug education in schools, where still the majority of pupils are not taking drugs regularly. Instead, the focus of drug education should be the prevention of drug misuse.

  6.6  The recent reclassification of cannabis has caused major confusion.Surveys show that many pupils now think that cannabis is legal, harmless and even some form of medicine. However, cannabis is not the innocuous drug it is made out to be. There has been a very significant increase in the numbers of young people attending drug treatment centres with cannabis addiction as their main problem. There is a wealth of evidence linking cannabis with serious mental health problems including schizophrenia, psychosis and depression. It is estimated that in London, about 80% of all new cases of schizophrenia are due to cannabis misuse, therefore causing major problems to an already overstretched psychiatric service. Cannabis is addictive and impairs learning, concentration and educational performance. Cannabis is also associated with significant lung damage including severe emphysema and head and neck cancers in young people. Cannabis on its own but especially in combination with alcohol increases the risks of road traffic accidents.

  We agree with the International Narcotics Control Board when it stated last year: "Advocates of drug legalisation, particularly of cannabis, are vocal and have access to considerable funds that are used to misinform the public."

  6.7  We believe that widespread cannabis abuse has become a major public health hazard and we note with grave concern that, while there is a focussed public health campaign against smoking tobacco, there is no such campaign against smoking cannabis.

  6.8  From a Christian standpoint we are concerned that the issue of drug misuse is frequently focussed only on the physical and perhaps also the emotional aspects of drug misuse, ignoring the spiritual dimension. For a drug user, drugs offer "salvation" from pain or a painful reality or from trauma, from depression, or from poor self-esteem and boredom. This, obviously, does not just apply to illicit drugs but also to legal drugs such as alcohol and tobacco. However this "salvation" is a myth and creates further serious problems including addiction and potentially early death. (See evidence in Annex D.) [Not printed.]

RECOMMENDATIONS

—  There should be an urgent overhaul of the current national drugs strategy. There must be a major shift away from harm reduction to primary prevention and demand reduction as the basis for all drug policies.

—  The Government should pay far more attention to leading medical scientists, clinicians and researchers, rather than just selected advisors and NGOs in pursuing drug policies.

—  A fundamental element of future policy should be the reversal of the recent reclassification of cannabis.

—  There needs to be a major public health campaign warning especially young people of the dangers of cannabis abuse and discouraging cannabis abuse.

—  Consideration, encouragement and support should be given to the established track records of many Christian help groups and drug treatment centres. (There is widespread concern that some of them are being penalised for no other reason than their religious affiliation).

—  Schemes for compulsory treatment for drug offenders should be expanded and far more rigorously enforced.

7.  TOXICITY AND ALLERGIES

The hidden risks

  7.1  There is an urgent public need to identify and, wherever possible, to avoid toxins.

  7.2  It is widely recognised that we are living in a dangerous environment in which we are in danger of being poisoned in a variety of different ways, through contaminated water, contaminated nutrition, through outdoor and indoor pollution, possibly also low-level radiation and electromagnetic fields. Perhaps the most worrying issue is the obvious ignorance of the long-term effects of many of the substances that we are ingesting.

  7.3  While there has been some research—not all of it independent from industry—into the health effects of toxic substances such as pesticides entering the food chain, we are concerned that much of the safety data relates to adults. It is therefore very likely that official "safe" thresholds are by no means safe for the developing bodies, especially the developing brains, of children.

  7.4  Furthermore, we are seriously concerned that the data examining toxic substances appears to focus on isolated substances. Not much research has been done examining the additive toxic effects of substances in a "cocktail". There is evidence, however that there can be a significantly increased toxic "cocktail effect" by the combination of several toxic substances even though all of them are well below their "safe" limits.

  7.5  It is impossible to even give an overview of the effects of toxins on human health and public health. We therefore want to limit our submission (including the evidence in the appendix) to a few substances and examples of toxicity, focusing on the adverse impacts of pesticides, air pollution and the role of toxicity in childhood conditions such as learning difficulties, autism and ADHD.

  7.6  Children are exposed to potentially carcinogenic pesticides from use in homes, schools, other buildings, lawns and gardens, through food and contaminated drinking water, from agricultural application drift, and from carry-home exposure of parents occupationally exposed to pesticides. Parental exposure during the child's gestation or even preconception may probably have great significance. Childhood malignancies linked to pesticides in case reports or case-control studies include leukemia, neuroblastoma, Wilms' tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, and cancers of the brain, colorectum, and testes. There has been a significant increase in childhood cancer over past decades, including non-Hodgkin's Lymphoma. Could it be that toxicity from pesticides plays a role in this increase?

  7.7  In this context we want to remind the Department of Health of the devastating effect of excessive alcohol consumption in the UK and deplore, that there appears to be no current Alcohol strategy in the UK. We are particularly concerned about the consequences of the proposed liberalising of licensing laws. This can only add to the already crippling problem faced by the emergency services.

  7.8  Alcohol misuse has a huge toll on the population. Over 5,500 people die each year due to direct effect of alcohol. However the total number of deaths where alcohol plays a part may be in excess of 30,000 a year. The number of alcohol-related deaths has increased dramatically over the past five years. One person in 13 is dependent on alcohol in Britain. British adolescents are among the worst in international comparison regarding alcohol consumption, being drunk and binge drinking. Alcohol misuse costs the UK in excess of £10 billion a year in health and social costs.

  7.9  It is estimated that every year, there are 8,100 deaths from particulate matter and 3,500 deaths because of sulphur dioxide in urban areas of Great Britain. The numbers of deaths by ozone in both urban and rural areas of Great Britain during summer ranges between 700 and 12,500 depending on which threshold for ozone is used. Particulate pollution therefore costs many lives, far more than the number of deaths from road accidents.

  7.10  There has been a dramatic increase in childhood conditions such as learning difficulties, ADHD and autism. There are many—sometimes controversial—theories on the causation of these conditions. However we are concerned that there appears to be little awareness—even in professional circles—of the contribution of neurotoxins such as lead, mercury, cadmium, dioxins, organophosphates and other toxins in those conditions.

  7.11  Socially, mental and moral toxicity may be spread through the media which condition viewers, listeners and readers to sex, violence and degradation. The desensitizing and indoctrinating of the public has a knock-on effect on national health. (See evidence in Annex E.) [Not printed.]

Recommendations

—  We believe that there needs to be a Royal Commission—independent of the chemical and food industries—to assess the full impact of toxicity and of processed foods on our lives.

—  In view of the widespread lack of awareness regarding the adverse effects of toxins, especially neurotoxins, on children, we believe that there should be a national screening programme for the most common toxins that adversely affect children such as lead, mercury, cadmium, dioxins, organophosphates and others.

—  In view of the devastating effect of alcohol on society we urge the Department of Health to develop an integrated alcohol strategy for the prevention and treatment of alcohol addiction, including ensuring the education system warns children of the dangers.

—  Resource allocation should be directly related to epidemiological evidence, and to the operation of "early-warning" public health systems. This should not be restricted just to infectious diseases, but should focus on a wider remit.

8.  DIET AND NUTRITION

A neglected area

  8.1  Healthy nutrition demands that we have a balanced diet, but millions of people suffer because of a serious imbalance of diet. We are constantly encouraged by commercial interests to consume excessive amounts of fat, salt and sugar. Children are encouraged to eat junk food and adults to have an excess alcohol intake. All this is leading to enormous social and health problems with substantial strain on the health service, which no government can ignore.

  8.2  It is likely that many of the diseases we see currently in western societies are due to changes in our diet: The dominating illnesses in modernised societies are new, or have become newly prominent, in the past 100-150 years. When traditional societies modernise, they, too, seem to develop these same "modernisation diseases" within a few decades. These illnesses include cardiovascular diseases such as ischaemic heart disease, hypertension and stroke; respiratory diseases such as asthma, metabolic diseases such as obesity and diabetes, malignancies such as major types of cancer including cancers of the breast, prostate and colon, allergies, gastrointestinal conditions such as appendicitis, inflammatory bowel diseases, irritable bowel syndrome and coeliac disease and behavioural disorders especially in children such as childhood hyperactivity and "autism".

  8.3  While it is possible that some of the above conditions are due to a "westernised lifestyle, part of the "westernised lifestyle" comprises a "western diet" which in itself consists of increased intake of processed foods, including increased intake of fats, sugars, salt and an increased intake of total calories. Obviously, other factors also contribute to a "western lifestyle" such as reduced physical activity, increased exposure to toxins through for example pesticides, air pollution, etc. exposure to electromagnetic fields, reduced amount of sleep and other influences.

  8.4  The medical treatment of many chronic lifestyle diseases such as ischaemic heart disease, hypertension, stroke, diabetes, asthma and cancer uses up most of the resources of the health service including drug budgets. The anticipated increase in these conditions, especially obesity, diabetes and cancer is likely to financially crush the NHS. Currently, among the highest prescribing drug costs in UK General Practice are cholesterol-lowering statins. However, antihypertensives and inhalers for asthma/COPD also contribute very significantly to drug costs. In addition to those costs, the social and economic cost due to incapacity, disability and death caused by these diseases can hardly be overestimated.

  8.5  The nutritional treatment of many chronic diseases is relatively cheap compared to drug costs. For example, one strategy for the secondary prevention of ischaemic heart disease (IHD) used a Mediterranean-style diet. This intervention led within three years to a 70% reduction in overall mortality rate, compared with the far more expensive statin treatment, which, over a five-year period led to at most a 30% reduction in overall mortality. Statin treatment is expensive. For secondary prevention, statins costs in the range of £4,000-9,000 per life-year saved. Primary prevention is even more expensive. Mediterranean diet is with a cost of around £300 per life-year saved only a fraction as expensive. Another study examined the impact of eating two or three portions of fatty fish per week on the survival of men with a previous heart attack. Within two years of the commencement of this simple diet change, a significant reduction in all-cause mortality was observed. This mortality reduction was similar to the reduction achieved in trials using statins for a period of over five years. We are convinced that the currently adopted strategy of combating IHD with statins and neglecting more beneficial dietary interventions both for prevention and treatment is a grave misallocation of scarce public funds.

  8.6  There is strong evidence from many studies that at least three dietary strategies are effective in preventing IHD: replace saturated and trans-fats with non-hydrogenated unsaturated fats, increase consumption of omega-3 fatty acids from fish or fish oils, and consume a diet high in fruits, vegetables, nuts, and whole grains and low in refined grain products. However the usual recommendation to simply reducing total fat in the diet is unlikely to reduce IHD. A recent review from Harvard University concluded: "Substantial evidence indicates that diets using non-hydrogenated unsaturated fats as the predominant form of dietary fat, whole grains as the main form of carbohydrates, an abundance of fruits and vegetables, and adequate omega-3 fatty acids can offer significant protection against coronary heart disease. Such diets, together with regular physical activity, avoidance of smoking, and maintenance of a healthy body weight, may prevent the majority of cardiovascular disease in Western populations."

  8.7  There are examples of community-based intervention programmes, such as the Finnish North Karelia Project, which influence diet and other lifestyles that are crucial in the prevention of cardiovascular disease. Broad community organisation and the strong participation of people were the key elements. Following this, the diet of the population has changed and these changes have led to a major reduction in average serum cholesterol and blood pressure levels. Following this, ischaemic heart disease mortality has declined by 73% in North Karelia. The project was based on low-cost intervention activities, where people's participation and community organisations played a key role.

  8.8  Unfortunately, while common sense teaches that nutrition is essential for health and well-being, nutritional medicine as a medical and public health specialty is, in our view, a neglected area. It is a fairly new science, is not routinely taught at medical school and appears to attract less attention than drug prescribing.

  8.9  It appears that far more research is done into drug treatment of chronic diseases funded by drug companies. Drug companies are obviously more interested in selling their drugs—ideally, from a company point of view, to patients with often life-long "incurable" illnesses such as IHD, hypertension, diabetes and asthma, than into the prevention and possibly even cure through nutrition. How many times have doctors been approached by drug representatives trying to promote for example a statin as opposed to someone wanting to promote olive oil or nutritional supplements?

  8.10  One relatively recent development over the past decades is the increase in consumption of processed foods. Processed foods include those that have been heated or fried, refined, artificially coloured, blended, or enriched to provide different flavours, textures and colour. Almost all processed foods contain many different chemicals and additives to help stabilise and preserve the texture, colour, flavour and freshness of the food. Additives including animal and vegetable fats, trans fats, salt colour dyes and chemical flavours are added to food to make them more appealing. In addition, preservatives like nitrates, sulphates and salt, are added to prolong the shelf-life of processed foods. This processing of food must be balanced against the fact that foods naturally degrade over time.

  8.11  The significant increase in ready-made meals which are based on processed foods show the following statistic: In 2002, the average household spent just 20 minutes preparing each main meal—down from one hour in 1980. British consumers now spend £7,000 a minute on ready meals. This is three times more than any other European country. (The Guardian, 29 May 2004)

  8.12  Eating excessive amounts of sodium—usually in the form of salt in processed foods or added by consumers—can lead to health problems, especially high blood pressure. Hypertension increases the risk of stroke, heart disease, and kidney disease. To reduce this risk of chronic illness, the daily intake of sodium should be limited to less than 2.5 grams. There are populations in the world that are able to subsist on much lower sodium intakes in the range of 0.2 grams per day. Few people currently consume less than the upper level of 2.5 grams of sodium, largely because of the amounts of sodium added during food processing. For example two slices of pizza contain about half of the upper level of sodium. Consuming this one meal would leave little room for additional sodium intake at other meals throughout the day.

  8.13  There is now no doubt that many food additives are actually or potentially dangerous, but often little seems to be done to take this matter seriously, presumably because of huge commercial pressures. Manufacturers deliberately manipulate the taste process of foods, increasing the appetite for "more" of the same food. The government needs to be far more aware of the significant danger of allowing commercial interests to endanger public health, particularly with the use of very dangerous chemicals which enter the food chain.

  8.14  Frying foods, especially starchy foods (potato and cereal products) at high temperature produces acrylamide, classified as probable carcinogen in animals. Furthermore, acrylamide is toxic to the nervous system of animals and humans. Swedish research found that while their raw ingredients contained no detectable levels of acrylamide, crisps contained levels 500 times more than the WHO maximum recommended level for drinking water. French fries contained levels 100 times more.

  8.15  Despite the widespread increase of allergies there appears to be very little knowledge on how to prevent the development of allergies in the first place. Treatment of allergies should not be limited to the reducing or eliminating of allergens but with altering the "wrong" immunological response of the allergic individual. Far more attention, therefore, needs to be given in the healing process to methods of building up the immune system so that it can deal effectively with disorders. A substantial contribution in this respect can be made by diet and with mineral and vitamin supplements. Sadly, under obvious pressure from international pharmaceutical companies, the European Union have seen fit to pass legislation which will dramatically hinder the use of these supplements. (See Annex F.) [Not printed.]

Recommendations

—  There is a case for a UK-wide integrated nutritional medicine strategy. There is a need for a nutritional prevention strategy of chronic diseases such as heart disease, stroke, asthma high blood pressure, diabetes, obesity, cancer and other chronic conditions.

—  A highly controversial area is the health impact of processed and refined foods and of food additives including colourings, preservatives, trans-fats and others. We therefore call for the establishment of a Royal Commission independent of the food industry to examine the public health effects of processed foods and food additives.

—  We strongly recommend there should be a national programme of research and development to guide the food industry in developing alternative technologies to decrease the content of food additives but also sodium, sugars and fat in prepared and processed foods, while maintaining quality, acceptability, and cost.

9.  HEALTH, CHILDREN AND THE MEDIA

Power without responsibility?

Lifestyle and the Media

  9.1  Exposure to media, including watching TV, playing video games, listening to radio and reading magazines has a powerful formative impact on children and young people, including their physical, emotional and spiritual health. Time spent watching TV and playing computer games exceeds the time spent on physical activity for most children and for many children exceeds the time spent with parents. British children spend on average five hours per day using media—more than in any other European country. In the US a young person graduating from high school has spent more time in front of a TV than at school.

  9.2  Television and the media therefore have a major influence on the values and behaviours of young people in addition to the impact on health and educational achievement. We are convinced that it has not yet been fully realised that the media has a formative influence on the values and behaviour of children and adolescents.

  9.3  Because children have high levels of media exposure, more so than in previous generations, the media have now greater access and time to shape young people's attitudes, values and behaviour than do parents or teachers. The media therefore replaces parents and teachers as educators, role models, and the primary sources of information about the world and how to behave.

  9.4  Time spent watching television or playing computer games takes away from important activities such as social interaction and development, especially time spent with the family, physical activity including playing but also reading and school work.

  9.5  Children's behaviour is influenced by information from television totally inappropriate for their age, and even incorrect. While there is the "watershed" this is rendered essentially irrelevant through video recorders that can be pre-programmed and the fact that nearly two-thirds of all children under six have a television in their room, and one-third of those up to the age of three have their own screen in their room.

  9.6  Younger children under the age of 8 often cannot tell the difference between the fantasy presented on television versus reality. Children are also adversely influenced by the thousands of advertisements they see each year, many of which are for alcohol, junk food, fast foods, and toys.

  9.7  Advertising often works by making the viewer feel unhappy with our lives, anxious and dissatisfied, lacking something. The messages are that you are not OK unless you buy this, wear that brand, wash your hair with, and look like that very slim model. It attacks our self-esteem. Girls in early adolescence are particularly vulnerable to messages about being OK as they are sensitive about their body image and whether they measure up to the peer group. Recent research indicates that there is a marked link between TV watching, and negative body and eating disorders in adolescents.

  9.8  Violence, sexuality, certain stereotypes, but also drug and alcohol abuse are common themes of television programmes and some computer games. Young children are impressionable and may assume that what they see on television or experience in a computer game is typical, safe, and acceptable. As a result, television and computer games expose children to damaging behaviour.

  9.9  Children who watch a lot of television are likely to have lower grades in school, read fewer books, exercise less, be overweight and are more likely to be verbally and physically violent.

  9.10  Public health initiatives therefore need to address the negative impact of the media on public health. We should not, however, overlook the fact that the media can sometimes have a positive impact on behaviour.

  9.11  We are particularly concerned about the negative effect of the media including TV advertising on public health in the following areas: nutrition and health including obesity and diabetes, behavioural changes including increased violence, sexual behaviour and self-image, educational achievement including literacy.

Food, Healthy Eating and the Media

  9.12  There are many adverse effects of watching TV on children's health. The time spent watching TV is not spent on physical activities and the foods depicted on TV—both in programmes and in advertisements—are frequently unhealthy. Also, while watching TV children are more likely to snack. Watching TV lowers children's metabolic rate to below what it would be even if they were sleeping, therefore by watching TV children "burn off" fewer calories than while sleeping.

  9.13  It is interesting to note that—at the same time where there is an explosion in childhood obesity—there has been a steady increase in time children spend watching TV, playing computer games or spending time on the internet. While the media alone cannot explain the explosion in childhood obesity, they play a major role in causing the epidemic of childhood obesity.

  9.14  There is significant evidence linking time spent watching TV with obesity. In one of the first studies examining this link it was found that among 12 to 17-year-olds the prevalence of obesity increases by 2% for every hour spent watching TV. Conversely nearly one-third of childhood obesity could be prevented by reducing TV watching to 0-1 hour per week.

  9.15  In addition to obesity caused by reduced physical activity while watching TV, the advertisements seen while watching TV are a powerful force to influence children's behaviour. They influence children to eat certain foods, drink certain drinks or buy certain toys. Advertisements have a powerful force to influence values (for example to impart the values of a consumerist society) and to shape behaviour.

  9.16  In the US, it is estimated that children have viewed an average of 360,000 advertisements on TV before graduating from high school. In addition to this children are exposed to advertisements in radio, newspapers, magazines and billboards.

  9.17  Many studies show that young children under 8 years of age are developmentally unable to understand the intent of advertisements and, in fact, accept advertising claims as true. The youngest viewers, up to age 8, cannot distinguish advertising from regular television programming.

  9.18  The media regularly carries advertising campaigns advocating the taste or the value of various foods, or promoting the image of the food supplier. What these campaigns often ignore is the absolute health factor of the food being promoted. In particular, sugar, salt and fat levels are often way above the levels that dietary experts say should be the maximum daily intake. Even foods promoted with campaigns that expound a healthy aspect of a particular food often ignore worryingly high levels of other ingredients such as sugar, salt or fat.

Alcohol Consumption and the Media

  9.19  The media have consistently depicted the drinking of alcohol as socially acceptable. Most television "soap operas" are built around the "local"—the Queen Vic for Eastenders, the Rovers Return for Coronation Street and the Woolpack for Emmerdale. In these programmes, all transmitted before the watershed, excessive consumption of alcohol is regularly depicted.

  9.20  Even in "docu-soaps" excessive alcohol consumption is regularly seen. Programmes about holiday reps and those programmes built around images from public monitoring cameras, tend to present images of peers who are drinking heavily, promoting the excessive intake of alcohol as a norm. Reality TV shows such as "Big Brother" often use alcohol as a reward measure. Many adolescents admire the fact that drunken behaviour has "bought" a member of their peer group their "15 minutes of fame".

Sexual Health and the Media

  9.21  There has been a steady increase in the amount of sex in the media, especially TV but also magazines and an increase in the explicitness of these portrayals. There appears to be a fairly consistent sexual message: most portrayals of sex depict or imply heterosexual intercourse between unmarried adults portraying promiscuity as the norm, with little reference to sexually transmitted infections (STIs) and AIDS, pregnancy, or use of contraception.

  9.22  The sexually explicit messages daily portrayed by the media have a formative influence on children's and adolescent's sexual behaviour, possibly more so than the influence of parents and the educational system. We are therefore particularly concerned about misleading, inaccurate and unrealistic information about sex which will be taken as "fact" by young people. For example, how many people in soap operas—in contrast to "real life"—contract an STI or become pregnant following casual sex?

  9.23  Heavy exposure to media sex leads to a wrong perception in that young people wrongly believe that "everyone is doing it". Exposure to media sex makes young people believe wrongly that sex is more common at an early age and more frequent than in reality. As a result, the media, especially TV may normalise precocious sexual activity and promiscuity.

  9.24  The media have consistently depicted sexual adventure and unstable sexual relationships as socially acceptable. In television "soap operas" such as Eastenders, Coronation Street and Emmerdale, all transmitted before the watershed, marital and sexual infidelity is regularly depicted. The constant featuring of sexual activity through television, is the cause of exciting story lines and inevitably leads to sexual curiosity occurring before sexual competence is reached.

  9.25  On television, abstinence among teenagers is rarely portrayed in a positive fashion. Modesty is mocked and charity ridiculed. Analyses show that the average American teenager will view nearly 14,000 sexual references, innuendoes, and jokes per year, yet only 165 of the references will deal with such topics as birth control, self-control, abstinence, or STIs. On soap operas—which are extremely popular with teenage and pre-teenage girls—the sexual content has more than doubled since 1980. Soap opera sex is 24 times more common between unmarried partners than between spouses. Music Television (MTV), 75% of concept videos (videos that tell a story) involve sexual imagery, over half involve violence, and 80% combine the two, portraying violence against women. While we are not aware of similar British data, we expect similar findings on British TV, especially since many American series are shown here.

  9.26  Advertising uses a significant amount of increasingly explicit sexual imagery. Sex is used to sell many everyday products. Advertising therefore directly contributes to the sexualising of society.

  9.27  The link to the media of this explosion in promiscuity and STI's is clear. Newspapers, teenage magazines and television all actively promote promiscuity and present extramarital sex as the norm. The music industry has rising sales of records which are often based on perverted sexual activity and promiscuity.

  9.28  Lyrics such as the examples in Appendix G are being pumped into young people all the time, the industry is totally unregulated and self-censorship has not worked. The net effect of such music is to dehumanise the act of sexual union and to destroy respect for self and others. The contribution of such lyrics must be questioned in the light of the current increase in sexually transmitted diseases as well as sexual crime.

Violence and the media

  9.29  There has been a significant increase in the exposure of children to TV and media violence, not only in TV programmes but also through violent computer games.

  9.30  Viewing media/TV violence can lead to increased antisocial or aggressive behaviour, desensitisation to violence (becoming more accepting of violence in real life and less caring about other people's feelings), or increased fear of becoming a victim of violence.

  9.31  Exposure to media violence results in many physical and mental health problems for children and adolescents, including aggressive behaviour, desensitisation to violence, fear, depression, nightmares, and sleep disturbances. This all has a direct bearing on the NHS.

  9.32  Prolonged exposure to violent media portrayals results in increased acceptance of violence as an appropriate means of solving problems and achieving one's goals. Television, films and videos normalise carrying and using weapons and glamorise them as a source of personal power in a world which is perceived to be increasingly dangerous and violent.

  9.33  Television exposure during adolescence has also been linked to subsequent aggression in young adulthood. A 17-year study concluded that teens who watched more than one hour of TV a day were almost four times as likely as other teens to commit aggressive acts in adulthood.

  9.34  In July 2000, the American Academy of Paediatrics, American Academy of Child & Adolescent Psychiatry, American Psychological Association, American Medical Association, American Academy of Family Physicians, and American Psychiatric Association issued a joint statement that concluded: "At this time, well over 1,000 studies point overwhelmingly to a causal connection between media violence and aggressive behaviour in some children."

  9.35  There is a direct link between violent video games and violence and aggression. According to some American researchers it is estimated that playing violent video games contributes up to one-fifth to the increase in adolescent violence. Decreasing the time spent watching TV and playing video games significantly reduces physical and verbal violence in children.

The Regulation of the Media

  9.36  With the introduction of the "digital age" there has been a vast increase in viewer and listener choice. Whilst this increase in choice is to be welcomed, there has been considerable relaxation of regulation and an increasing reliance on self-regulation. We would submit that many of the issues highlighted in this document are a direct result of the more lax standards that are now applying to broadcasting. This has now become a major public health issue.

  9.37  Young people are particularly vulnerable during their formative years. Research by the Independent Television Commission (ITC now incorporated into Ofcom, as part of the Digital Action Plan in 2003), indicated the number of second and third television sets in households, many of which are watched by children with little or no parental guidance or supervision. In 2002 the ITC found that 19% of households had one television set, 36% had two, 27% had three with 12% having four sets.

  9.38  The ITC report "What Children Watch" issued in June 2003 made it clear that children have access to television, and are often watching it during the majority of their "home" time. This access is often unfettered, and may also include use of video recorders with most children having their own video collection.

  9.39  The proliferation of channels together with the strong development of the independent production sector has seriously diluted the regulation of individual programmes. The licences granted to platform operators may impose responsibilities for the material carried. However the content provider contracts negotiated with the platform operators will give indemnity to the platform operators and the content providers most often source material from organisations even more remote from the regulatory authorities. Independent producers, often established for a single series with itinerant staff, have bought in packages from music suppliers who will not allow editing of material, or programming sourced from overseas.

  9.40  Unfortunately the media has largely lost the sense of responsibility that it once had.

  9.41  The sad truth is that most children and young people in the United Kingdom now have direct access to pornography with grave consequences for their future well being.

  9.42  As a Christian community we are very concerned at the spiritual impact of violence, sexual promiscuity, and pornography on the young now being transmitted through the media. (See further evidence in Annex G.) [Not printed.]

Recommendations

—  We believe that there needs to be an urgent Public Health Summit involving representation from the Government, especially the Departments of Health, Education and Skills, Culture, Media and Sports, OFCOM, representation from professional organisations such as the Royal College of Paediatrics and Child Health, the media including TV, magazines, advertising companies and companies producing computer games and others assessing the impact of the media on young people's health including legislative control. The areas that need to be examined include those mentioned in this submission: advertising to children, impact of violence and sex depicted on TV and the impact of electronic media on eating patterns as well as general health and physical activity of young people.

—  We urge the Government to implement regulation of advertising in the media of products with unhealthy levels of sugar, salt and fat, especially to children, just as the advertising of cigarettes has been regulated. This should be introduced in spite of likely pressure from commercial interests associated with sugar and other commodity production.  

—  Further consideration should be given, as a matter of urgency, to ways of addressing healthy eating and increasing levels of exercise amongst young people so as to address current increasing incidence of obesity. Maranatha acknowledges that the Government is taking some initiatives on these issues. However obesity is now approaching epidemic levels and emergency action on this issue should be initiated this year.

—  We urge Government to work with the media to ensure that drinking, drug-taking, casual sex and violence are not glamorised, and that portrayal of drunkenness is minimised.

—  We urge the Government to examine popular television and work with broadcasters to introduce a balance of fidelity into the depiction of relationships in programmes transmitted both before and after the watershed.

—  We urge the Government to work with the music industry and broadcasting and media to urgently devise a method of introducing responsibility into the industry and in the promotion of popular music.

—  We urge the Government to examine the regulatory framework for content broadcast on all platforms and to ensure that Ofcom is exercising its prime responsibilities in light of the issues raised in this submission.

—  The Maranatha Community has suggested in this submission and in previous submissions solutions that should be considered to reduce the incidence of disease related to promiscuity, alcohol consumption and poor diet. In our opinion, the media has a very large part to play in developing and delivering campaigns on these issues. A responsible media can, indeed must, help to build a new generation where health is improving.

10.  SPIRITUALITY AND HEALTH

A neglected area

  10.1  In the Judeao-Christian tradition the healing process embraces body, mind and spirit. The spiritual dimension of life is a fundamental part of the healing process. Modern western medicine acknowledges the contribution of body, mind and emotions in disease and healing but fails to recognise and totally lacks understanding of the spiritual dimension of health and sickness.

  10.2  A very high proportion of the hospitals and centres for healing were originally established and maintained for generations by the Church and Christian bodies.

  10.3  Spirituality refers to the relationship between man and God. Spirituality is the means, both for the individual and society, to bring a sense of meaning to "being human". The spiritual component of the healing process enables patients to have a sense of identity and self-worth, belonging and purpose, even in sickness.

  10.4  In comparatively recent times there has been a quite irrational trend towards the dismissal of the central spiritual role both in causing disease and in the healing process. The rejection of spirituality is based on a rejection of a belief in God. However, to claim that there is no God is no more "objective", "rational" and "scientific" than to claim that there is a God, even though those who base their worldview on the assumption that there is no God often claim to be "rational" and "scientific". Official documents may refer to the physical, emotional or social dimensions of health without mentioning the spiritual dimension at all. The increased secularisation of society has undoubtedly robbed many of the benefits of spiritual healing. There are now growing signs of a rediscovery of this.

  10.5  In many respects we are a sick society and this sickness is manifest in almost every part of our national life. Sickness is seen in our physical, emotional and spiritual condition. Sickness may be self-inflicted due to poor nutrition, smoking or other unhealthy lifestyles. It may be environmental and may be attributed to toxins/pollution in air, water and food. This sickness may also be rooted in social influences such as poverty or working conditions. While we see a recognition of many of the above factors in public health, we deplore the complete absence of an understanding of the spiritual roots of sickness which we consider very significant contributors to ill health, perhaps comparable to the contribution of nutrition both to ill health and to healing.

  10.6  Studies have shown that religious commitment significantly reduces the risk of depression and suicide, and reduces the risk of alcohol, nicotine and drug misuse. Spirituality can positively help patients dealing with recovery from surgery, or with severe or chronic medical or emotional illness including cancer. Faith can play a central role in the lives of those who are terminally ill and allows them to "die well".

  10.7  Spirituality and the practice of religion generally enhance adolescent and adult health behaviours. Adolescents who attend church regularly and report that religion is important to them are much less likely to engage in binge drinking, smoking, or using cannabis. They are more likely to eat in a healthy fashion, to exercise regularly, get adequate sleep, and wear seat belts. Among adults, the practice of religion is associated with increased physical exercise, lower rates of smoking and alcohol abuse, improved mental health including reduced depression, and maintaining marital stability.

  10.8  It is therefore not surprising that faith is linked with significantly increased life expectancy. The beneficial effect of spirituality on life expectancy is comparable to the effect of not smoking or taking regular exercise.

  10.9  There is very substantial evidence that Christian experience and belief has a powerful and sometimes dominant influence on the healing process. We are today seeing the emergence of a large number of Christian healing centres in which there is a partnership between ordained priests and ministers and health professionals.

  10.10  As a Christian community, the Maranatha Community has extensive experience in all aspects of the Christian Healing ministry and over many years we have experienced many healings—sometimes quite dramatic healings—through prayers. These healings have involved many individuals affected by conditions such as advanced malignancies, serious "incurable" medical conditions, infertility and serious mental health problems.

  10.11  Perhaps one of the most relevant aspects of spirituality in terms of the healing process is the message of forgiveness, especially in the Christian faith, whether we call it reconciliation, restoration, offering new hope, affirming acceptance etc. Experience has shown that the giving and receiving of forgiveness, personal, individual and corporate, is pivotal to many aspects of healing. The Christian faith gives patients the ability to forgive and to be forgiven. It is vital that the NHS provides facilities for this process to be accommodated.

  10.12  The role of hospital visitors and chaplains has been firmly established and much appreciated for generations. There is, however, currently a widespread concern about the drastic limitations which have been placed upon the NHS Chaplaincy. Their role has been diminished by virtue of them not being allowed crucial information about patients on entry into hospital. It has been claimed that this is due to the Data Protection Act. There is no evidence whatsoever of any complaints over access to this information by chaplains and ministers and many patients have expressed their dismay at what they regard to be an unacceptable intrusion of bureaucracy.

  10.13  Whereas the acceptance of the spiritual dimension of healing has brought considerable help to countless people there is, sadly, much evidence that there are dangers in allowing occult practices to intrude into the Health Service. Most occult practices are extremely dangerous and have left a trail of casualties. The NHS should never under any circumstances countenance occultic techniques such as Reiki, nor the operation of spiritist mediums within the Health Service. Many are disturbed at the possibility of National Health Service resources being diverted to a variety of dubious and potentially damaging "New Age" practices.

  10.14  Whereas the Department of Health must clearly meet the needs of the minority religions, sight should not be lost of the fact that in the last national census, 72% of the population of the United Kingdom claimed to have a Christian faith. It is important that the majority of the population should not in any way be deprived of the benefits of Christian prayer within hospitals and clinics, especially as there is very clear evidence supporting the benefits of spirituality in recovery from illness. It needs to be recognised that a very substantial proportion of all patients are in a real emotional and spiritual need and this should not be disregarded.

  10.15  As a Christian community, we would like to introduce the biblical term "righteousness" into the discussion on public health. Righteousness means "right relationships" between man and God, right relationship to myself (Jesus' command is to love your neighbour as your self—there is the command to have a right relationship with others and with oneself) right relationships with others and right relationships with nature and the environment. The right relationship of the individual with God leads to a meaningful life and to healing through experiencing God's love. The right relationship with oneself leads to a healthy lifestyle, including healthy nutrition, a healthy self-image which is neither corrupted by self-aggrandizement nor self-denigration and no need for drug or alcohol dependencies. The right relationship with others leads to peace and healthy communities. The right relationship with the environment leads to a respect for nature and the environment, reducing pollution and preserving species. We believe that if this concept of righteousness were followed, this would lead to a healing of the individual, of society and of the environment. (See evidence in Annex H.) [Not printed.]

Recommendations

—  There is a need for greater consideration to be given within the NHS to the spiritual dimension of healing and it is suggested that the church's experience of the healing process should be shared more widely with the National Health Service. It is, therefore, proposed that there should be a consultation between the Department of Health and representatives of churches and experienced specialist Christian bodies.

—  It is proposed that all chaplains within the NHS are given equal professional status with other members of the medical team and enabled to have access to basic information concerning patients.

—  Consideration should be given to the carrying out joint studies with doctors and those experienced in the Christian Healing ministry, to explore ways and means of achieving a deeper understanding of the spiritual aspects of the healing process.

11.  POLITICAL FACTORS AND HEALTH

Who decides?

  11.1  In this section, we wish to look at three areas where we are convinced, that interests of certain individuals or groups have unduly dominated the decision-making process to the detriment of public health. These include the downgrading of cannabis, the current sexual health strategy and the link between drug companies and industry-sponsored research overstating the beneficial effects of their products.

  11.2  Often, political decisions are taken upon the advice of "independent" or "expert" committees such as the Advisory Council on the Misuse of Drugs, the Sexual Health and HIV Strategy Integrated Steering Group, the Teenage Pregnancy Unit or the so-called Independent Advisory Group on Sexual Health and HIV. There are grave concerns that these bodies make recommendations, which have widespread implications for public health, based on an unrepresentative membership.

  11.3  It is of serious concern that there may be potential serious conflict of interests. Organisations that provide services and are represented on government advisory bodies include among others the Family Planning Association and Brook Clinics. It is surprising to note that these organisations, which directly benefit from the allocation of resources for family planning services, have been appointed to be members of "independent" advisory committees, thus deciding the direction of policies regarding sexual health. Not surprisingly, the policies recommended by these bodies advocate for example the expansion of family planning services.

  11.4  The recent reclassification of cannabis caused confusion. It is likely that it already has led to increased use of cannabis with all the detrimental effects on public health. The reclassification was based on incomplete evidence. The recent evidence linking cannabis to severe mental health problems such as schizophrenia and other psychoses could not have been taken into account because this research was published after the Advisory Council on the Misuse of Drugs (ACMD) submitted its report in March 2002. The ACMD report recommended the downgrading (reclassification) of all cannabis preparations from a class B to a class C.

  11.5  We are particularly concerned about the composition of the Advisory Council on the Misuse of Drugs (ACMD). A significant proportion of the members of the ACMD are also members of organisations involved in the promotion of "harm-reduction". The ACMD had no members of leading drug prevention organisations, no expert on schizophrenia and only few scientists on its panel. Even though the majority of research directly linking cannabis with mental illness including schizophrenia was not published until November 2002, the Home Office maintained that this research had been taken into account when recommending the reclassification. In fact, the ACMD as still not give proper consideration to the most recent scientific evidence.

  11.6  The Home Affairs Committee in their enquiry "The Government's Drugs Policy: is it working?" invited many individuals and organisations to give evidence. The committee invited about three times as many witnesses favouring the downgrading of cannabis, decriminalisation or even legalisation of cannabis than witnesses who oppose reclassification or who favour a restrictive drug policy. Not surprisingly, this enquiry therefore recommended that cannabis be downgraded from Class B to C and ecstasy be downgraded from Class A to B.

  11.7  Groups such as the Sexual Health and HIV Strategy Integrated Steering Group or the recently formed Independent Advisory Group on Sexual Health and HIV takes decisions regarding sexual health policies upon advice and recommendations. We are seriously concerned about the composition of these bodies. Of the membership of those groups we recognise leading members of "pro-choice" organisations such as the Family Planning Association, Sex Education Forum, National Children's Bureau, Brook Advisory Service , Marie Stopes, British Pregnancy Advisory Service, and others. The Chair of the Independent Advisory Group on Sexual Health and HIV is Baroness Gould who is also President of the Family Planning Association and Chair of the All Party Pro Choice Group. Significantly, there are no members of "pro-life" groups represented on these panels.

  11.8  When the Health Committee of the House of Commons reported its findings in its report into sexual health in June 2003, there was a significant imbalance regarding the printed and unprinted memoranda. Essentially all memoranda published by individuals or organisations that were critical of the current approach to sexual health or were "pro-life" were not reprinted. These unprinted memoranda include submissions by the Maranatha Community, the Council for Health and Wholeness, by SPUC, CARE and others.

  11.9  There is now rapidly growing concern that key areas of medical research may be neglected in academic institutions in favour of research into areas which will generate profits for large pharmaceutical companies. There is particular concern that professional advice may be given on important public health matters by those who have interests in commercial organisations involved the subject of appraisal.

  11.10  Richard Smith, the Editor of the British Medical Journal writes in an editorial (31 May 2003): "The pharmaceutical industry is immensely powerful. It is one of the most profitable of industries, truly global, and closely connected to politicians, particularly in the United States. Compared with it, medicine is a disorganised mess. Doctors have become dependent on the industry in a way that undermines their independence and ability to do their best by patients."

  11.11  We are particularly concerned, that medical practice is based on evidence gained from trials that are largely funded by drug companies. Due to the high costs of funding research, there has been a very worrying trend over past decades with more and more research being sponsored by drug companies and less research being funded independently. Researchers participating in research funded by drug companies usually have to sign an agreement which prohibits them from publishing results or data without the permission of the drug company. It is therefore not surprising, that research funded by drug companies is far more likely to find in favour of the company's drug than independently funded research.

  11.12  Whether a medical trial is sponsored by a drug company or not has a major impact on the outcome. In an analysis of 370 studies, the drug under investigation was recommended as treatment of choice in only 16% of trials funded by independent organisations, but in 51% of trials funded by drug companies. Trials funded by drug companies were over five times as likely to recommend the drug treatment as treatment of choice compared with trials funded by non-profit organizations. Studies of cancer drugs sponsored by not-for profit organisations were nearly eight times more likely to report unfavourable conclusions than drug company sponsored studies of the same drug. Studies sponsored by manufacturers of a newer class of antidepressants (Selective Serotonin Reuptake Inhibitors) favoured this drug class over the older tricyclic antidepressants more than non-industry-sponsored studies. It is therefore likely that conclusions in trials funded by drug companies are more positive due to biased interpretation of trial results.

  11.13  With the advent of evidence-based medicine many reviews of the scientific literature include an assessment of how robust the published evidence is, for example based on the type of study used. For example, anecdotal evidence is considered to be less reliable than evidence from randomised trials. Whether or not a study has industry sponsoring or not is likely to affect the outcome of the trial. We are surprised that there is no widely used scoring system, which classifies medical research according to the degree of independence from industry sponsoring.

  11.14  We are particularly concerned that many experts involved in guideline development for medical practice such as General Practitioners or hospital doctors, are not independent of the pharmaceutical industries. Not surprisingly, these guidelines frequently favour a certain approach—for example drug treatment—over non-drug including nutritional approaches.

  11.15  There is furthermore the danger that large pharmaceutical conglomerates have an unfair interest on legislation affecting health. An example of this is an EU Directive which may close down most of Britain's 2000 health shops. It is part of the huge programme of EU legislation which is being "fast-tracked". Pharmaceutical companies have been lobbying behind the scenes for years to introduce the "Herbal Medicines Products" Directive which seeks to apply to herbal remedies the principle of continental law that things can only be allowed when they are specifically authorised. (See evidence in Annex I.) [Not printed.]

Recommendations

—  It is imperative that government advisory groups such as the Advisory Council on the Misuse of Drugs, the sexual health advisory groups and others become truly independent groups. There should be no appointments to those advisory groups of any individuals or organizations that are likely to benefit financially from policy decisions made. All current members of all advisory bodies need to declare their potential conflict of interest publicly. Policy decisions should be made on scientific evidence, not on the basis of political lobbying.

—  There needs to be an increase in independently funded medical research.

—  We call for the establishment of a scoring system, which classifies medical research according to the degree of independence from industry sponsoring. All guidelines —especially government guidelines—need to incorporate this scoring system in their assessment of new drugs or therapies.

—  There needs to be an urgent re-evaluation of national guidelines issued where the authors have had a potential conflict of interest.

January 2005

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89   All studies of child-abuse victims which look at family type identify the step-family as representing the highest risk to children. However, the term step-father needs to be defined, since it used to refer to men who were married to women with children by other men. It is now used to describe any man in the household, whether married to the mother or not. An NSPCC study of 1988 which separated married step-fathers from unmarried cohabiting men found that married step-fathers were less likely to abuse: "for nonnatal fathers marriage appears to be associated with a greater commitment to the father role". (Gordon, M and Creighton, S (1988), "Natal and nonnatal fathers as sexual abusers in the United Kingdom: A Comparative Analysis", Journal of Marriage and the Family 50, pp 99-105.) Back

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Prepared 2 June 2005