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Mr. Lansley: I am not quite sure what evidence the hon. Gentleman has to back the idea that I have somehow been converted. If he goes back, for example, to before the general election to the opportunity that I took in September 2004 to set out our policies on public health, he will find that one of the first things that I did was to say that that was our top priority. I said—and I would have done it—that if I had become Secretary of Sate after the election, I would be Secretary of State for Public Health and when we debated health inequalities, the Secretary of State would be here, not an Under-Secretary of State. I made it clear that that focus on public health was intended to improve not just health outcomes for the whole population.

Mr. Jones: Will the hon. Gentleman give way?

Mr. Lansley: No. The hon. Gentleman will have to sit down.
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The intention was not only to improve health outcomes in the whole population, but to increase the relative health of those who are poorest. Why did the Minister not just get up and say what the objective is? We agree that the objective of our policies is to improve the health outcomes of the people of this country and those of the poorest fastest. Why did the Minister not say that?

Caroline Flint: I did.

Mr. Lansley: The Minister did not say that. That is what must be done and she is confusing the aggregate data—it is astonishing that she carries on doing so—on whether we are making progress in improving the health outcomes of the whole population with the question of whether the poorest and the least healthy people in this country are improving their health faster than the rest of the population. They are not, and the Government should acknowledge that fact so that they can do something about it.

I asked some questions about evidence, which is central to the issue. If there are two things that have bedevilled the tackling of health inequalities, the first is that we just cannot agree about the causes. Of course, poverty is one of the causes. The hon. Member for North-West Leicestershire (David Taylor) made a rather absurd proposition about that and then left. Of course, there are many causes: poverty, poor housing, environment, family structures, education, ethnicity and genetics. Those are all causes.

Dr. Andrew Murrison (Westbury) (Con): That is right.

Mr. Lansley: Indeed, and we could say that there have been substantial shifts over recent generations. For example, one could go back 100 years when infectious disease led to 25 per cent. of the deaths in this country. The figure is now 1 per cent., and I hope it stays that way, touch wood. What lies at the heart of the debate is the fact that we must be aware—the Minister acknowledged this—that we must not only deal with those environmental issues and the physical and societal factors that cause ill health and inequality—

Mr. Kevan Jones: Poverty.

Mr. Lansley: I do not deny that poverty is included. The hon. Gentleman will be aware of the simple fact that the latest data in the family resources survey, which are from 2003–04, show that, in the lowest quintile by income, the ratio of the top to bottom quintile incomes has deteriorated compared with 1997–98. So not only are family incomes falling in the 2003–04 data, the situation of the poorest is slightly deteriorating compared with that of the richest. I do not know whether he wants to dispute that—maybe not.

The point that I was making is that if one takes the long view, which we have to do, those environmental factors, important as they are, are at risk of being overtaken by personal, behavioural factors. Even if we reduce income inequalities, reduce the number of people living in poor housing—as has happened—improve the environment and get rid of toxins in the air, which we have done because a Conservative Government introduced the Clean Air Act 1993, and eliminate or
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reduce the threat of infectious diseases, behavioural issues may still mean that some health inequalities are intractable and not reduced.

In some parts of the population obesity rates may be higher, drug taking may be higher, smoking may be more prevalent, alcohol intake may be higher and sexual health may be worse. [Interruption.] I do not dispute that the Minister said all these things. We have to focus on them and part of the purpose of today's debate is to try to get some agreement about the necessity of acting on both sides of the equation. In the past it has tended to be the case that Labour Members talk excessively about the environmental, physical and economic factors, and Conservative Members talk rather more about the behavioural factors. We must acknowledge that we have to do both, and make progress on both. We must also be aware that, over time, those behavioural factors have begun to show how intractable health inequalities are.

The hon. Member for North Durham (Mr. Jones) asked about more money for Easington. Easington has more money. I cannot remember the precise figure, but it is about £1,200 per head for the primary care trust, and the figure in my constituency is £880, so Easington is getting more money. If shifting resources within the NHS were the answer to health inequalities, Scotland would be very healthy. The Minister did not mention this, but the lowest life expectancy in this country is in Glasgow, at 69.1 years for men compared with 80.1 years for men in East Dorset. I am not aware that East Dorset is thick with NHS resources.

Mr. Jones: It was interesting to hear what the hon. Gentleman said about behaviour, but inequalities in parts of my constituency and other parts of the Durham coalfield were caused by the last Conservative Government.

Mr. Stephen O'Brien (Eddisbury) (Con): Rubbish.

Mr. Jones: The hon. Gentleman may say that but, overnight, villages lost their economic heart, so there was increased worklessness, and things such as drug taking increased. I am sorry, but the hon. Member for South Cambridgeshire (Mr. Lansley) cannot stand here today and say that that Government do not have some responsibility for the poor health and inequalities that still exist in some of the former mining villages in County Durham.

Mr. Lansley: I am not sure that the hon. Gentleman heard me say that the last Conservative Government had no responsibilities. Did I say that? Perhaps he would like to demonstrate where I said that.

Mr. Jones: Is the hon. Gentleman then prepared to apologise to individuals and villages in the north Durham coalfield and other parts of County Durham for the last Conservative Government?

Mr. Lansley: I will certainly apologise for the fact that health inequalities did not narrow more under the last Conservative Government if the Minister will get up and
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apologise for the fact that health inequalities have widened since 1997. She is not going to do that, as the hon. Gentleman knows. I will not apologise—I have come across this point before—for what the last Conservative Government did. As it happens, I was not a politician at the time but a civil servant, and I stood next to Norman Tebbit when he signed the deal with Nissan to bring that business to Sunderland. The transformation of the north-east economy did not happen post-1997; it began in the mid-1980s. I know, because I was there.

If we are to tackle health inequalities, we must be aware of the serious problems coming down the line. The Minister referred, for example, to the incidence of smoking among young women. There is also the increase in consumption of alcohol among young women. I was talking recently to Professor Roger Williams, who treated George Best. He is seeing in his surgeries young people, and increasingly young women, who have liver disease which to all intents and purposes is irreversible. That will be an enormous burden of mortality and morbidity in years to come.

At the rate we are going, obesity will in three or four years overtake smoking as the principal cause of avoidable death in this country. The Minister will know that over the past 10 years—before the hon. Member for North Durham chastises me, this is not a trend that was established in 1997, although it has continued over the past eight years—the proportion of our population that is obese has risen from 16 per cent. for men and 13 per cent. for women to 26 per cent. for both women and men. Our children are getting fatter faster than any other children in western Europe.

If that does not change, we will have an epidemic of weight-related diseases such as diabetes, stroke and heart disease; we will have an epidemic of mental health problems as a result of drug abuse; we will have an epidemic of liver disease as a result of the consumption of alcohol; and we will have an epidemic of infertility and related disease—pancreatic inflammation in respect of chlamydia and related sexually transmitted infections. The Minister did not mention the fact that the number of sexually transmitted infections has doubled over recent years. These things have to be tackled.

The Minister did not talk either about the structure of public health services. One of the things that I said before the election was that we needed a new structure. We must ensure that the focus is institutional and financial as well as political, and it is not at the moment. There may be professional leadership from the chief medical officer—even if he had to fight Ministers in order to get through his view on smoking—but the service is not integrated. We have the functions of the chief medical officer on the one hand and those of the Health Protection Agency on the other. Out in the field, directors of public health in primary care trusts must be tearing their hair out trying to get public health messages through the chaos and noise of PCT reconfiguration. Before the PCT restructuring was mooted by the Government, directors of public health found their priorities pushed to the margin, with the single exception of stop-smoking services, to which the Government attached a target.

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