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Stephen Williams (Bristol, West) (LD): We have had a wide-ranging debate, although we have focused rather narrowly on Surrey in the past 20 minutes or so. I want to go back to where we left off on Tuesday night, when, collectively, we made probably the biggest advance in public health legislation for decades by passing a full ban on smoking.

The prevalence rates for smoking are illustrative of the wider health inequalities that exist throughout society. I looked at the statistics for the south-west of
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England. The highest prevalence of smoking is in my own city of Bristol, where it is 33 per cent., and the lowest is in an area that has been mentioned several times today, east Dorset, where it is 20 per cent. There are also great variations within areas. In the Henleaze ward in my constituency the figure is 12 per cent., while in the Knowle West ward, in Bristol, South, the constituency of the Paymaster General, it is as high as 56 per cent. Those wards are only about two and a half miles from each other. There is an enormous variation in quite a small geographic area. In broadly middle-class parts of the city, the prevalence of smoking is below 20 per cent. In working-class or deprived communities it is always over 40 per cent., and in some areas over 50 per cent. Throughout the city, the rates are higher among men than among women.

Perhaps the key vote on Tuesday night was on whether we should remove the exemption for private members' clubs. Several Members, mainly but not exclusively Conservative, said that attendance at a private club was a matter of choice. Had I been called to speak, I would have said that where people go in the evenings is often not a matter of choice. In many parts of the country, particularly south Wales, where I grew up, going to a private members' club rather than a pub is the norm. If we had not removed that exemption, health inequalities in such areas would have widened rather than narrowing.

Mr. Lansley: The prevalence of smoking is probably higher in Liverpool. Did the hon. Gentleman note that the Minister of State, Department of Health voted for the exemption?

Stephen Williams: That is interesting. I assume that the hon. Gentleman is referring to the right hon. Member for Liverpool, Wavertree (Jane Kennedy). I admit that I did not note that she voted for the exemption, but I am sure that the people of Liverpool will take careful note. As the hon. Gentleman will know, an excellent organisation called Smokefree Liverpool is promoting a private Bill to impose a full smoking ban throughout Liverpool—of course, it will not now be necessary—led by Liberal Democrat-controlled Liverpool city council.

Health outcomes are not always a matter of choice. They are often related to the accident of where people were born, their family circumstances, the occupation of family members, the housing in which they were brought up and the degree of poverty in their household. The hon. Member for South Cambridgeshire (Mr. Lansley) quoted from a briefing that I too received, from the British Thoracic Society, about chronic pulmonary diseases such as bronchitis, emphysema and asthma. Those diseases can often be linked with occupations in declining industrial areas. It is a complicated picture.

Mr. Kevan Jones: In the days when I dealt with the tobacco industry, the great city of Bristol was a major producer of cigarettes. Might there not be a connection between the high incidence of smoking in the city and
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the manufacture of cigarettes there? Will the hon. Gentleman be calling for the closing down of the tobacco industry in Bristol?

Stephen Williams: It is often dangerous to presume too much knowledge of areas represented by other Members. I do not know the hon. Gentleman's constituency, but I am sure that he knows more about occupational patterns there than I do. The smoking industry in Bristol went into decline a long time ago. I think that only very expensive top-of-the-range cigars are still produced in south Bristol, although the world headquarters of Imperial Tobacco is still there. The white-collar jobs remain in the Bristol cigarette industry, but the blue-collar jobs do not. The hon. Gentleman is partly right, however: the incidence of smoking in south Bristol can, to an extent, be linked with the fact that workers in the Wills factories were given free cigarettes almost as part of their pay.

What we did on Tuesday night to eliminate smoking in public places represents a big step towards narrowing health inequalities, but there is still much to be done. We need to deal with alcohol consumption, poor diet and other contributors to ill health.

One thing that has not been mentioned so far today is the location of health care services. The recent White Paper on community services contains an interesting section on what the Government call "under-doctored areas"—a phrase that I had not heard before. It includes a table showing the bottom 10 per cent. of areas in England in terms of the number of general practitioners per 100,000 of population. North Manchester PCT has 41, and Wigan PCT and Blackpool PCT each have 45. The accompanying map shows a clustering of low-level GP services in the north-west, south Yorkshire and Tyneside. Of course, they are the areas of greatest general deprivation in England, and they also have some of the worst health outcomes.

However, this is not just a north-south phenomenon. As is often quoted, Hastings is a pocket of poverty and deprivation on the south coast, so it is no surprise to discover that it has a GP rate of 46 per 100,000 people—a figure that matches those for the north of England. According to the Department of Health, a GP rate of 58 per 100,000 people constitutes under-doctoring. On comparing PCTs across the country, it is clear that rural and more prosperous urban areas have twice as many GPs per head of population as the bottom 10 per cent. of areas that I just mentioned. Interestingly, that distribution has not really changed since the NHS was formed in the 1940s. So Aneurin Bevan's vision of a health centre for every community in the country is still not that close to being realised, 60 years after he pioneered his service.

There is, therefore, a correlation between a low concentration of GPs and the worst health outcomes. Given that the general trend of the White Paper is to move the focus of health care away from secondary and toward primary care—and, we hope, toward preventive care as well—it is all the more important, as we undertake that switch, that PCTs with under-doctored areas be given the incentives and resources that they need to ensure that everyone has access to a GP.

As the hon. Member for North-West Leicestershire (David Taylor)—he is no longer in his place—said earlier, men are notoriously reluctant to visit their
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doctor. Teenage boys are often taken reluctantly to the doctor by their mothers, and men are often pressured into going by their partners. It is true that in many ways, men can be their own worst enemies, and not only in terms of visiting GPs. Men are three times more likely than women to become an alcoholic, and four times more likely to have a drug addiction. They are also more likely to be obese and to smoke. As the hon. Member for South Cambridgeshire said earlier, we should not overlook our responsibilities in this regard. It is not simply a question of the Government providing services; we must all behave responsibility. None the less, according to the most recent figures from the Office for National Statistics, male life expectancy is 76.3 years, whereas female life expectancy is 80.7 years.

The House Magazine, of which we are all doubtless avid readers, ran a supplement on men's health in its 30 January edition. It contained some interesting articles, including one by me.

Mr. Lansley: Quote yourself.

Stephen Williams: Do not tempt me. The introductory article was written jointly by Professor Nesse and Daniel Kruger, and the following quote sums up the situation:

Of course, disparities have always existed and are often due to different working patterns, warfare, child-rearing and so on. None the less, at the start of the 21st century, social class is still a factor affecting health outcomes, and men still die younger than women do. Indeed, men are twice as likely as women to develop one of the 10 most common cancers affecting both sexes, and especially bowel and lung cancer, but there remains a great disparity in outcomes in respect of cancers that are peculiar to gender. We heave heard about breast cancer already this afternoon in connection with the drug Herceptin. That debate highlights the fact that much more research is carried out into diseases that affect women than is the case with men, and that more drugs are available for women.

On my lapel, I wear a blue metal symbol, and I get asked every day what it means. I have to make sure that it is the right way up, as otherwise people think that it has something to do with the Scottish National party. In fact, it represents a man covering his testicles and is meant to highlight testicular cancer. The pink ribbon campaign has been a great success in raising awareness of breast cancer among women, and has raised vast amounts of money for research into treatment. We need to put much more effort into raising awareness and funds in respect of the diseases that affect men.

Bowel cancer affects both sexes. It can be treated successfully if it is caught early, but men are still more likely than women to die from it. Men in whom testicular cancer is detected early have a 90 per cent. chance of getting successful treatment. That shows that the advice and support given to people is very important, as is their level of awareness of their own health, but we also need to look at the disparities between the support and advice that are offered to disease sufferers.

A recent survey showed that 34 per cent. of prostate cancer patients were given relevant advice and support, whereas 70 per cent. of women suffering from breast
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cancer felt that they had been given adequate advice and support. Again, that may be due to men's reluctance to ask for advice and so does not necessarily represent a failing, but it is true that many more organisations exist to support the health of women.

I turn briefly to children. We know that there is a disparity in the funding for hospices for children and for adults, and a debate on that subject has been held in Westminster Hall. However, there is also a difference in the support that is given to children whose parents have an illness that may be terminal. I shall raise that matter when I visit Bristol Royal Hospital for Children tomorrow morning.

Health inequalities in this country arise between men and women and rich and poor, but inequalities due to race have not been mentioned much in this debate. The hon. Member for South Cambridgeshire mentioned the NAO report on stroke care, which was considered at last Wednesday's sitting of the Public Accounts Committee. A surprising fact that emerged from the report was that black and ethnic minority people are far more likely to die from strokes than are white people. No explanation of that finding was given, but it is clearly worth further investigation. Moreover, a black African person is 44 per cent. more likely to be detained under mental health legislation.

Last week, the Minister and I debated sexual health and HIV in Westminster Hall, where I said that it had been shown that 45 per cent. of new HIV cases in the city of Bristol in the past two years involve black African men. That is especially significant, given that they make up only about 4 per cent. of the population. When we attempt to tackle health inequalities, we must look at the awareness of certain groups in society. We must tackle their reluctance to discuss their diseases, try to remove the stigma attached to doing so, and encourage them to find professional help.

We need better access to services targeted at people who are at the greatest risk, and to ensure that interventions are made earlier. To that end, I welcome the Government's proposal, contained in the White Paper, to introduce so-called health MOTs or life checks, but I hope that they will be targeted at those most in need.

That raises questions about joined-up Government. I am a member of the Education and Skills Committee, which this week looked at how educational attainment varies between declining industrial areas and more prosperous parts of the country. In Bristol, the Bristol, West constituency has the highest uptake of higher education in the country, and the Bristol, South constituency has the lowest access to higher education. Educational attainment is also linked to poverty and therefore ill health.

In the early 1970s, statistics show that men were twice as likely to die young if they came from an unskilled group than if they came from a professional or managerial group. Thirty years on, they are three times as likely to die young. At the start of the 21st century, the difference in life expectancy between those who live in Dorset, which has been mentioned several times, and those who live in Manchester is 9.5 years for boys and 6.9 years for girls. The hon. Member for South Cambridgeshire mentioned Glasgow as an area where such health inequalities are starkly obvious, and I would add the south Wales valleys.
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We have had a century of state intervention in health care under Governments and coalitions of all three parties. We have 150 years of public health legislation and worker protection laws. We have a society with greater wealth and prosperity, better homes and safer working conditions, and we are all living longer. Although rich and poor are living longer, the poor have not caught up with the rich. The gap has actually widened on some indicators under the Labour Government and there is still much more to do.

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