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Consideration should be given to establishing a comprehensive review (the first in almost 20 years) into arrangements to improve and safeguard the health of the public.
Earlier in the debate, a misunderstanding arose between my hon. Friend the Member for South Cambridgeshire and me. The last review of the public health discipline in this country was carried out by Donald Acheson, who published his report in 1988almost 20 years ago. The present chief medical officer recommends, and I agree, that it is high time that that work was reviewed, not least because Donald Acheson recommended a level of commitment to the public health discipline by 1998 that in 2006 is still not matched. I hope that Ministers will tell the House when they intend to honour that first recommendation.
Health service commissioners should take steps to satisfy themselves that expenditure on public health reflects the needs of their population.
I believe that Ministers accept that now. It is a pity that during the 10 years in which the Labour Government have been in office, they have not focused resourceson need through commissioning [ Interruption. ] The Minister says that they have, but her predecessors in the period in which the right hon. Member for Holborn and St. Pancras was Secretary of State for Health did not believe in commissioning and made it clear that he intended to wind it up, so it is hard for her to make that claim for the whole 10 years in which Labour has been in office.
The third recommendation is that all NHS bodies should ensure that their public health capacity and capability are sufficient for their proper functioning. In his report the CMO makes it pretty clear that he does not believe that the present level of public health commitment is fit for purpose. Furthermore, he draws attention in his report to the fact that there is a twentyfold variationthis is a health inequality among the different parts of the countryin different PCT areas in their commitment to the public health
discipline. That cannot be the record of a Government who accept the importance of public health as the backbone to well informed commissioning.
I conclude with the simple thought with which the chief medical officer heads the chapter on the subject in his reportRaiding public health budgets can kill. It is like the advertisement on cigarette packets. Raiding public health budgets can kill: that is what the Government are doing, and that is the consequence for which they must accept responsibility.
Dr. Howard Stoate (Dartford) (Lab): I am delighted to take part in the debate as I am co-chair of the all-party group on primary care and public health, and as the House knows, I still do some work as a practising general practitioner.
I am particularly pleased that the Government have set 1 July as the date for the implementation of smoke-free legislation in England. I hope that the Minister will follow that up with the announcement of a major public education campaign to ensure that the public and licensees are fully aware of the implications of the new legislation.
Next years date will also provide a major incentive for smokers to quit. As well we know, of the 12 million smokers in this country, at least 8 million at any one time would love to give up smoking. I hope that they now have a date to work to, so that they can plan their strategy. I am pleased that in general practice we can prescribe nicotine replacement therapy and that most practices, if not all, have nurses who are well trained in helping people to stop smoking. Coupled with the prescriptions that we are able to give on the NHS thanks to the Government, that is making an impact on the number of smokers whom we see. That will reduce the burden of ill health in the future to a welcome degree.
In line with the polluter pays principle, I would like to see a profits tax on tobacco companies thatwould fund educational programmes on the health risks of passive smoking and the monitoring and implementation of smoke-free public places. I know that that is controversial, but it would show that the Government meant business by making sure that the companies that profit from smoking put something back into the community to educate people on the ill health which that causes.
I also support proposals to raise the minimum legal age for the purchase and sale of tobacco from 16 to 18. Far more needs to be done to discourage children from smoking, and increasing the limit to 18 would be a step in the right direction. Raising the legal age would also send a strong clear message to young people about the dangers of tobacco, and in conjunction with other anti-smoking strategies would, I hope, help teenagers resist taking up a habit that many of them will live to regret in their shortened lives.
It has been stated that alcohol is implicated in about 40,000 deaths per year in this country and is directly responsible for 5,000 deaths a year. That is a jumbo jet full every month. The World Health Organisation recently identified alcohol as the third highest risk to health in developed countries. Almost 40 per cent. of men and 25 per cent. of women exceed daily
benchmarks of three to four units for men and two to three units for women on at least one occasion a week. Twenty per cent. of men and 10 per cent. of women drink more than double the daily limit in one session at least once a week.
The rate of binge drinking is even more alarming among young adults: 37 per cent. of 16 to 24-year-old men and 27 per cent. of 16 to 24-year-old women binge drink regularly. Between 1988 and 2000 the number of women consuming over 14 units a week rose by 70 per cent. Approximately one in four 16 and 17-year-olds are hazardous drinkersthat is, they have experienced immediate problems, such as loss of memory, injuries or failure to do what is expected of them, after a nights drinking. Among 16 to 24-year-olds, this figure rises to 42 per cent.
Even more alarmingly, 11 to 15-year-olds who drink alcohol now consume nearly twice as much as they did in 1990. They consume on average 9.8 units a week, compared with 5.3 units a week in 1990. Since the early 1970s there has been an eightfold increase in deaths from chronic liver disease among men aged 35 to 44, and a sevenfold increase among women of the same age group.
It has been estimated that alcohol costs the NHS up to £3 billion a year in hospital services alone. Every Friday and Saturday night, 70 per cent. of all accident and emergency admissions and 80 per cent. of pedestrian road deaths are alcohol related. One in four acute male admissions is alcohol related. The cost of alcohol abuse to the wider economy is estimated at£20 billion a year.
There are two key factors in the increase in heavy drinking, particularly among young adultsprice and availability. Alcohol is getting cheaper. In the past40 years, consumption per person has doubled and the price of alcohol relative to income has halved. The number of shops selling alcohol has risen sharply, and a third of all 24-hour licences granted were given to supermarkets, where alcohol is cheapest.
I do not want to be a killjoy at Christmas, but the fact is that alcohol will wreck many lives over the festive period, and we need to take firm action. I propose that the Government should move towards legislation on banning the advertising of alcohol as they have for cigarettes. We need to emphasise the impact of alcohol abuse in young people on the development of drug habits and to improve recognition of the need for counselling and treatment services, particularly for young people. There is also an urgent need for more school-based education founded on an understanding of young peoples perceptions of drinking.
There are about 1 million obese children under the age of 16 in the UKthree times as many as 20 years ago. Those soaring obesity rates have led to an increase in childhood type 2 diabetes, which will lead in future to more heart disease, osteoarthritis and certain cancers. Estimates indicate that if current trends continue, at least one fifth of boys and one third of girls will be obese by 2020. I am pleased that Ofcom has finally put forward proposals to restrict the number of advertisements for foods high in fat, salt and sugar, but they do not go far enough.
David Taylor (North-West Leicestershire) (Lab/Co-op): If my hon. Friend were public health Minister in a future Administration, would he follow the example of Canada, which has banned the use of trans fats in processed foods? Trans fats have double the damaging effect of saturated fats and are a serious health risk that has loomed large over the horizon. Does he agree that that issue must rise up our own Governments agenda?
Dr. Stoate: I thank my hon. Friend for an interesting observation. As he says, trans fats have been implicated in significant levels of disease. I am pleased that Canada, among other countries, has outlawed them completely, and I would like this country to move towards doing so. There is no technical reason why the food industry cannot use the available alternativesit is just a matter of the will to do so. I hope that the Government will be able to push food manufacturers in the right direction on that important issue.
We need to go further on banning advertising of foods high in fat, salt and sugar, mainly because the fact that Ofcoms proposals will not affect some of the programmes popular among children, such as soaps and quiz shows, will significantly undermine the impact of the ban. It would be far more effective and meaningful if the cut-off point were extended to the9 oclock watershed, which all parents understand.
There is very little evidence about the effectiveness of intervention. More research is needed on the effectiveness of weight management and treatment programmes, the longitudinal impact of obesity on individuals and society, and the impact of physical activity on obesity and co-morbidities.
Dr. Stoate: The hon. Gentleman makes an important point. Obviously, the food manufacturers would say that it is all about activity, while other specialists, particularly those from the National Obesity Forum, say that it is a much more complex interaction between calories in and calories out. Nothing like enough is known about the relative merits of calories and activity. There is clearly a relationship between the two, but it is necessary to do far more work to find out exactly where the problem lies so that we can come up with more effective strategies.
One of the most worrying aspects is that many parents do not have enough information to make healthy choices for their children. A MORI poll carried out some years ago found that 70 per cent. of parents said that they did not have the information that they needed to ensure that their children ate a well-balanced and healthy diet and that much more needed to be done. We need a much more sustained and consistent public health campaign to improve parents and childrens understanding of the impact and benefits of healthy living. Families need to be educated and empowered through guidance that recognises the impact of those factors on childrens development of lifelong habits to do with eating and activity.
There is a strong case to be made for the establishment of a national obesity institute to improve collaboration between stakeholder groups. In addition,
extra funding should be available to establish and sustain training programmes for those involved in the care of children with obesity. That should be complemented with resources to allow children to gain access to specialist regional obesity services. We simply need more specialist nurses and GPs. Every primary and secondary school should have a school nurse to advise children on healthy living and other lifestyle issues. At present, there is only one school nurse for every 10 or 11 schools in the country, and we should improve on that significantly.
There should be increased access to subsidised sporting facilities for children and their parents. Ready access to such facilities is particularly important for those from lower socio-economic groups. Exercise on prescription, provided at reduced cost, or free of charge, should be expanded. I was pleased to hear the Ministers recent announcement about prescribing more exercise classes; that is a welcome step in the right direction.
We have heard a fair amount about sexually transmitted infections this afternoon. The latest report from the Health Protection Agency presents data for 2005. Through the presentation and description of epidemiological data, the report highlights the fact that, despite the increasing complexity of the situation, our HIV and sexually transmitted infection surveillance systems have evolved to become among the most comprehensive and informative in the world, and that is very welcome. It is essential to campaign for education strategies that increase young peoples knowledge of the full spectrum of sexually transmitted infections.
Well-designed sex education programmes have been shown to be effective. The Mens Health Forum recently carried out a project, aimed to reach men with messages about chlamydia and sexual health, and it was a good example of an effective education programme. The project was backed by the Department of Health and Roche Diagnostics, and it worked with male students and soldiers to increase understanding of young mens attitudes to sexual health. It was followed by a programme in which testing kits for chlamydia were made available for collection from mens toilets, including some in university colleges. Positive health behaviours must be promoted among individuals who are infected, so that they come forward to seek treatment and go on to practice safer sex. We must ensure that we go ahead with improving access to GUMgenito-urinary medicineclinics. I am pleased that my hon. Friend the Minister announced an aim of reaching the 48-hour target by 2008; that is very welcome.
We have already heard about the importance of maintaining a specialist public health work force. The recent reconfiguration of strategic health authorities and primary care trusts has so far led to a reduction in the number of directors of public health from 303 to 152. I hope that all the people displaced by the reorganisation will be re-employed as public health consultants, because we must make sure that we do nothing to undermine or reduce the important work done by directors of public health and their departments.
I hope that, in partnership with local authorities and voluntary organisations, directors of public health and public health consultants will continue to ensure that
the local populations needs are assessed and addressed through public health programmes. They currently provide leadership in three domains of public health: health protection, health improvement and tackling health inequalities. I am concerned to make sure that the reconfiguration of PCTs and strategic health authorities in no way reduces or dilutes the work that is currently carried out.
For us Labour Members, the story has been one of good news: the reduction in mortality rates for heart disease, strokes and cancer are impressive, and, as we heard, there has been a significant extension of the childhood immunisation programme, which has certainly prevented many hundreds, if not thousands, of preventable deaths among young children. We have every right to be very proud of our record, but the old adage is truea lot has been done, but there remains much to do. I am keen to work with my colleagues on the Front Bench to make sure that the improvements made in recent years on public health are maintained.
Mrs. Nadine Dorries (Mid-Bedfordshire) (Con): I shall focus on sexual health, but first I should like to pick up the Minister on a comment that she made about flu vaccines. She said that she allowed an increase in flu vaccine provision this year, but may I remind her that the only allowing that takes place is on the part of the British public, who allow us to come to the House to serve them? Her comment may be indicative of the extent to which the Government are out of touch with the British people; we do not allow the British public anything.
An entire generation has been let down and blighted by the Governments failure to protect our teenagers in respect of sexual health. The Government knew that there was a problem with sexual health, and that is why the Secretary of State announced that £50 million was to be spent on a sexual health campaign, but only£4 million was spent. We can see a pattern emerge: when any investment is made, or when the Government want to take credit for any inward investment, they do so, but the minute that there is a problem, they blame the hospital managers. However, hospital managers cannot be blamed for the statistics. In 2004-05, cases of syphilis were up 23 per cent., chlamydia was up 5 per cent., genital warts was up 1 per cent., and genital herpes was up 4 per cent. Newly diagnosed cases of HIV doubled in 10 years and, among women, there was a sixfold increase in 10 years, with 3,036 cases now being diagnosed a year. That cannot be blamed on hospital managers.
The next round of cuts at Bedford Hospital will be unveiled today, with sexual health the main casualty...The document proposes that Genito Urinary Medicine..is moved out of the hospital, to be dealt with by GPs.
I had a quick ring-around of my local GPs, who said that they have no specialist training in genito-urinary medicine, and have absolutely no idea how they are supposed to cope with genito-urinary medical problems in their surgeries, given the increase in sexual health problems.
Some people criticised the AIDS campaign of the 1980s, which was mentioned earlier, because of the tombstones and the eerie images, but at least it gotthe message home. It meant that the general public knew how important safe sex was and what the consequences of not having safe sex could be. It is hardly surprising that new cases of HIV have risen dramatically. According to the Department of Healths own statistics, two thirds of men and women newly diagnosed with HIV said that they received no written or televised information, and that no information that they received had affected their sexual health. The same set of statistics, revealed by the Government, show that most people learn about HIV and AIDS through television soaps, so people learn more about AIDS from EastEnders than from the Government.
Caroline Flint: I thank the hon. Lady for giving way, because it gives me the opportunity to put the matter straight. It is not the case that I was encouraging a campaign with that aim. I went to an event organised by Sainsburys that involved parents, who said that, if they were to try more fruits and vegetablesnot bananas and apples, but other, perhaps less common, fruits and vegetablesit would be great if the supermarkets allowed tastings in their stores. Parents, particularly those on low incomes, felt that they might then spend their money on trying a variety of fruit and vegetables. That is about listening to parents on how they think that the industry, and supermarkets, could help.
Mrs. Dorries: I can only suggest that the Minister take the matter up with the BBC, which widely reported that there would be a supermarket-wide campaign, teaching children how to eat bananas. Those are the exact words taken from the BBC website. In an age of over-sexualisation of children, where teenagers are constantly under pressure from television, magazines, cinema, peer-group behaviour and retailers, does the Minister not think that it would be more important to send out clear messages on sexual behaviour and personal values, and does she not think that we should spend some of the £50 million that was promised on hard-hitting advertising campaigns?
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