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12 Nov 2009 : Column 162WH—continued
"Moreover, while the view that reducing relative income inequalities was the key to reducing health inequalities has many enthusiastic proponents, we did not see any conclusive evidence that suggested changing tax and benefit policies to reduce income inequalities
would lead to a reduction in health inequalities. Such claims tended to centre on theoretical assertions rather than be supported by robust evaluative evidence. We note that the Government has commissioned research, to be carried out by Professor Sir Michael Marmot, into the evidence about these wider determinants of health."
We should wait until Sir Michael comes back on this, whether in his report next year or the post-2010 strategy, before we make general assumptions. I know that many have been made in the past, and theories have been given. I am not attacking Richard Wilkinson, for whom I have a high regard. I have worked with him on other matters to do with health inequalities, and he has influenced debates in this House for many years. We should wait and ensure that we do not jump to assumptions that have been easy to jump to in the past. People say, "If only we had fairer income distribution, things would be a lot better in the garden." The issue goes far deeper than that. Looking at our constituencies, we must know that by what happens on the ground.
Dr. Stoate: My right hon. Friend has basically agreed with what I said earlier, which is that it is more to do with perceptions. There are far more deeply rooted factors than simply wealth inequality. It is about how people perceive themselves and their role in society. That can have just as big an effect as material wealth in itself.
Mr. Barron: That is right, and I would like to move on to what my hon. Friend said about the local environment. An issue that we looked at that has not been highlighted in this debate is the availability of food in a locality. Jamie Oliver was a witness to the Committee. Some sceptics on the Committee said that he should not have been included. We tried to tie him down-in view of what was said yesterday in the media about the salt content of his sausages, somebody else may be trying to tie him down as well.
We discussed with Jamie Oliver not just food labelling-obviously, we did that-but also what happens in communities where there are lots of takeaways, and whether they should be restricted. Things are probably not measured as well by fast-food takeaways as they are by supermarkets. He said that if the high street was
"riddled with fast food options on every corner and hardly any fresh food options, then, essentially that is like having more off licences and pubs in place of high alcoholism."
He said that we should not be surprised if people have unhealthy diets in such circumstances. I am pleased that the Government recognised in their response that local government has a responsibility in this area. I know that some authorities in the east end of London have exercised their responsibility by using planning permission to control the plethora of fast-food outlets. Jamie Oliver said to the Committee that if we do not have places that sell fresh food, we should not be surprised if people do not eat fresh food. In essence, those matters are for planners, but we should look at them.
Mike Penning:
Over the years, we have assumed that fast-food outlets are something new. Of course, the big chains are new, but I grew up in north London and the east end of London in socially deprived areas, which have always had pie and mash shops, jellied eel shops,
bagel shops and salt beef. The crucial difference now is the amount of exercise that is being done after people eat an amount of fast food.
Mr. Barron: And I have no doubt that some people probably did much more manual labour, as well. Our lifestyle has changed significantly in my lifetime, and those are the reasons why. That is what we have to address.
I wish briefly to deal with two more things. I agree with what has been said about capitation fees. My dilemma is that last year the target got higher because of a reassessment, so Rotherham was well under, but I would not argue that money should be taken from primary care trusts that are over their target. We must remember that although Rotherham is underfunded on the new calculation which may get rid of the historical calculation and bring in a more sensible one, the issue is about actual needs based on assessment of communities.
We are still building things like the Rotherham Institute for Obesity, and still doing things on the ground with overweight and young people, including sending them to Carnegie college up in Leeds. We will be running Carnegie weight loss colleges for schoolchildren in our community centres. Although this is happening, we have not reached the target. It is about more than just reaching targets and saying, "We've got this money now." However, I would not advocate that money be taken out of communities: if I am in Parliament in 12 months-I do not know who will be sat in the Minister's chair then-I will be arguing for money for communities like mine to carry on improving their health.
Finally, on tobacco policy, in a sense the answer to the question by the hon. Member for Hemel Hempstead (Mike Penning) about what happened in respect of the vending machine debate, and the good decision taken in the Health Bill, is that the Government, at the eleventh hour, decided to let the House have a free vote, allowing Members of Parliament to exercise their own judgment, as they did on smoking in public places. We would be a lot better as legislators if we did it ourselves, because party politically we are frightened to death of the nanny state, but as individuals we can see the need for intervention in all our communities-in respect of different age and gender groups and everything else-and we can defend those decisions on the ground.
My hon. Friend the Minister used to be in the Whips Office at one time. We ought to get the message through to all parties in Parliament and to the usual channels that parliamentarians, on many occasions, can take the right decisions without having to respond to Whips, who are sensitive about arguments that I think are quite old-fashioned. Members of Parliament are sent to the House because our constituents want a representative of the state. That is the whole point of the exercise and why we are sent to Westminster, whether we are in government or opposition, or whatever. We are the state's representative in our constituencies and we should not be frightened of taking decisions on behalf of our constituents, because that is to the general good.
You will be pleased to know that I will not go any further, Mr. Bayley. I thank hon. Members for their interventions and comments in relation to our report on health inequalities. As I said at the start, I hope that this is not the end of the debate on health inequalities in this
country. Lifestyles will be the big public health issue in the 21st century and this report is designed to start the debate, not end it.
Hugh Bayley (in the Chair):
Despite the uncertainty about the time available, I think we have had a good debate about an important issue. I thank all hon. and
right hon. Members who participated for exercising enough restraint to ensure that everybody who wanted to speak was able to do so.
4.32 pm
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