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Lord Fraser of Carmyllie: My Lords, as I am sure the noble Lord knows from his long experience in the industry, of the coal which is imported into the United Kingdom, some half is in respect of coal for which we either do not have any capacity or certainly do not have an adequate quantity. The other half is imported essentially because coal which is imported is sold to generators and others at a price cheaper than coal can be produced in this country. I agree with the noble Lord

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that if coal were to be subsidised, it would be possible to provide it all in the United Kingdom. But I am far from convinced that that is an appropriate way forward for our generating industry.

Lord Ezra: My Lords, the coal that I was talking about is coal that is easily substitutable. There are 7 million tonnes of coking coal imported to which I did not refer. I was not talking about subsidised coal. Is the Minister aware that, had the extra capacity been there and bearing in mind our present experience of the cost of British coal, it could easily have been replaced?

Lord Fraser of Carmyllie: My Lords, I have indicated to the noble Lord what I understand to be the position. The total amount of coal imports is either in grades or types, including anthracite for which we have insufficient sources of supply.

The Earl of Lauderdale: My Lords, will my noble friend the Minister agree that the industrial use of coal is bedeviled by pollution problems?

Lord Fraser of Carmyllie: Yes, my Lords; it has been, although I am sure that my noble friend now appreciates that very substantial improvements have been made in terms of washing out the gases which are emitted from power stations fired by coal. What was a problem in the past has been eliminated in large measure, although it clearly could be improved.

Lord Dubs: My Lords, does the Minister agree that a sensible fuel policy should be based not predominantly on one source of energy but on a number of sources of different fuels? That being the case, would the noble and learned Lord care to comment on the proposition that imports of orimulsion and pet coke, which themselves are the dirty fuels in use, represent a threat to the coal industry which would not be desirable?

Lord Fraser of Carmyllie: My Lords, I certainly agree with the noble Lord's opening proposition that there should be a variety of fuels which can be used to generate electricity. However, as far as concerns orimulsion, I am bound to tell the noble Lord that there is an application by a generating company in this country to use orimulsion in Pembrokeshire. That is a matter which is presently before my department for consideration. Therefore, in those circumstances, I am sure that the noble Lord will appreciate that no comment from me would be appropriate at present.

Lord Dormand of Easington: My Lords, the Minister did not refer to that part of my supplementary question in which I said that both nuclear power and gas receive what in effect is a subsidy. It is no wonder that the electricity generating industry is using more gas. We all know about the "dash for gas" which this Government encouraged. Surely the Minister agrees that from time to time--and certainly within the past two years--there have been very critical periods when electricity supply has almost not come about because of the lack of power. That is why we are staying on coal.

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Is it not ludicrous to be importing 15 million tonnes of coal, which is much more than the special kind of coal to which the Minister referred?

Lord Fraser of Carmyllie: My Lords, we could have a long discussion about the extent to which nuclear power is being subsidised in historical terms. However, so far as concerns gas, I do not accept from the noble Lord that it is in any sense subsidised at present. It is a fuel which is very cheap at the moment; it is very available and very efficient in the way that it is used for generating purposes; and it also has very significant advantages in environmental terms. For all those reasons, it seems to me to be appropriate that we should be using gas to generate electricity; indeed, the noble Lord's noble friend on the Opposition Front Bench indicated that it would be desirable to have a variety of fuels used for the purpose.

Lord Brougham and Vaux: My Lords, although I do not believe everything that I read in newspaper reports, has my noble friend the Minister read a recent press report about heavily subsidised German coal coming into the United Kingdom? If he has, can he tell the House what the Government are doing about it?

Lord Fraser of Carmyllie: My Lords, if my noble friend saw such press reports then that is correct. We are aware of allegations that German coal producers have been dumping subsidised anthracite, especially in the North East of England. That is a matter which this Government have brought to the attention of the European Commission.

Lord Varley: My Lords, now that the private companies have depleted the very large stocks of coal that they inherited following privatisation, are the Government aware that there is much anecdotal evidence that essential development work is not now taking place in the deep mines that remain and that we could be in a very serious position in two years' time? Are the Government indifferent to the situation; indeed, do they know about it? Finally, has the Coal Authority any role to play in the matter?

Lord Fraser of Carmyllie: My Lords, I have heard some allegations that that type of developmental work is not being undertaken. However, I do not know how sound such allegations are. I certainly have no broad indication that significant problems are likely to emerge over the next few years. If there is a problem confronting the coal industry, it is that it must be in a competitive position over the next few years when, undoubtedly, there will be a number of other options for generating electricity following the increased use of gas and the combined cycle gas turbines which are very efficient in every possible way.

Lord Monkswell: My Lords, if the private owners of the coal industry run down that industry and do not invest in it to such an extent that in a few years' time this country runs out of power generating capacity and

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ability, will those people be sent to gaol for effectively destroying a national asset which is important for our future survival?

Lord Fraser of Carmyllie: My Lords, I am bound to say that I believe the private owners of coal are somewhat wiser than the noble Lord. They have no purpose in deliberately running down an industry at a loss. They are in business to ensure that the industry is efficiently and competitively run. Although production levels have been dropping, those companies that are in private hands are running at a profit at present. That is the best safeguard of their long-term future.

Poverty and Ill Health

3.5 p.m.

Baroness Jay of Paddington rose to call attention to the impact of poverty on ill health in Britain today and the case for action to raise the standards of health of the nation's poorest families; and to move for Papers.

The noble Baroness said: My Lords, the Motion before the House this afternoon is about social justice--it is about poverty and inequity which is perhaps why it seems to be of little interest to noble Lords on the Benches opposite. Certainly social justice has found no place in the agenda of the present Government.

In your Lordships' House we often debate health policy, usually in the context of the National Health Service. Your Lordships are rightly very concerned about the state of the NHS, about its funding and about its organisation. But good health is about more than the NHS. It is about how we live. It is about the kind of country we are. It is about what priorities we give to things like proper childcare, to worthwhile employment for school-leavers--and, indeed, for everyone of working age--to decent housing, to the environment and to building cohesive communities.

Those are the underlying factors which affect the well-being of the whole population and which determine everyone's health. The tragedy is that we live in an increasingly divided society. The income gap between the rich and the poor is now wider than at any time since 1945, and that divide has grown faster than in any other comparable industrialised country. Sadly, the economic gap is now mirrored by a stark health divide.

Today in Britain in 1997--50 years after the NHS was created--the average life expectancy in the lowest tenth of the income scale is eight years less than those people in the highest tenth. Men and women of working age in the poorest groups in society are more than twice as likely to die prematurely as those in the highest groups. It has been calculated that 30,000 to 40,000 people die before their time every year because of their standard of living. As one commentator observed, if that number of people died unexpectedly in a series of air crashes, floods or in any other catastrophic natural disaster, the public outcry would be overwhelming, but the deadly effects of poverty tend to be ignored. The particularly alarming fact is that as

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economic inequality has widened in Britain in the past 18 years, so these health inequalities have widened in step.

Death rates at all ages in some of the most disadvantaged areas in our country have not only worsened in relative terms to better-off places but, among some age groups--notably, and very disturbingly, among young men--death rates have actually risen. That is particularly shocking when we remember that death rates overall have been going down since the 1930s. It is shocking but it has little to do with the performance of the National Health Service. As my right honourable friend the Leader of the Opposition in another place said at a recent health service conference:

    "When I meet people who have been unemployed for many years in poor housing with bad health, I know what will transform their lives is not just a better hospital or more regular visits to a doctor: it is a job, good housing and a sense of security. The way to improve the nation's health is to start to build a more inclusive society".

I was vividly reminded of those points last week at a meeting about preventing heart disease. Heart disease is the biggest killer in the United Kingdom and, once again, there is a social divide. You are more than twice as likely to have a fatal heart attack if you are in social class V than in social class I. The medical experts believe that heart disease can be largely prevented. At that meeting they explained that it is about getting the right messages across about healthy lifestyles and about making those clear to people. However, a distinguished cardiologist from Manchester was angrily disputing that view. He said that most of his patients came from the Moss Side area. They were surviving on benefits and could not afford the recommended low fat diet foods and expensive fresh fruit. It was often too dangerous for them to take exercise by walking in their neighbourhoods, and they certainly did not belong to gyms. They were suffering from stress because of the circumstances of their lives and smoking was sometimes their only luxury. Health education would not help them; only a much broader social policy approach to improving their lives would reduce the number of heart attacks of that doctor's patients.

There are now three main causes of death in Britain today. Heart disease is the first and the others are strokes and cancers. All three hit the poorest worst. Social class differences affect health during life, as well as length of life. Overall there is compelling evidence that people who live in disadvantaged circumstances have more illnesses, greater distress, more disability and shorter lives than those who are more affluent.

This is of special concern when we consider the health of our children and the numbers of families living in poverty today. Families with young children are disproportionately represented among the poorest families. They make up 43 per cent. of the total population, but 57 per cent. of them are living on the lowest incomes. One third of our children--over 4 million--are being brought up in poverty, often in single parent households. Not surprisingly, this economic fact is reflected in depressing facts about the children's health. Those facts show that inequalities are built in from birth.

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In 1997 we are three generations into the history of our welfare state. In spite of what are on the whole excellent maternity and obstetric services, there are still 50,000 babies born every year who are officially recorded as having low birth weights. Infant mortality in the poorest neighbourhoods is 11 per 1,000 live births. That is more than twice the number in our more affluent communities. A child in social class V who survives infancy is still twice as likely to die before the age of 15 as a child from social class I, and five times more likely to die in an accident. I know that my noble friend Lord Murray of Epping Forest will speak further about the dreadful impact of accidents later this afternoon.

My next point is less catastrophic but it is still serious. There is more and more evidence of poorer children being malnourished or of being more susceptible to respiratory diseases such as asthma because of pollution or damp housing. I know that my noble friends will return to these subjects later in the debate. Last autumn the Health Visitors Association produced a disturbing national survey of children's health and nutrition. Some 61 per cent. of the health visitors surveyed reported seeing iron deficiency and 93 per cent reported gastro-enteritis.

In another report, rather pathetically entitled Children who have no Breakfast, researchers found that in the most deprived inner city schools, 15 out of every 100 primary school children had no breakfast to eat at all before they left home, and nine were not even given a drink. This kind of malnutrition, combined with generally unsuitable and often overcrowded living conditions, is causing the so-called "poverty" diseases to return. In 1997 health visitors across the country now report seeing rickets and TB among families they visit. Recently the British Medical Journal reported that there had been a 35 per cent. increase in TB in the poorest tenth of the population. It is no wonder that the Health Visitors Association report concluded that Britain seems to be returning to the social conditions of 100 years ago. This is an intolerable situation. We cannot passively sit and observe as the great gains in health and welfare which most of us have enjoyed in the 20th century are undermined by the desperate poverty of our most vulnerable families.

The independent health policy institute, the King's Fund, recently issued this challenge:

    "the socio economic causes of health inequality can be amenable to changes in public policy. Such injustice could be prevented but this requires political will".

For the past 18 years the political will has been singularly lacking.

I remind your Lordships of the present Government's record on poverty and ill health. In 1977 the Secretary of State for Health in the previous Labour Government--our much missed noble friend the late Lord Ennals--commissioned Sir Douglas Black, the distinguished physician, to investigate the whole subject. Sir Douglas's seminal report was published in 1980. It could have provided the essential base and policy guide to any responsible government wanting to take action in this area. However, by 1980, of course, the Conservatives were in power and the new Secretary

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of State, the noble Lord, Lord Jenkin of Roding--I am sorry that he does not appear to be present--simply refused to accept the findings of the Black Report. He said he could not endorse what had been written.

Sir Douglas was unlucky to hit the tide of Thatcherism as it began to surge. Social analysis and collective solutions to any problems were unfashionable in a country where the concept of society itself was under threat from the highest level. During the 1980s the Black Report gathered the proverbial political dust somewhere in the recesses of the Department of Health. Fortunately this did not deter the health research community, including my noble friend Lord Rea, whom we shall hear from later. As unemployment rose and economic inequalities widened, researchers have continued to build up an incontrovertible dossier about the links between deprivation and disease and early death. Recently we have had the authoritatively comprehensive overview of the Social Justice Commission which stated:

    "by analysing the different causes of good and poor health we can understand why tackling inequalities in health goes well beyond what is conventionally thought of as health policy".

I am delighted that my noble friend Lord Borrie, who chaired the Social Justice Commission, will speak in this debate.

Belatedly even the present Government have come to recognise that there is something in this approach. In 1992 they launched the public health strategy The Health of the Nation. However, this flagship policy failed even to mention social inequality as a factor in health. The need to address poverty on a broad front was simply ignored. Instead over the past few years we have had many ministerial exhortations to change our individual personal behaviour. Noble Lords no doubt recall Mrs Edwina Currie's advice to old people who were threatened by hypothermia because they could not afford heating. She advised them to wear woolly hats and socks in bed. Mrs Bottomley recommended her solution to heart disease; namely, to eat fewer biscuits and to run up and down stairs.

I well remember attending one high level presentation to launch The Health of the Nation where a group of rather exasperated London doctors challenged the then Secretary of State and told Mrs Bottomley that the Chancellor of the Exchequer was far more important to the health of their patients than she was. Latterly there have been some initiatives by the Department of Health to examine what it rather euphemistically calls variations in health and variations in health services across the country. The most recent guidance speaks of,

    "reducing variations by targeting resources where needs are greatest".

However, as the House will be only too well aware, this is almost impossible in the fragmented health service we have today where services are devolved to local trusts and there is little capacity for overall strategy, let alone direction of resources. It certainly does not address the broader issues of social policy which go beyond the remit of the health department.

The Department of Health may have simply neglected the problems of inequality in health, or else responded rather belatedly and inadequately. However, the rest of

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the Government are guilty of actions which have positively damaged the health of poorer people. Apart from the economic decisions which produced record levels of unemployment and a widening income divide, policies about public transport, road traffic, rented housing and homelessness have all contributed to worsening health. Benefits policy has also had a negative input. Importantly, the removal of one parent benefit announced in the previous Budget is bound to make life more difficult for the millions of children already living in poverty. Their health is bound to suffer. All the evidence shows that when poor families become poorer they first economise on food. The children's parents are likely to suffer additional mental stress as well as increased physical deprivation.

Perhaps the single greatest government failure in this area is the failure to tackle the tobacco industry. Smoking related diseases are the greatest cause of premature death and serious ill health in Britain today. And today smoking is predominantly a habit of the poor. Three times as many people in unskilled occupations smoke compared with professional groups. There are particularly high rates among the unemployed and young lone parents; and most smokers start between 13 and 15 years old.

All of that is widely known. It is equally clear that conventional health education will have little impact on disadvantaged people who may see cigarettes as an important prop in difficult lives. The long term approach is of course to improve those lives. But in the short term it is disgraceful that the Government have not taken tougher action to curb smoking, and in particular have resisted demands to ban tobacco advertising. An incoming Labour Government will ban tobacco advertising as a priority in our public health policy. There will be a new Minister of public health to lead public health policy at the national level and to co-ordinate local action as well as to encourage good practice.

We shall review and republish the Health of the Nation in 1998 to coincide with the 50th anniversary of the start of the NHS. The new Health of the Nation will be more likely to follow the Australian national health strategy which calls for action in five areas: the distribution of economic resources; education; living standards; conditions of work; and social support. That approach would reflect the determination on this side of the House to make improved health a central goal of all social policy. We shall aim to reduce poverty and inequality through the commitments to help people move from welfare to work, to end poverty pay by introducing a national minimum wage, and to improve housing conditions by the phased release of local authority capital receipts.

The ambition is to ensure that those measures individually produce improvements in the health of our poorest families and that together they create more equity--a more inclusive society. To achieve an inclusive society where everyone, not just the advantaged and affluent, has the opportunity to achieve their greatest health would indeed be a victory for social justice. I beg to move for Papers.

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