Previous Section Back to Table of Contents Lords Hansard Home Page

Lord Rea: My Lords, before the noble Viscount sits down, and as we have a little time in hand, perhaps I may say how grateful I am that he referred to the Whitehall study. However, he implied that the better health of the higher grades was due to the fact that they led a better life style--less smoking, more exercise and so on. But Professor Marmot and colleagues took that factor very much into account. They allowed for all known risk factors that one can think of, and still they accounted for only a 25 per cent. difference in mortality and sickness absence rates. All known risk factors accounted for only 25 per cent. of the gradation.

Viscount Brentford: My Lords, I make no comment on that. I agree with it. I do not think that that affects the main thesis of what I said, but I thank the noble Lord.

5.35 p.m.

Lord Murray of Epping Forest: My Lords, the noble Viscount, Lord Brentford, drew our attention to comparative death rates of people in lower social classes. It is a fact of life, and of death, that children born into social class V, essentially defined by level of income, are 50 per cent. more likely to be stillborn or to die in the first week of life than those born into the top social class. Sixty per cent. are more likely to die in their first year of life than those born into the top social class. The life expectancy of children born to social class V is around seven years less than those born into the top social class. Many factors contribute to that. One factor on which I propose to speak, and to which reference has been made by several noble Lords, is poor housing.

Low income is correlated with poor housing and there is a particularly strong correlation between low income and temporary accommodation, including bed-and-breakfast hotels and short life flats. "Temporary" can be anything from a couple of weeks to several years.

12 Feb 1997 : Column 282

Many studies have highlighted the ways in which the long-term use of temporary accommodation affects the physical health of children, notably through bronchitis, colds, flu, and so on, as well as their mental health and their behaviour.

However, no less significant--it is a point to which I particularly wish to draw your Lordships' attention--is the higher incidence of children who sustain accidents in those substandard living conditions. The Government's report The Health of the Nation recorded that children in social class V are four times more likely to suffer accidental death as those in social class I. I shall address my remarks to the incidence of accidents to children and to the relationship between child accidents and inequality. I very much welcome the observations on this issue made by the right reverend Prelate the Bishop of Lichfield.

Accidents are the single biggest cause of child deaths in the UK, killing more than even childhood cancers such as leukaemia. In 1993, the most recent year for which I have figures, 585 children aged under 15 died in the UK as the result of accidents. The Child Accident Prevention Trust estimates that no fewer than one in five of the population under 15 attends hospital accident and emergency departments each year because of accidents. My noble friend Lord Desai drew our attention to the cost of many factors. It is worth noting that the cost to the NHS alone is estimated at £150 million a year, without taking account of the costs to the police and other emergency services.

The rate of child deaths in the UK through accidents is falling. That in itself is more than welcome, even though the rate of decline is lower than the general fall in child deaths as a result of illness and disease. Unfortunately, there are no comprehensive official statistics for non-fatal child accidents, but estimates by the Child Accident Prevention Trust suggests that there has been little, if any, change in recent years. Does the Minister agree that this is an obstacle to the development of an effective prevention strategy? What is being done to improve the collation of statistics on accidents?

What is beyond doubt is the higher incidence of accidents to children in poor families living in poor accommodation. I refer to burns, falls from heights, spillages of hot liquids, and so on. Child accident statistics published by the Office of Population Censuses and Surveys shows that children in social class V are nine times more likely to die as a result of a fire than those in social class I. We are always hearing of fires caused in bed-and-breakfast accommodation by the use of substandard gas heaters and overturned paraffin oil heaters.

Until 1988, families on benefit could claim one-off payments for household equipment if they could show that, without it, there would be serious risk to health and safety. That covered household equipment such as efficient heating appliances and fireguards, as well as such items as stairgates. Since the introduction of the Social Fund those payments are no longer available. The only way to get money for a fireguard is through a discretionary loan repayable by

12 Feb 1997 : Column 283

deductions from income support--itself set at a level which falls well short of meeting minimum tolerable standards. My noble friend Lady Symons of Vernham Dean drew our attention to the invidious choice imposed on many people between heating and eating. No less invidious is the choice imposed on many mothers between feeding themselves and protecting their children against danger.

Those hazards are increased by the location and quality of accommodation for poor families. Children are particularly at risk from accidents on the higher floors of high-rise flats--notably falls from windows or balconies. Most housing authorities accept that it is inappropriate to house families with children in such conditions; but as the number of homeless families increases, some authorities are forced to compromise their policies in order to reduce the number of families living in B&Bs.

It is also a matter of concern that, according to the Health and Safety Executive, injury rates are rising in our schools. In a 1994 survey, the National Union of Teachers reported that in nearly one school in five a pupil or staff member suffered an injury or illness linked to the condition of the school's fabric. With capital spending on school buildings and maintenance at half the level it was in real terms 20 years ago, that is not surprising. What does surprise me is that I understand that the minimum standards laid down in the 1981 Education (School Premises) Regulations are to be replaced by weaker standards. That will only intensify the risk of accidents in schools.

I fully take the point made so ably by the noble Lord, Lord Butterfield, about the relationship between behaviour and health. I believe it is quite consistent with that to suggest that there is also a relationship between the Government's behaviour and the health of our citizens. I suggest that there are in particular three ways in which the Government might with advantage modify their own behaviour in order to help reduce the number of accidents to children and reduce the inequalities which expose the children of low-income families to greater risk of accident.

First, essential safety equipment should again be made available through grants, not by loans against income support. Secondly, as was emphasised this afternoon, we need much more vigorous action to improve the housing options for low-income homeless families. And, thirdly, local authorities should be firmly directed, and adequately funded, to enforce acceptable safety standards in bed-and-breakfast and other forms of temporary accommodation.

I welcome the assurances of shared concern and protestations of solicitude from so many speakers from the opposite--I almost said, prematurely, Opposition--Benches, notably the noble Baroness, Lady Brigstocke, and the noble Lord, Lord Birdwood. Against that background of support I urge these proposals on the noble Baroness the Minister with yet more confidence.

12 Feb 1997 : Column 284

5.44 p.m.

Lord Prys-Davies: My Lords, in 1980, the Secretary of State for Health of the new Conservative Government dashed many hopes when he promptly rejected the recommendations of the Black Report, claiming that the cost was:

    "quite unrealistic in present or any foreseeable economic circumstances, quite apart from any judgment that may be formed of the effectiveness of such expenditure in dealing with the problems identified".

That seems to be as depressing a decision as one can imagine from any government department. The failure since 1980 to implement any of the Black Report recommendations has caused disappointment to many and must have caused a great deal of needless suffering on the part of many of the poorest families.

However, as we heard from many speakers, the Black Report has not gone away. I noted the caveat of the noble Lord, Lord Butterfield, but it seems to me that the basic theme of the Black Report has been re-stated by many subsequent authoritative studies and papers which gave ample warning of a correlation between health and poverty. That is one of the reasons for our concern; namely, that the gap in health status between the social groups has grown since 1980. That point was forcefully made by my noble friend Lady Symons.

To my mind the most striking support for the recommendations of the Black Report comes from the medical profession and is to be found in the 1995 report from the Board of Science and Education of the BMA. After acknowledging that there will always be a need for more research into the correlation between health and poverty, the BMA nevertheless concluded:

    "the currently available evidence is more than sufficient to enable effective policy development".

I should be grateful if the Minister will tell the House how the Government respond to that finding of the BMA. We are entitled to know how they view it.

There is also the impressive evidence of Sir Donald Acheson, the department's former Chief Medical Officer. In his 1991 annual report--his final report--he summed up:

    "The clearest links with the excess burden of ill-health are: low income, unhealthy behaviour and poor housing and environmental amenities".

I should very much like to hear from the Minister when she replies whether the Government agree that poorer families need more income, better nutrition, improved homes and better access to education, as well as health education and equal access to the best medical services according to their illness needs.

Do the Government still maintain, as they did in The Health of the Nation, that health inequalities are too difficult to understand? Is that their position?

There has been frequent reference during the course of the debate to The Health of the Nation. I should tell the House that we in Wales find ourselves in a dilemma over that document as we are still awaiting a health strategy document from the Welsh Office. The Welsh Office produced a draft health strategy document some two or three years ago, but for reasons that are not well understood it has never seen the light of day.

12 Feb 1997 : Column 285

Although the noble Baroness the Minister has no special responsibility for the Welsh Office, can she explain the delay and say whether or not a strategy document will be produced before the general election?

The importance of children is properly included in the Motion. It has been thoroughly examined by many speakers this afternoon and I have nothing to add except to make one brief comment. I believe that the first textbook to be written in the English language on children's diseases was written by a physician practising in rural Wales, Thomas Phaere. In his book, The Boke of Chyldrene, there is the sentence which in modern English reads:

    "Here to do them good that have most need, that is to say children."

Those words were written about 400 years ago. They are still true today.

I wish to mention the need to reduce differences in health status between and within regions to which reference has been made by the right reverend Prelate the Bishop of Lichfield. I believe this particular need is relevant to the Motion before the House.

Over the last few months I have been trying to help a small ad hoc group of professional people to develop a scheme which would improve conditions for young mothers and children in the small township of Blaenau Ffestiniog, high up in Snowdonia. It is a clearly defined community with a population of about 5,500. It has a sense of history and belonging, but it has also a sense of deprivation. It has exceptional problems, many jobs have disappeared. There is long-term unemployment as well as youth unemployment. Many young mothers are without work and often without skills. Income is low. Social security dependency is high. There seems no immediate prospect of economic growth and there is much ill health and mental illness. There may be a problem of drug misuse but surprisingly, according to the local office of the clerk of the magistrates, the relevant information on drug abuse is not readily available. So to my mind there are signs of bureaucratic inertia.

However, my hopes are raised because at shopfloor level an ad hoc group of devoted and imaginative local child health professional workers and voluntary workers has not allowed barriers to come between them. They have brought forward a scheme for assisting young families and young people of the area. It seems to me that that is similar to what was described by one speaker this afternoon and it is just the kind of local initiative that requires encouragement. Barnados in Wales has been and remains a considerable source of advice to the group. I hope that the Minister will be able to give us an assurance that the need to support the initiative at Blaenau Ffestiniog and similar initiatives will be brought to the attention of the Secretary of State for Wales.

Looking generally into the future, a new Labour government will, of course, have a huge agenda. Nevertheless, I hope that it will in the first Session of the new Parliament aim towards implementing the Black recommendations, because that would be a move in the right direction, although I have no doubt that there may be snags of which the civil servants will advise.

12 Feb 1997 : Column 286

5.54 p.m.

Lord Colwyn: My Lords, it is always a pleasure to take part in a debate on health initiated by the noble Baroness, Lady Jay. I must apologise to the House for missing some of the earlier speeches, particularly the noble Baroness's opening speech. It is not easy trying to contribute to a debate and having to miss an explanation of what it is all about, but noble Lords will forgive me when I say that my first duty has to be to my patients. Many of them are understanding when appointments are moved to enable me to take part in a debate, but I have to admit that I had not noticed the debate for this afternoon until it was pointed out to me by my noble friend Lord Oxfuird two days ago.

Although we sit on opposite sides of the House, I am well aware of and appreciate the continuing commitment of the noble Baroness to the state of care in the community and this afternoon her crusade on behalf of the less well off. The noble Baroness's debate is very interesting. I believe that successive governments--I mean Labour as well as Conservative administrations--have done all they can to raise standards of health throughout the community, providing ever-escalating funding to improve the quality of the health service.

Our debate this afternoon should be concerned not with the impact of poverty on ill health but with the poverty of knowledge on ill health today. The health service is free at source. Anyone can see a doctor, visit a hospital, have free treatment. What is often lacking is quality advice on the prevention of illness and on the maintenance of good health.

I agree with some of the remarks of the noble Lord, Lord Prys-Davies. The greatest advances in the promotion of health during the last century have been entirely due to the installation of efficient plumbing and drainage systems. Chronic illness is rising. I believe that I am correct in saying that at any one time almost one-third of the adult population has a long-standing illness of some kind.

The NHS has very little to do with health and far too much to do with sickness--with dis-ease. Sadly, instead of the NHS focusing on health, it has concentrated resources on illness. Surely it is a case of waiting for the horse to bolt. Only a dentist could mix a veterinary metaphor into an NHS debate. All that is taking place within the context of a general increase in the use of pharmaceutical drugs. Seventy-five per cent. of all visits to a GP end with the prescription of a synthetic drug. About 20 per cent. of all adults--that is something over 15 million people--are constantly taking some form of prescribed medicine.

I find that fact very disturbing, but it becomes even more menacing when considering the amount of illness which is induced by these very drugs. The assumption that the body can be regarded as a machine whose protection from disease and its effects depends primarily on internal intervention and the idea that illness can be classified into specific named diseases, each of which has a single cause, have led to indifference to and disregard of the external influences and personal behaviour which, without doubt, are the predominant determinants of health.

12 Feb 1997 : Column 287

With our present attitudes to health, it is inconceivable to think that illness should be viewed as a helpful, although often severe, reminder that perhaps there is something at fault with one's lifestyle or attitude. It is precisely because this possibility has been largely ignored that so little attention is being paid to the whole concept of health promotion. Health promotion is about the maintenance of good physical and mental health. It has very little to do with medicine and disease management and everything to do with the ways in which people live and the social and psychological environments in which they do it.

Millions of people, whether they be rich or poor, suffer unnecessarily simply because they are not being directed towards maintenance of health. Merely to increase funding for the health service, to simplify access to doctors and hospitals, without first identifying key factors of health is a recipe for disaster. Many of your Lordships will have seen the recent plethora of articles and programmes on health in the newspapers and on television and the radio. They all have one message in common and I think that the commentators are finally coming round to the idea that health is very much related to environment, nutrition and good sense.

I have to admit that some of us here--and I declare my interest as President of the All-Party Group for Alternative and Complementary Medicine--have been saying for years and years that good health depends on what you eat, where you eat it and the maintenance of a good immune system.

May I quote an article from the Sunday Times of 19th January. It stated:

    "Big increase in infant diabetes blamed on cow's milk feeding ... Doctors have discovered diabetes is increasing at an alarming rate of more than 10 per cent. a year among children under five. Experts believe that using cow's milk to feed infants and exposure to certain viruses at birth may be to blame".

How many families do noble Lords know who could have told them 20, 30, 50 or more years ago that mothers' milk is best? The article went on:

    "In New Zealand, researchers have found that large doses of a B vitamin can help prevent diabetes".

I am sure that my noble friend will be aware of the recent problems concerned with the Committee on Toxicity's recommendations to the Food Advisory Committee on the toxicity of vitamin B6, which were accepted without any input or advice from the health food manufacturers or professional nutritionists. It is an issue which I hope to take up with my noble friend on another occasion, but it is an example of ignorance affecting health outcomes.

In the Sunday Times last weekend I read of a startling new discovery by Professor Phillip Lamey at the Royal Victoria Hospital in Belfast claiming to have worked out how to treat long-term migraine by adjusting the way teeth bite together, using small plastic splints to avoid the production of neuropeptide chemicals which trigger violent headaches. Is that a new discovery? A major breakthrough, indeed. My Lords, my dental colleagues and I have been treating such headaches for 20 years and the treatment has been dismissed by the majority of the medical fraternity as inconsequential.

12 Feb 1997 : Column 288

So the answer to the noble Baroness, Lady Jay--and I hope the answer that she will elicit from my noble friend--is that the maintenance of health is dependent--as well as on housing and full employment--on water supplies, sewage disposal, elimination of atmospheric pollution and provision of a diet containing high proportions of unprocessed food and raw vegetables. Then, and only then, when we deliver a true health service to all should we be able to eat our words concerning the present concept of a health service based on sickness.

6.2 p.m.

Lord Borrie: My Lords, the debate initiated by my noble friend Lady Jay of Paddington has already been worth while and there are more speakers to come. The debate has attracted a large number of speakers.

Two years ago this month, the Joseph Rowntree Foundation published its authoritative report--some noble Lords referred to it this afternoon--on the subject of income and wealth. Among its key findings were that income inequality in the UK rose rapidly between 1979 and 1990 and that the pace at which inequality had increased in the UK was faster than in any other country of the world except New Zealand.

One of the members of the Rowntree team was Mr. Howard Davies, then Director General of the CBI and now Deputy Governor of the Bank of England. In a newspaper article on the day of the Rowntree Report's publication, he wrote that, when growing numbers of people become detached from the market economy, it represents a significant waste of resources and increases other social costs, in the health service and in the criminal justice system, as well as the social security budget.

Who can doubt, especially at this point in the debate this afternoon in your Lordships' House, that poverty and ill health are closely linked? The BMA paper of 1995 on inequalities in health, to which my noble friend Lord Prys-Davies referred a moment ago, confirmed the view of the Joseph Rowntree Foundation that inequalities in living standards had indeed increased in the UK since 1980 and that severely unequal societies--not just societies with high rates of poverty--had worse health and worse economic growth than less unequal societies. In 1987 the Health Education Council said that:

    "all the major killer diseases affected the poor more than the rich".

I shall not give your Lordships a number of statistics, partly because of the objections of my noble friend Lord Birdwood and partly because an adequacy of perfectly good statistics has already been given. Nor shall I refer to the particular problems relating to children's health because many of your Lordships have referred to children. I simply want to emphasise the importance also of the need to raise the standards of health and care of those at the other end of the age spectrum--the elderly. I do so because poverty among the elderly is widespread. It has a serious adverse effect on the health of the elderly. I am grateful to the noble Baroness, Lady Brigstocke, who said earlier that one-third of our elderly are at or below the poverty line--I repeat, one-third of the elderly are at or below the poverty line.

12 Feb 1997 : Column 289

Fifty years ago almost all the elderly were poor. We know that that is no longer the case, at least for some elderly people--an increasing proportion of the elderly. A number of people enjoy the fruits of occupational and other private pensions and adequate care, if needed, either at home or in residential facilities. But there is tremendous and increasing inequality among the elderly. Apart from the group that I mentioned, there are those who are dependent on the state pension, topped up by various means-tested benefits, if they are understood and applied for, including income support. The very worst off are often those who are entitled to income support or other benefits but are put off from claiming through the difficulties involved, the stigma attached or otherwise in some way.

The elderly are living longer, which is partly due to the benefits of the health service and the rest, but inevitably as the years go by they become more prone to physical and mental ill health. If they are poor, they are likely to have a less healthy diet, poorer housing conditions, inadequate heating and less opportunity for and access to exercise facilities. All those factors will exacerbate the risk of ill health. The impact of such expenses as those for eye tests, which are essential to check on the possible advent of eye disease, may cause them to neglect or postpone taking desirable precautions, which better-off elderly people would take. It will be interesting to hear the Government's response to the Starred Question of my noble friend Lord Molloy, which deals with that matter, in two weeks' time.

Sadly, while it is generally understood that babies and very young children are extremely vulnerable and dependent, it is not always recognised and understood that there is at least a possible vulnerability, possible dependency and possible disability among the elderly. They are often overlooked. Some noble Lords may have noticed newspaper accounts last week of a report by the Association of Community Health Councils, backed up by over 200 complaints from families of hospital patients, which showed that in some hospital wards food for elderly patients is placed beyond their reach and no attempt is made to see whether they are strong enough to feed themselves. The eminent medical correspondent of The Times, Dr. Tom Stuttaford, formerly a Conservative Member of the other place, recounted in his column a personal experience of visiting in hospital an octogenarian relative, who was too debilitated to feed herself. Yet her meals were just put on her bedside table. Half an hour later, the food was gathered up again, with the jolly quip, "No appetite yet, I see".

Where, one might ask, is the old-fashioned nursing that would have coaxed the frail into taking the nourishment essential for their recovery and well-being? I am concerned that someone of Dr. Stuttaford's experience and eminence should comment--I use his words--that there is a "creeping tendency" in the National Health Service to regard the very old as expendable and undeserving of the expense of high quality care which ought to ensure their survival.

If I might draw a conclusion from the particular and, one hopes and believes, exceptional circumstances that I have just quoted about the possible position of the frail elderly in hospital, it is that here and more generally we

12 Feb 1997 : Column 290

need an approach that is holistic. Responsibility for the care of the elderly is surely not something which can be neatly divided up between, let us say, the dispensing of antibiotics, on the one hand, and the provision of food and cups of tea, on the other hand, with the availability perhaps of occupational therapy. Such divisions of responsibility may mean that really no one has responsibility for the patient as a whole person.

Similarly, as the BMA has put it, a "total approach", rather than just a service-oriented approach, is needed if inequalities in health are to be addressed in general for the whole population. People's health can be influenced by many different aspects of public policy ranging from dealing with the squalor of poor housing conditions to the adequacy of income in old age, from improved working conditions to the banning of advertisements for tobacco. As my noble friend Baroness Symons said, there is a need for a co-ordinated approach across a number of different government departments. This debate is as much about fiscal and welfare policies, public policy generally, as it is about the state of the National Health Service. It is surely a debate which is welcomed from all parts of the House.

6.11 p.m.

Lord Haskel: My Lords, that poverty leads to disease and early death is beyond dispute. That is why poverty is a matter of morality and not just a matter of economics. This debate is precisely about that--to draw attention to the moral issue of poverty and inequality causing ill health--and I congratulate my noble friend Lady Jay on her rather angry introduction, a justifiable anger if I may say so, shared by many of us.

On these Benches we have always been anxious to attack poverty and the causes of poverty because we see it as a moral issue. The noble Lord, Lord Birdwood, and the noble Baroness, Lady Brigstocke, implied that this view is shared by the Government. That is not so. The Government's view on poverty was clearly stated by the right honourable Mr. Peter Lilley, who, on 13th June, 1996, in a speech on welfare reform and Christian values in Southwark Cathedral, stated:

    "Conservatives believe that eliminating poverty and pursuing equality are not merely different, they are ultimately incompatible."

In other words, a trickle down view. Trickle down is a fantasy. All it does is lead to greater inequality and more poverty. My noble friend Lady Turner told us that, the Government know that, and I think even Mr. Lilley knows that because in November 1994 he said,

    "The single most significant social change affecting the United Kingdom is not the ageing of the population, nor the breakdown of the family, nor the increasing proportion of women at work. Rather, it is a phenomenon which is still largely unrecognised--a growing dispersion of earnings".

And he is right.

Many noble Lords have told us how income inequality has grown further and faster in Britain than in any major industrialised country except New Zealand, as my noble friend Lord Borrie reminded us. My noble friends Lady Turner and Lady Symons gave us the figures. If we define poverty as net income at less than half the average earnings, poverty was 7 per cent. in 1979 and today it is 24 per cent.--nearly one in five

12 Feb 1997 : Column 291

of the working population. The noble Lord, Viscount Brentford, told us that the poorest 50 per cent. are better off. If this is the case they must have carried the bottom 10 per cent. of the population because they are considerably worse off in absolute terms. The richest 10 per cent. are much better off and this is what Mr. Lilley meant by the "growing dispersion of earnings".

My noble friend Lord Borrie spoke of the elderly. The composition of the poor today is much more weighted towards the workless than the retired. The percentage of pensioners in the poorest decile has halved since 1979, while the percentage of unemployed has doubled. My noble friend Lady Turner reminded us that in Autumn 1996, 4.3 million people in Britain were without paid employment and wanting a job--more than twice the number of officially unemployed. This is why the Bank of England--and may I assure the noble Lord, Lord Astor, that they are no apologists for the Labour Party--in their quarterly inflation Report in July 1996 concluded:

    "Almost the entire net improvement in unemployment performance in the 1990s, compared with the 1980s, was accounted for by the rise in inactivity".

So the root cause of this inequality is not the tax and benefit changes since 1979, but the increased worklessness and widening income distribution. This was clearly brought out by the Rowntree Report and the report on social justice chaired by my noble friend Lord Borrie. And many noble Lords who have spoken have told us that poverty is caused by an absence of education, an absence of skills and an absence of opportunity.

But there are the poor who are in work caused by this widening income distribution. Among male workers, the gap between the highest paid and the lowest paid is now at its greatest this century. New evidence has shown that the growth in wage inequality is driven by skills.

Nor has just raising benefit been shown to be the answer to poverty. Welfare used to be a stop gap for short spells of unemployment. Now, welfare has become a way of life. What is worse, if you do get back into work, you are more likely to become unemployed again. Those who leave poverty have a tendency to fall back into it and the poverty trap has deepened in the modern labour market.

Paul Gregg's recent book Job, Wages and Poverty, shows why there has been a massive increase in workless households because of the poverty trap, and how the poverty trap has deepened with a cycle of low pay and no pay.

And so we have a picture of poverty: a large group of people who stand little chance of leaving poverty and unemployment behind because they lack the skills, the education and the opportunity; the unemployed, the economically inactive, and those on low pay subsidised by welfare. In total, one household in five has no breadwinner.

After almost two decades of Conservative Government, little has been done about this. Their failure to educate our workforce is legendary. And their

12 Feb 1997 : Column 292

legendary policy of a flexible labour market has left us with even greater poverty. The right reverend Prelate the Bishop of Lichfield said that prevention is better than cure. He is absolutely right. That is why the best way to attack poverty is by getting people into good jobs. And that is why Labour's anti-poverty strategy concentrates on raising education and skills level in the workforce and introducing welfare to work measures rather than just raising benefits. That will create a flexible workforce; not a flexible labour market to easily hire and fire but a workforce flexible in skills and abilities which can adapt to the changing demands of the economy.

That is why we will use the windfall tax to train 250,000 youngsters. That is why we will use the money from the assisted places scheme to reduce class sizes, and that is why we will seek to reduce the starting rate of tax instead of eliminating capital gains tax and inheritance tax. We will help the many to move out of poverty rather than help the privileged few. That is why we will also have a national childcare strategy.

The Minister will say that the Government are now intending to follow the same policy. They steal our clothes. Indeed, Mr. Lilley made announcements last week about training schemes designed to get people off welfare. I can only say that it is too little and too late, and point to the years of missed opportunity. And what a missed opportunity! Since 1979, there has been an unparalleled opportunity available for this Government to invest in Britain's people and to eliminate poverty. Let me explain. In today's money, the Government's income from the North Sea and from privatisation is equivalent to £35 million every single day for the past 16 years. Many would argue that this income comes from assets which belong to us all. To save the Minister time, I can tell her that this is equivalent to £6 per person per day.

My noble friend Lord Desai spoke about the effect of misdirected public expenditure on poverty. Would you not think that with an extra £6 per person per day, a reasonably competent government would have been able to reduce poverty and inequality? Instead of reducing poverty, this Government have managed to treble it. What an indictment of the Government's mismanagement! What an indictment of their priorities! What a missed opportunity to reduce poverty and inequality! What a missed opportunity to improve the nation's health!

6.21 p.m.

Lord Luke: My Lords, I should first like to thank the noble Baroness, Lady Jay, for introducing this important debate. There have been some excellent speeches. I have not agreed with everything that has been said and particularly not with what the noble Lord, Lord Haskel, has just said, but I shall try very hard not to be repetitive.

My interest in this subject stems from my family's involvement with health matters over four generations. Bovril was my old family company. We made a product called Virol, which was based on malt extract, and was widely known as a valuable food supplement for

12 Feb 1997 : Column 293

children and adults to help prevent rickets and other diseases derived from chronic malnutrition. So noble Lords can imagine that I was a little worried when I heard the noble Baroness, Lady Jay, say that the incidence of rickets had increased recently.

I have carried out a little research. I find that a recent survey by the Health Visitors' Association claimed that 4 per cent. of the health visitors asked had encountered a child with rickets. Whether or not that is true, I do not know. However, the Committee on Medical Aspects of Food and Nutrition Policy is inquiring via an expert sub-group into bone health in the United Kingdom population.

I belong to the Court of the Sons of the Clergy, a 350 year-old charity devoted to the relief of clergymen and women and their families. It does not, thank God, have to deal with extreme poverty, or penury, but frequently with the results of relatively low pay coupled with less than adequate management of limited resources. I mention this because it shows how difficult it is to define the word "poverty". Here I rather dangerously cross swords with the noble Earl, Lord Russell. I think it is important to define the word "poverty". In the Oxford English Dictionary it is inter alia,

    "the condition of being without adequate food, money, etc.".

I prefer to use the words "relative poverty", "inequality", "penury" or "extreme poverty", as "poverty" by itself conjures up in the minds of those who have not been attending this debate harrowing photos of starving children in Africa and other third world countries.

I believe there is no valid reason to find malnutrition through shortage of funds in this country. Available benefits, concentrated by this Government where they are most needed, have increased in value by more than inflation since 1979. They undoubtedly provide enough resource for living; not plush, luxurious living, but sufficient to get by on, and with good and sensible management of funds, a little more. This may not be ideal, but I believe that everything possible should be done to encourage independence and a move away from reliance on the state. However, many Labour politicians talk a great deal about poverty--we have heard a great deal of it today--high poverty levels and indeed increasing poverty levels. But really, my Lords, how many of those earning below the national average income do not have a freezer, central heating, often a car and sometimes a microwave, and, of course, that most important staple of all, a television set?

If the level of "poverty" is based by Labour on a percentage of the national average income, rather than as an absolute standard of living, then the goal posts continually move, and however rapidly the standard of living rises in this country there will always be relative poverty. Poverty itself--that extremely emotive word--can be used to show that the wicked Conservatives are condemning millions of fellow citizens to "poverty", implying a lack of resource to buy food--hence malnutrition of children. It is a poor argument.

The quality of food, and whether it will or will not keep people healthy, is a highly complex matter. I agree with the noble Lord, Lord Addington, that it is probably

12 Feb 1997 : Column 294

true that many teenagers and young adults do not receive in an acceptable and understandable way good advice and training on the nutritional value of different foods; for instance, the simple fact that fresh food should, by and large, be more healthy and does not often cost more.

In carrying out some research for this speech I have taken some information from a report from the Family Policy Studies Centre entitled Diet, Choice and Poverty 1994. Some rather interesting facts emerge from its survey of 48 of the poorest families in a deprived area of the Midlands. Junk food is often superficially more attractive to children and their parents too often take the line of least resistance. I can remember being in awful trouble through not wanting to eat my cabbage. I was made to, my Lords, and much the better I am for it. The report also shows that when a family is very poor pride has much to do with the priorities in terms of how it spends its money. If money is short, it appears that extra emphasis is put into keeping up appearances--street cred. That is very interesting. It also seems that there is a strong tendency to buy only food that it is known the children like, to avoid the possibility of waste, because there is no inclination to say, "Eat it, there isn't anything else". That does not seem to be right.

I have been concerned in the past with the Order of St. John. For a long time it has been trying to widen first-aid teaching in schools. I believe that first aid should be a compulsory part of the national curriculum in all schools. That would do more to save life and injury than anything else.

I shall finish with a brief quotation from Izaak Walton:

    "Look to your health; and if you have it, praise God and value it next to a good conscience; for health is the second blessing that we mortals are capable of; a blessing that money cannot buy".

6.28 p.m.

Baroness Farrington of Ribbleton: My Lords, when I first became a Member of your Lordships' House, one of the best pieces of advice I was given was never to speak in anger, so I shall seek to abide by that. I speak with some trepidation in this debate. The noble Lord, Lord Butterfield, who is not in his place, referred to those of us who dangerously increase our risk factor by putting an inch on our girth as we get older. I am disqualified to speak. I am a self-admitted smoker but I support the Labour Party's ban on tobacco advertising.

In this debate I wish to speak about the effect of homelessness on the health of young people. Homelessness is generally devastating for young people and it impacts very severely on their physical and mental well-being. An NCH Action for Children survey of vulnerable young people, the majority of whom were in temporary accommodation or homeless, found that one-third had had only one or no meal within the past 24 hours; nearly all were following unhealthy diets--good, home-cooked broth is very difficult to make on the streets of Victoria at night. A disproportionately high number have been recently physically ill and the overwhelming majority were depressed and nervous.

12 Feb 1997 : Column 295

Unsurprisingly, these problems are most acute among those whom we shall pass tonight on our way home from your Lordships' House.

The 1995 Mental Health Foundation survey found a disturbingly high level of psychiatric disorder among homeless young people. A quarter had attempted suicide in the past year; more than half had been the victims of parental abuse or neglect; they had twice the likelihood of psychiatric disorder as other young people in that age group and only 15 per cent. were receiving treatment.

These are among the factors highlighted last week at the NCH Action for Children's Youth Homelessness Initiative, House Our Youth 2000. It calls for changes in housing and social services to develop a partnership approach; to develop policies and to respond to the need in particular for mediation when the young person first becomes homeless and seek to return him or her to the family; to devise strategies to improve access to, and the quality of, private rented accommodation and a more effective benefits safety net.

To those very sound objectives I would add the points raised by my noble friend Lord Haskel in his contribution to this debate. In particular, I single out investment in a satisfactory supply of high quality, well-insulated housing for people in need in this country. It is a scandal--I speak with sadness, if not in anger at this stage--that billions of pounds have been wasted, as the noble Lord, Lord Haskel, said, tied up in local authority budgets. I say to the noble Lord, Lord Astor, that the real tragedy lies in money which is tied up. The housing need is there, but local authorities are prevented from spending that money to meet the need.

It is a vicious circle. Many of the homeless young people come from poor quality, overcrowded accommodation which has put intolerable pressure on families. The grinding poverty that many have experienced in their families has contributed to the inability of the family to cope with a growing young person. I would not dare to go to those living in overcrowding and poverty--I declare an interest in local government as a councillor in Lancashire--and tell any young Lancashire woman that if only she borrowed my cookery book she could cook a meal for a family for 40p. on the day of the week before her benefit is due.

While there are examples of people who despair and give in and who lack the proper skills to be able to feed their families properly, most of them look at good quality food. I refer to those who have the confidence to look at the issues and organically produced food. They look at the price tags and go for the cheapest offer of processed food with which to fill their children. It is a vicious circle. It is the young people in communities with poor housing who are most likely to suffer unemployment themselves. We waste so much money in this country on the cost of unemployment instead of putting those young people to work.

We had this matter explained at Question Time. If it is right to tax the banks with a windfall tax, how much more worth while is it to tax the privatised utilities and their high level of resources in order to get

12 Feb 1997 : Column 296

these young people back to work. We have family pressure and poverty wages. I believe that the figure was 250,000 over-50s who have been excluded from the unemployment list. They are excused from being considered available for work. If this Government stay in office, those over-50s, single grandfathers, will be told that they may no longer seek help from social security in order to stay in their homes. They too will put pressure on family accommodation as they seek to get away from cheap rooming houses and try to move in with their married sons and daughters, creating greater pressure.

All these factors contribute to homelessness. I do not believe it is possible to look at what has happened in society and say that all the faults are those of the Government and their policies. That would be unreasonable. There is a cycle of factors which has occurred to create this very vulnerable group of young people. What has happened as that problem has grown? More and more young people sleep on our streets, first in the poorest areas of London, Glasgow and Edinburgh and then in the large cities like Manchester and Liverpool and now in some of our smallest market towns. It is possible to find homeless young people in those places. Health breakdown is one of the factors.

We on these Benches share all the concerns of the Government about law and order. But the most likely victim of violent crime is a young man. Statistically, a young man is most at risk. We walk past those young people whose health and housing needs are not being met, and who are not a worthwhile investment for those whose interest is making money out of housing. Their housing needs cannot be met by market forces. They are also the most likely victims of crime in the streets of our towns and cities tonight.

I said at the beginning that I had been advised not to speak in anger. I would speak in despair, were it not for one fact. I cannot stop because, like noble Lords, I am a parent and I cannot avoid seeing those young people on the streets. I do not come here in a paternalistic spirit. Despair will not solve their problems. I have been fortunate in my life. The young people to whom I have referred could have been my children in different circumstances. Any one of us can have a child on the streets if we are unfortunate. We all have a duty to work together to get them off the streets.

6.38 p.m.

Lord Rea: My Lords, when the noble Lord, Lord Butterfield, spoke as the 13th speaker, he considered himself lucky because of all the friends that he had gathered through listening to the previous speeches. However, by the time one reaches the 24th speaker just before the gap in the list of speakers, it is almost un embarras de richesse of friends that one has to think about. The other problem is that almost everything that one was going to say has already been said. Therefore, perhaps I may crave your Lordships' indulgence because I have had to do some mental cutting and pasting with my speech.

The noble Lord, Lord Luke, spoke about different kinds of poverty. He said that he preferred to speak about relative poverty. That is a reasonable aspect of the

12 Feb 1997 : Column 297

matter to look at. So let us think about the relevance of relative poverty rather than the people at the very bottom of the scale.

The importance of that has been demonstrated by Dr. Richard Wilkinson, who was introduced to us by the noble Lord, Lord Butterfield. He has stated that the greater the proportion of wealth going to the lowest 70 per cent. of the population--that is, to the majority of our people--or the more equal the distribution, the higher the life expectancy or, conversely, the lower the mortality rate. That is the case over quite a range of incomes per head in the developed world. Indeed, Dr. Wilkinson showed that that applied when 25 developed countries were compared. It has also been shown to be true when the individual states of the USA are compared. The more unequal the income distribution, the higher the mortality rate.

It was the same Richard Wilkinson who, when a post-graduate student, wrote an open letter which was published in the Guardian in 1977, to Lord Ennals (who was mentioned by my noble friend) when he was plain David Ennals, the Secretary of State, pointing out some worrying statistics that were beginning to appear which suggested that the mortality rates of the different social classes were again beginning to diverge after nearly two decades--the 1940s and 1950s--when the gap had started to narrow. Those were the decades of the 1939-45 war, of the first Labour Government and of the early years of "Butskellism".

Unlike the present government, David Ennals took immediate steps and within three months had set up the working group on inequalities under Sir Ronald Black, about which so much has been said. Although the Government rejected the Black Report, it was taken seriously by the research community, the World Health Organisation and by a number of other countries which began to look into their own health inequalities with considerable concern, even countries with Conservative health ministers such as the Netherlands.

Although the causes of the inequalities could not be fully disentangled by the Black working group, it concluded,

    "there is ... much which cannot be understood in terms of the impact of so specific factors, but only in terms of the more diffuse consequences of the class structure: poverty, working conditions, and deprivation in its various forms".

In other words, the health inequalities related to patterns of living over which the National Health Service is relatively powerless.

Practically all of the 37 recommendations of the Black Report are highly relevant today and although starting a decade late, the Government have partially implemented some of them. I refer, for instance, to the Health of the Nation strategy. That comes close to one of the recommendations, as does the setting up of a Cabinet committee, under Tony Newton, to monitor the progress of those Health of the Nation programmes. However, neither of those initiatives directly addresses the problems of social inequalities, as Black suggested they should. It would be interesting if the Minister could tell us how many times that high-level Cabinet committee on the Health of the Nation has met and something about its deliberations.

12 Feb 1997 : Column 298

In much strengthened form, such a Cabinet-level, cross-departmental committee should be able to make a serious impact on many of the factors affecting health which lie outside the remit or capabilities of the Department of Health itself, such as poverty, housing, nutrition, working conditions, education and transport. Transport is particularly important in terms of the nutrition of people with lower incomes. If you live on a housing estate, you often cannot get to where the food is cheapest because the public transport system is not very good, particularly since the privatisation of bus services. There are also those much more subtle areas such as community support and stability, to which noble Lords on all sides of the House have referred. It has been calculated that living and working conditions are responsible for about 80 per cent. of the premature mortality and worse health of the less privileged part of the population. Factors which medical care can influence account for only about 20 per cent. of the total.

One of the Black Report's recommendations which has been vigorously followed (although not by the Government until recently) has been to increase research into health inequalities. Since 1980 there have been literally thousands of well conducted studies confirming and amplifying Professor Black's findings. My noble friend Lady Jay mentioned that I have recently carried out some research that is relevant to today's debate. I was going to keep that quiet, but as my noble friend has invited me to describe it, I shall do so briefly.

The study was carried out in a north London inner-city group practice. It is entitled Counting the Cost of Social Disadvantage in Primary Care. Its findings were based on a retrospective analysis of five years of patients' records. The methods used are described in our paper--here comes a plug, my Lords--which appeared in the British Medical Journal on 5th January. The main findings were that the cost per head of providing primary care, including medication, for patients in social classes I and II worked out at very nearly £100 per annum while the cost for those in social classes III and IV was £250 per head, or two-and-a-half times as great. That difference was rather greater than we had expected. We think that it is an inner-city effect. We found, for instance, that those in the lowest two social groups had 4.3 times as many episodes of serious illness as those in the professional group. The cost aspect of the study is a stark reminder of the other costs which poverty inflicts on the National Health Service--that is, if the care is equitably applied according to patient need (and there is evidence that it is not quite so equitably applied as we should like).

That is just one small piece of research. As I have said, there have been thousands of other well conducted studies. The most recent compendium of such studies is to be found in Health and Social Organisation: Towards a Health Policy for the 21st Century which was published by the Centre for Health and Society, which has just been established at UCL. One wonders what the noble Baroness, Lady Thatcher, our previous Prime Minister, would have thought of a centre with such a title. If studied, that volume could well serve as a basis for the health policy of the next government. I recommend it.

12 Feb 1997 : Column 299

Our most important public health issue is the one that we have discussed today. With our new Minister for Public Health, we on these Benches will start to address the problem effectively as soon as possible from 2nd May.

6.50 p.m.

Baroness Robson of Kiddington: My Lords, I join other noble Lords in thanking the noble Baroness, Lady Jay, for introducing this debate. We have had a long and interesting debate with 25 speakers. No one who has listened to the debate can be in any doubt about the influence that social and environmental factors have on the health of the nation. It would be churlish not to admit that the health of the nation has improved over the years since 1970. That improvement has happened in all classes of society, but the difference is that the improvement has been greatest among the middle classes. That has inevitably resulted in the gap between the health status of the affluent parts of society and those in the poorer areas having widened during those years; in other words, it has become worse than it was when we all suffered poorer health.

One must therefore draw the conclusion that poverty, poor housing, environmental conditions and poor diet have a profound effect on the health of that part of the population in social classes IV and V. The evidence for that statement is overwhelmingly presented by the body of people who are most involved in providing healthcare in the community, such as the BMA, the RCN and the Health Visitors Association.

The BMA calls for the Government to consider, above all, their policies in the field of housing, unemployment, transport and the environment, and to relate them to their policies on health. It calls upon the Government also to look more closely at their cost-saving exercises in the NHS, such as the abolition of free eye examinations and its implications for the long-term health of people, particularly people over 65.

Of all tests, eye tests are probably one of the most powerful tools for diagnosing early signs of potentially dangerous conditions, such as diabetes, cataracts, glaucoma, detached retinas and even brain tumours. Those are conditions which, if detected in their early stages, can be treated effectively at a relatively low cost. The RNIB confirmed that people are becoming ill and suffering incurable eye disease because of the withdrawal of free eye tests. The Government claim that it would cost £120 million a year to reinstate free eye tests. I should like to ask whether, against that so-called saving, they have made any assessment of the inevitable future increased cost to the NHS of not treating people with more advanced illnesses at the right time because of the lack of an early diagnosis.

My noble friend Lord Russell asked the Government always to ensure that the savings are greater than the costs of the increased care that will have to be provided in the future. Eye tests are a good example of preventive medicine which we on these Benches would wish to reinstate.

12 Feb 1997 : Column 300

The RCN is concerned especially about the impact of poverty on children in our society. Many noble Lords have spoken about that. They have said that there are today 4.3 million children living in households whose income is less than half the national average. In 1979, the figure was 1.4 million. There has been a three times increase since then. Despite that, the RCN is concerned that there is no mechanism for weighting community and district nurses and health visitors' care on the basis of need. Inner cities are areas of worst deprivation but they receive no higher priority for the supply of those community nurses and health visitors than other areas which do not have the same need.

Health services should target and focus always on those most in need, in particular people living in poverty. Probably the most disturbing report that I read when preparing for the debate is the one from the Health Visitors Association published in November last year. I do not believe that it is scaremongering. It goes as far as to say that Britain would seem to be returning to the social conditions of 100 years ago. According to its survey, 29 per cent. of health visitors encounter TB every year; 93 per cent. gastroenteritis; and 4 per cent. rickets. One of the most upsetting things that it found was that 83 per cent. of health visitors encountered failure to thrive among children, which, together with rickets, is a sign of severe malnutrition.

My noble friend Lord Russell suggested that there should be hospital tests to detect malnutrition. Malnutrition and an unhealthy infant diet have long-term implications for the future. We are looking to build up problems for ourselves in the future by neglecting what is happening in society, because malnutrition and a bad diet are likely to increase the incidence of heart disease in later years. It is a tragedy that the many improvements in health and welfare now possible are being undermined by extreme poverty.

Another problem which has been mentioned is the increase in asthma. It is a disease that is growing alarmingly. Sufferers from the most deprived areas are almost twice as likely to be admitted to hospital than others. On average, 155 children with asthma are admitted to hospital each day of the year in this country. There again, there seems to be no doubt that poverty has an enormous impact on the incidence. Damp and mouldy housing, together with high levels of pollution in urban areas, are largely responsible for the difference in incidence between social classes.

At the end of the debate there seems to be no doubt that poverty, poor housing and environmental conditions are responsible for the widening gap in health between social classes I and II and social classes IV and V. Genuine progress towards closing that gap will take place only with the involvement in the NHS of other government departments and local authorities. Too often actions are taken by other government departments, perhaps in a cost saving exercise, which have an enormous impact on the health of the nation and the cost to the National Health Service. Close co-operation between the NHS social services and social security and the departments responsible for the environment and housing are a prerequisite for any improvement in the status of health, in particular that of the poorest in our

12 Feb 1997 : Column 301

community. I charge the Government--whether the present Government or that coming in on 2nd May--to make sure that the departments which have an influence on the health of the nation work together and not against each other.

7 p.m.

Baroness Hayman: My Lords, I believe that the whole House will wish to thank my noble friend Lady Jay for her masterly, lucid and comprehensive speech and for giving so many Members the chance to speak on such an important subject. She has provoked a debate which has inspired many speeches of a high quality. They have not all been speeches of anger, but they have certainly been speeches of passion which has been rightly provoked.

The speech of my noble friend Lady Farrington was the better for being angry. It was a fine contribution and it reminded us that there are issues in our society about which we should be angry. Only with that passion will we tackle them. I say to the noble Lord, Lord Luke, that it is true that money cannot guarantee good health. However, a lack of money can certainly guarantee that one's chances of good health will be reduced.

The figures relating to children have been mentioned many times today. We know that a baby whose father is an unskilled manual worker is one and a half times more likely to die before the age of one than the baby of a manager or professional worker. We know that the poorest children are twice as likely to suffer from respiratory disease, four times more likely to be killed in a traffic accident and six times more likely to die in a house fire than are their counterparts in Social Class I. We should take those figures into great account and be angry about them. My noble friend Lord Desai said that there are issues at work which are not merely about the workings of the health service; they are issues which relate to overall social conditions in our country and issues which we must attack comprehensively.

There has been much debate about whether there is any real, absolute poverty in Britain today. My noble friend Lady Symons of Vernham Dean spoke about the people who in winter choose between heating and eating. My noble friend Lord Murray of Epping Forest spoke about the mothers who choose between feeding their children and protecting them from the risk of accident. They were expressions of real poverty in our society. Many of us read in the myriad of material available for the debate the stories from individual families about the choices that they must make. We are most reluctant to start hectoring about good housekeeping and feeding families well for a week on the kind of money that we can spend without thinking in one evening on a meal for four.

We should be concerned not only with absolute poverty but also with relative poverty because of its effect on illness and the cost of that to society and its effect on economic growth. That point was made by my noble friends Lord Paul and Lord Haskel. The work of Wilkinson was referred to by my noble friend Lord Rea and it has been shown that very unequal societies, not only those with high rates of poverty, have worse health and economic growth than less equal societies. Winston

12 Feb 1997 : Column 302

Churchill knew about that in 1943. He then stated that there was no better investment for a nation than to put milk into babies. He said that healthy citizens are the greatest asset that any nation can have.

If we are to perform economically well in the future we must perform well in terms of the health of our population. As regard concerns about child nutrition, when one compares countries, say, in the Pacific Rim, Malaysia and Singapore it is fascinating to note that they are looking at ways of feeding their children properly as part of producing an effective, well educated workforce for national success in the future.

In some ways, it has been a very depressing debate. We have heard a repetition of depressing statistics and depressing tales of how income poverty is compounded by the deprivation which comes with bad housing and living in a polluted atmosphere. My noble friend Lady Hilton spoke clearly of the effects of bad housing and pollution. The noble Lord, Lord Addington, spoke of the impossibility of having a healthy lifestyle when one lives in an area in which one's chances of dying prematurely are four times greater than in an affluent area.

I thought of the poem by Larkin when contemplating the terrible inter-relationship between housing, poverty, deprivation and a poor environment. Everyone remembers the first line of the poem, but that is not the one I shall quote. The final stanza begins:

    "Man hands misery to man, It deepens like a costal shelf, Get out as quickly as you can, And don't have any kids yourself".

That is a terrible philosophy, but looking at some of the poverty and deprivation that we heap on individuals today one understands that despair.

Much has been said about the importance of looking at both costs and benefits when considering prevention as regards healthcare. The noble Earl, Lord Russell, has spoken of that on previous occasions. However, we must be careful before we throw up our hands, as did the noble Lord, Lord Jenkin of Roding, when the Black Report was published, and say, "It's all very difficult. It's not certain that they were the causes, anyway. It's not certain that if we carried out those measures they would have any effect and, anyhow, it is too expensive". It is very easy to say that it is too expensive and to ignore the transfer of costs to other departments.

One sees that everyday with the health service. We are always willing to pay the cost of the repeated hospital admissions of the child with respiratory disease, but we are not willing to pay the cost of providing an adequately heated and insulated home for that child. We are willing to pay the plastic surgeon to repair the damage caused to children by the fires in which they are injured, but we are not willing to pay for fireguards and smoke alarms. We have a very narrow definition of cost and benefit, which gets us into terrible difficulties.

I believe that reference was made by my noble friend Lord Borrie to the Rowntree Report and the comment on it by Mr. Howard Davies, who said:

    "Too much of our public spending is devoted to compensating for the effects of failure rather than investing in the ingredients of success".

12 Feb 1997 : Column 303

It is the short-termism which deals with those consequences of failure but does not deal with investment which I believe is so damaging to us as a nation.

It is the acceptance of the inevitability--that quote that we have had from across the Floor--that the poor will always be with us; the inevitability that things will get worse; and the catalogue of neglect which has seen the nutritional standards of school meals go down, the withdrawal of the EU subsidy for school milk and the water privatisation programme which has allowed families in this country to be disconnected from clean water. There is that terrible acceptance that those things will always be there and nothing can be done.

But other countries do not accept that. Japan is a very interesting example in terms of economic growth and stopping inequalities. There are very low differentials in income levels in Japan. The height of its citizens has increased, as has the life expectancy of its citizens. Moreover, it has increased the healthy life expectancy of its citizens which Social Trends showed us this month that we have failed to do. Japan has the highest number of centenarians of anywhere in the world and they are healthy centenarians.

After the war, in Finland, a much poorer country than this one, raised infant mortality rates to much better than those in this country and they still are because of the focus on child and maternal health. Sweden has actually abolished the differentials in perinatal mortality between social classes. In America, 6.3 million children receive a free school breakfast every day. They have milk and a proper hot meal--not a bag with a sandwich, a biscuit and a coloured drink which is what the nutritional standards in this country allow. That is done not because it is some great Scandinavian liberal democracy which believes in socialised medicine but because it has worked out that every dollar invested in child nutrition in school saves three dollars in medicare.

Therefore, there are proper cost-effective reasons for taking action. There has been much talk about what is private and public responsibility in relation to health. I have worked for most of my working life in voluntary organisations and I do not challenge the scope that there is for community action. That is very important. But it is also important that we should not leave national issues like the health and nutrition of our children to charitable endeavour. It is a matter of concern for the whole country.

I listened to the right reverend Prelate describing that scheme in his own diocese. He described how a community can become involved and do a great deal to help itself. While listening to him, I was reminded of that haunting and powerful saying that it takes a whole village to raise a child and it takes a whole nation to raise a generation: to invest in that generation's health, education and development, to ensure that both individuals and the community to which they belong thrive.

12 Feb 1997 : Column 304

It will take something else in this country. It will take a change of focus and direction of government policies after the sorry record of the past 18 years. We need a change in government so that there will be the leadership needed to create a more inclusive, less divided society. On these Benches, we are eager to embark on the task of creating that healthier society.

7.15 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege): My Lords, first, I start by congratulating the noble Baroness, Lady Jay, on initiating what has been a fascinating debate, the subject of which is poverty and its link with health. I cannot vouch for the state of your Lordships' health. When listening to my noble friend Lord Brentford, who told us how we should support each other in your Lordships' House to give up smoking and to encourage healthy lifestyles, I was thinking of your Lordships' Guest Room. I was feeling somewhat unequal to the task. Perhaps I shall just issue visitors with a government health warning.

This evening, a number of theories have been postulated; statements have been made; and conclusions have been reached, many of which have been surrounded in controversy. However, I believe that there is a consensus that the causes of poverty are the most complex of all social issues and their link with health is deeply difficult. There is even disagreement as to definitions, a theme which was explained most ably by my noble friend Lord Luke. I thought that the noble Earl, Lord Russell, was going to sidestep that whole issue but if I understood him correctly, he was defining poverty as it relates to income support.

There is a problem with that definition because the more people there are on income support, and the more we help the less well off, the more poverty is created. Of course that is misleading. Likewise, using a fraction of national average income can be misleading as that ignores the rise in average income itself--about 37 per cent. in the UK since 1979. It ignores the fact that everyone is better off, including those who have least income.

I do not wish to delve into semantics but I state the obvious in saying that no ideology can solve the problems and no party has the monopoly of compassion. But this Government have demonstrated, through their actions, that they have been neither complacent nor uncaring. We are not burdened with the doctrine that everyone should be treated the same. Free of that constraint, we have targeted resources towards those who really are poor, in line, with the urging of the noble Lord, Lord Prys-Davies.

That money has paid dividends. Independent research by the Institute of Fiscal Studies shows that there is very significant movement in and out of the 10 per cent. of those on the lowest incomes, a point made by the noble Lord, Lord Haskel. But surely the noble Lord is pleased that, of those who are in the bottom decile, up to half have moved up one year later.

I understand the great interest which the right reverend Prelate the Bishop of Lichfield has, especially regarding the influence of unemployment on a

12 Feb 1997 : Column 305

community, on families and on individuals' health. That is one reason that this Government have been so concerned with the economy. Our economic policies have cut unemployment by almost 1.1 million since its peak in 1992 and a further fall of 67,000 for the last month was announced today, the eleventh consecutive month of falling unemployment figures. That contrasts sharply with the experience of other European Union countries, in particular Germany, which has sustained an increase of 0.5 million in one month.

Time and again, poor people do not ask for social security payments; they ask for jobs. They want to earn their way out of poverty. They seek the self-esteem referred to so powerfully by my noble friend Lord Birdwood. That is why we oppose the job-destroying minimum wage. We are not ashamed of spending money to attract inward investment. It is what it says: investment for the future as well as now. As my noble friend Lord Astor said, overall economic policy has a profound effect on poverty and health.

I am sorry that the noble Earl, Lord Sandwich, feels that the Government are not on the side of the poor. Perhaps he has not related our policies to the results that we have achieved. During our tenure, average incomes have increased not only for those in work but also for those seeking work. The vast majority of people today are better off. Average incomes have risen by more than one-third, and those rises are not confined to a few top earners. Average income is up for all types of family, including lone parents. The least well off--those in the bottom 10 per cent. of income--have seen a rise in the consumer goods they own, and I rejoice in the fact that everyone is now better off.

During the past 18 years this country has been through a dramatic period of perestroika. From the chaos of 1979 we have come to realise that we have to compete in a world market. In parallel with that change there has been a revolution in health services. The ethic of the NHS has been nurtured but the delivery has been revolutionised. In 1979 inefficiency was commonplace--in fact it was never measured--and we had "never never" waiting lists. Today the average waiting time for an operation is four months. We are treating more people, for more conditions, with more staff and with a range of drugs and high-tech equipment--for example, laser beam technology--undreamt of 15 years ago.

The noble Baroness, Lady Jay, implied that the NHS was not that relevant to improving health. I would disagree with that view; indeed, so would the 9 million people treated last year. Moreover, I believe that her noble friend Lord Desai, in a fascinating--and, yes, largely spiritual--speech, made that point well. I must say that it is very interesting to listen to an economist who remains untouched by the Treasury. It is most refreshing.

The noble Baroness, Lady Jay, and the noble Lord, Lord Prys-Davies, were dismissive of our Health of the Nation policy. Perhaps they are aware that it is applauded by the World Health Organisation and lauded by it as a model for other countries to follow. The WHO recognises it as a world leader and a world beater. It is

12 Feb 1997 : Column 306

not a woolly series of political statements, as I suspect the Labour Party's sequel will be; it is a highly focused action plan, consisting of five key areas with 27 targets. Of those 27 targets, there are only two areas in which we are not making progress--obesity and teenage smoking. Deaths from coronary heart disease and from cancers are coming down in all parts of the country and length of life has been extended.

I would not claim that the Health of the Nation policy should take all the credit. But, as my noble friend Lady Brigstocke said, the public today are better informed, lifestyles are changing, teenage pregnancies are reducing and the number of people smoking is going down. I believe that great credit should go to the Health Education Authority for its work.

The noble Lord, Lord Addington, mentioned the "Life Project" in the Wirral. Although I accept some of the noble Lord's humorous comments, I do think that the way that that project has influenced the local community is quite simply inspiring--likewise, many of the other health alliances which involve all sections of an area. I shall perhaps bore your Lordships on another day with details of a scheme that I visited in St. Helens and Moseley entitled "Hairdressers for Health". However, I shall not do so today.

I turn now to what is happening in the country and I look especially at our children today. Our children are growing taller and heavier than ever before and that is in all socio-economic groups. Infant deaths, deaths of babies under a year--an international indicator of general health--are at their lowest rate ever. Among social classes IV and V, infant death rates have fallen by more than half in the past 15 years. So, today, infant death rates in social class V are better than those in social class I just 15 years ago. That is real progress. Overall, the trend is one of steadily improving health.

Of course, to celebrate that achievement is not to deny that there remain stubbornly persistent differences in rates of illness and death between different social groups. Indeed, that issue was raised by many speakers this afternoon, especially the noble Lords, Lord Murray and Lord Borrie, and the noble Baroness, Lady Robson. But those disparities are not new; they did not suddenly appear in 1979 or, indeed, in 1992. Nor should we mislead ourselves into thinking that such variations are somehow unique to British society. I was amazed to hear the noble Baroness, Lady Hayman, mention Finland. Finland has far greater disparities between its various social groups than we have when it comes to health.

Next Section Back to Table of Contents Lords Hansard Home Page