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Baroness Hayman: My Lords, I was in fact talking about Sweden in terms of differentials in infant mortality and about Finland's performance since the end of the war, when it was low down in international comparisons overall as regards perinatal mortality. It has now moved right up the scale.

Baroness Cumberlege: My Lords, if we look at all the health indicators in Finland, it will be seen that they do far worse than this country, as does France. That makes the point that this is not particularly pertinent to Britain; it is across developed countries.

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While it is the case that our excellent national statistics have shown an association between health and social status for more than a hundred years, the same pattern is also seen in other developed countries. Some commentators argue, using particular measures of health, that some of the differences in Britain have become wider since the war. But, as I said, this needs to be seen against the tremendous overall gains in health and life expectancy which have benefited every social class. Simplistic arguments tend to imply the possibility of simple solutions and do not do justice to the complexity of these issues.

Both poverty and health are influenced by a huge range of factors. In the NHS jargon, it is impossible to ring fence them. Housing, employment, behaviour, genetic endowment, education, family relationships, lifestyles, geography and access to health services, all play a part.

It is certainly true that there is a link between deprivation and illness--not least mental illness. I use the word "deprivation" advisedly, because loss of employment, loss of a marriage or a family breakdown are causes of both illness and poverty. Only recently we debated "the family" in your Lordships' House without being able to formulate "the answer". Again, I believe that H.L. Mencken was most apt when he said:


    "For every difficult and complicated question, there is an answer which is simple, easily understood and wrong".

My noble friend Lord Colwyn very succinctly described the complexities: there really is no quick fix. Therefore, the Government have addressed the problem systematically. Through the Child Support Agency we have sought to introduce a system where, particularly mothers with children, get financial support. I am sure that the noble Baroness, Lady Turner of Camden, will acknowledge that family credit has helped 700,000 people to get back to work. We have just launched the "Parent Plus" initiative to help lone parents get back to work. The long term unemployed now make up 37 per cent. of claimants compared with 43 per cent. 10 years ago.

Our voucher scheme is being introduced to increase the number of good quality nursery places for four year-olds, which will not only benefit the working parent but will also help the child reach its educational potential and will therefore provide a spin-off to health. I share the view expressed by the noble Lord, Lord Ponsonby, that childcare is a crucial issue. I am sure that the noble Lord will be pleased to hear that we have doubled the number of nursery places in the past 10 years.

The noble Baroness, Lady Hilton, is of course correct to say that bad housing and unhappy communities cause illness. While it is part of the national character to dwell on failure, the extension of home ownership has been the greatest single factor in improving the quality of housing; and, indeed, we should celebrate the lowest mortgage rates for 30 years.

Over five years, public investment has built or refurbished around a quarter of a million homes for social renting or shared home ownership. The problems

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of cold, damp and mould are being tackled by renovation and regeneration polices. Nearly 2 million homes have benefited from grants for basic insulation and draught proofing under the Home Energy Efficiency Scheme.

The noble Baroness referred to the 1991 English House Conditions survey. She will realise that it pointed to a falling number of unfit homes over the previous year. I can assure the noble Earl, Lord Russell, and the noble Baroness, Lady Farrington, that the Government are committed to ensuring that there is no necessity to sleep rough. The Rough Sleepers Initiative and the Homeless Mentally-ill Initiative are helping get people off the streets and into secure accommodation. Indeed, 35 projects funded by my department are helping homeless people to make contact with primary care services and to integrate them into mainstream services.

We share the views of the right reverend Prelate and those of the--

Earl Russell: My Lords, I am sorry to interrupt the Minister. I do not wish to dispute anything that she is saying, but I would be grateful if the noble Baroness could give me an assurance that she will look at the points that I raised about the difficulty of the homeless in registering with a GP.

Baroness Cumberlege: My Lords, I shall certainly do so. However, as I said, we have schemes at present which are geared towards that. Nevertheless, I quite appreciate that the noble Earl wants a fuller response and I shall endeavour to write to him in that respect.

As I was saying, we share the view of the right reverend Prelate and those of the noble Lord, Lord Paul, about the problems of inner cities. We are committing almost £4 billion over three years to economic and social regeneration through the single regeneration budget. We can expect regeneration to pay health dividends through helping to create better homes and environments for families and communities, and improved prosperity. The active involvement of local people which is such an important feature of schemes such as City Challenge, increases pride and self-confidence and brings communities together. The results have been startling. Desolate, miserable, crime ridden inner-city areas have been transformed into thriving communities. Places where people were unwilling to go, let alone live and work, have been transformed and are now desired. As a Sponsor Minister I can confirm the transformation that I have witnessed.

I wish to refer briefly to education, as I know the Chief Medical Officer believes that education is one of the main keys to improved health. It is encouraging to see that educational standards are improving, with more young people obtaining good school-leaving qualifications. Today one in three are in higher education, compared with one in eight only 18 years ago. I was concerned to hear the noble Earl, Lord Russell, say that some of these students are ill. I expect that is a complex matter which also concerns lecturers, quality of education and other factors.

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My noble friend Lord Birdwood is quite right; it is not for governments to tell people how to live their lives. That is arrogant and patronising. What is more, we know that it does not work. We should give them the information and then it is up to individuals to make their choices, not least in the area of food. The noble Baroness, Lady Jay, my noble friend Lady Brigstocke and the right reverend Prelate referred to diet and nutrition. I hope they will be reassured that a survey of the diets of over 3,000 children aged between 10 and 14 carried out in 1982 showed the intakes of all nutrients were above recommended levels. Government surveys over the past 20 years have consistently shown that there is no evidence of malnutrition in British children. I understand the points that were raised about the health visitors' survey. We find that quite an unsatisfactory survey, in that we are experiencing difficulties in obtaining the evidence and also as regards the methodology that was used.

Baroness Farrington of Ribbleton: My Lords, can the Minister confirm that her former honourable friend, Mr. Matthew Parris was unable to live for, I believe, two weeks and feed himself while living on an income equivalent to income support, which at that time was higher in real terms than it is now? He has since ceased to be her honourable friend and has taken to writing about her noble friends instead. My recollection is that he could not feed himself, let alone feed a family.

Baroness Cumberlege: My Lords, we recognise that some people on low incomes have particular difficulty in eating a healthy and varied diet. That is absolutely true. But often where they live the right food is not available and they do not have storage and cooking facilities. We have done much work with the supermarkets on different baskets of food and we know that a healthy diet is composed of all sorts of foods. We are encouraging people to eat more bread, potatoes, pulses, seasonal vegetables and fruit. Those are not expensive items. We believe there is no such thing as a bad food or a good food. What we seek is a balanced diet.

When one is dealing with people on low incomes, one of the factors is energy. They do not have the energy to cook often if they are poor. There is also the question of accessibility to food. There is a range of issues here. What I am trying to put over to your Lordships this evening is that there is no quick fix. These issues are extremely complex. I become quite concerned when noble Lords on the Benches opposite think that one can snap one's fingers and the problem will be solved. We know that that is not so.

Noble Lords: Oh!

Baroness Cumberlege: My Lords, that was the impression I had. It is interesting to hear the Shadow Chancellor say that for the next two years he will keep to the same public expenditure levels as our Chancellor has indicated. The Labour Party thinks that it will solve these problems without any increase in resources. I interpreted what many noble Lords opposite were saying this evening as a plea for better housing and other such

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provision. However, that would require more resources. This Government have promised more money for the National Health Service for five years, unlike the party opposite. We know that health services also have an influence on the health of our nation. I am running out of time because of the interventions.


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