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Lord Joffe: My Lords, I, too, congratulate the noble Earl on introducing this important debate and his fine speech. Our Government deserve credit for their continuing commitment to reach the 0.7 per cent

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target of national income as aid by 2015. In September last year, in the Comprehensive Spending Review, DfID got the steepest increase of any department in order to keep the UK on track. We have much to be grateful to the leadership of the Prime Minister for.

However, debt relief is being charged against the 0.7 per cent target, as well as the costs of climate change, which were never envisaged when that target was created and were not included in the MDG costings which underpinned the commitments made. The costs of climate change have been estimated at between £50 billion and £100 billion. Already, £900 million has been allocated by the UK to climate change adaptation and mitigation. It is not clear whether this sum and additional future climate change funding will be treated as part of the 0.7 per cent target. Will the Minister clarify this critical point in her response?

Against this background, it is clear that, in addition to meeting the MDGs, funding additional to the 0.7 per cent is required and that new and creative approaches must be taken. The Prime Minister has been at the forefront of developing innovative financial instruments, first through the International Finance Facility for Immunisation which, together with UNITAID, has raised $1.25 billion, and then through the advance market commitment. In addition, other innovative proposals are being developed by organisations such as Stamp Out Poverty, a network of more than 50 UK organisations working on innovative sources of development revenue.

One of those proposals is a small tax on currency transactions which, according to a report last year by the UN University, has the potential globally to generate $33 billion annually. Due to the electronic automation of the markets, it can be put into operation almost immediately. The recently appointed Special Representative on Innovative Finance to the Secretary-General of the United Nations has said:

“We must have taxes on currency transactions”,

and the Secretary-General himself has expressed his support. The All-Party Group for Debt, Aid and Trade, after an in-depth inquiry, has recommended that the Government give serious consideration to the proposal. However, the Treasury has not so far been supportive of such a levy, even though more than £2 billion of extra aid revenue could be generated annually by a duty of less than one hundredth of 1 per cent on sterling transactions alone. Will the Minister outline the reasons for the Government’s opposition to such a levy? Development experts across the world believe that unless initiatives with this kind of vision and scale are introduced, it is hard to see how the MDGs will be met.

As signalled by the noble Earl, I now turn to funding for mental health, probably the most neglected health area in the developing world. Worldwide mental health accounts for 14 per cent of all deaths and disability, and 800,000 die each year from suicide, largely as a result of mental disorders. Such disorders are not simply the plight of wealthy nations; they equally burden the health of developing countries which can less afford to deal with them.

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Given its worldwide prevalence, mental health is noticeably absent from the MDGs. None of the indicators for the three health-related MDGs—HIV, maternal health and child health—targets mental well-being. Despite their absence in the MDGs, mental health is present across all three health goals. The HIV infection is associated with rates of anxiety and depression five times as high among people suffering from mental disorders as the general population. In relation to the maternal health goal, I can add nothing to the eloquent address of the noble Lord, Lord Patel. In relation to the child health goal, it is hardly necessary to say that depression in mothers negatively impacts the health of children. The consequences are that babies of depressed mothers have a five times greater risk of being underweight and stunted by the age of six months.

Mental disorders do not receive any specific part of the health budgets in much of Africa or Asia. Most of the countries that do make provision for mental health care do so at a level of only 1 per cent of their health budget. It is essential to recognise that without addressing mental health, the three health-target-related MDGs will not be achievable. It is also essential to recognise that MDGs cannot be dealt with in isolation. I would urge DfID to take account of this in the application of its funds to meet the MDGs and also applaud it for its support of BasicNeeds, a UK charity which does such fine work on mental health in the developing world.

1.12 pm

Lord Graham of Edmonton: My Lords, we are privileged to be given the opportunity to take part in this important debate and I thank the noble Earl, Lord Sandwich, for initiating it. He has been well known to me during the past 20 years. He has not just come into the debate fresh, as I have, because “sustainability” must be his middle name. He has been talking about these issues for many years.

I feel humble to be in the presence of so many people I categorise as knowledgeable and expert. The topic has been debated from all sides and, more importantly, by practitioners who try to assist human beings who are less fortunate than we are who live in this country. In listening to what has been said, I have felt saddened, appalled and angry, but determined to try to do my best.

I am pleased to hear general commendations to the Government for attempting to achieve the targets. In many other spheres, targets are sometimes derided as being inappropriate, but they are sensible mechanisms, or weapons, to use in judging whether one has been serious in trying to meet commitments. I have read the excellent document produced by Ian Cruse in the Library, and we have been well served by it. I am a member of a repertory company that appears regularly in debates on other topics, but I am a stranger to this repertory company, although I intend to attend its debates much more frequently. For someone like me, a layman in the field, it is a most worthwhile document in assisting me to appreciate what has been happening.

Let me give an illustration from my background. The House is well aware, because I declare it regularly, of my commitment to the Co-operative movement and idea. In 1949, I was a student at Stamford Hall,

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the Co-operative college near Loughborough. Among my contemporaries—I was a secretarial student—were students in management and social science from overseas. There were students from Nigeria, Sudan and India. A special friend of mine was a man called Mavro Mavromatis from Cyprus. In the way of the world, I went to Cyprus in 1976. I had lost touch with him, but said to the official taking us around, “By any chance, does the name Mavro Mavromatis mean anything?”. He went away, came back and asked, “Would you like to meet him?”. I said, “Yes”. He appeared, and he was the registrar of co-operatives in Cyprus. That made my day. I use that to illustrate that the Co-operative movement is very much involved in trying to do what it can in this field, particularly in education and organisation.

In 1895, the Co-operative movement established a body called the International Co-operative Alliance, with millions of people all over the world combining to do what they could to lift the lot of people out of poverty. The principal of the college told me yesterday that there is a co-ordination among the co-operative movements in Europe to try to do what they can in support of these goals. I asked him to give me one or two illustrations of the kind of things that are on his plate at the moment. He told me that members of the staff are in Ethiopia, eastern and southern Africa and Dar es Salaam. They are committed to a programme of post-tsunami reconstruction. In the Andaman and Nicobar Islands, and in the European Union, they are doing what they can. I say that with no sense of self-aggrandisement because, listening to what has been said today, I am conscious that the Co-operative movement is only one of hundreds of organisations which are doing their bit.

The Minister and her colleagues have a great responsibility not to let us and other parliamentarians off the hook. It is far too easy to be sidetracked by other issues—enormous issues that need to be solved. However, in a very busy life, the Prime Minister, members of the Cabinet and everyone in this country who has a place to work and to live, and, above all, a school for their children and a hospital or GP for their wives and family to go for advice, ought to reflect on just how lucky we are to be here. Therefore, I warmly welcome the opportunity to declare my interest in humanity and to pledge to the noble Earl that he can count on me at any time in the future to assist him in his efforts.

1.18 pm

Viscount Craigavon: My Lords, I should like to focus on the relatively new MDG target, 5B, which is the ambitious target to achieve by 2015 universal access to reproductive health. I am most grateful to my noble friend Lord Sandwich for giving us the opportunity to debate this issue, and in particular for his challenging speech. The reproductive health target is in tandem with the maternal mortality target under MDG 5, but with its own indicators as to whether it is being achieved. It is called 5B because it is a new target that was added in 2005.

As has been said, MDG 5 is severely lagging behind any reasonable timescale, and at present rates, it is most unlikely to be met. In the opinion of those

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in this field, the new reproductive health element is essential to begin to achieve anything like the intended improvement in maternal mortality, as well as to fulfil the reproductive health commitment, agreed and enunciated as long ago as 1994 at the Cairo conference, that there should be universal access to sexual and reproductive health services. The resources and the will to meet that originally declared intention were never fully forthcoming, but some very considerable progress has been made.

More recently, the faltering progress in this field has been due to a combination of a lack of resources, adverse political climate and language and simple inertia in some countries. In the background in recent years has been the unhelpful attitude of the United States, which may not continue. In this country, my impression is that the relevant department, DfID, wants to do its best in this field in securing resources and encouraging the use of clear and unambiguous language in debating and discussing this issue. DfID and its Ministers should be given credit for recently allocating £100 million pounds over five years to UNFPA for contraceptive supplies, but recently the general level of support from us and other European countries has decreased, partly in the shadow of support for HIV/AIDS and apparently more immediate issues.

Now that MDG 5B is a clearly declared target, we should fully support it and, if possible, take the lead in encouraging others to support it. Apart from anything else, such aid contributes directly to achieving other MDGs and is meant to be one of the most cost-effective forms of assistance. This MDG is about the right to sexual health as part of general health but is also about sustainable fertility levels. In the excellent briefing note by the Lords Library on this debate, our attention was drawn to an article in the Financial Times on 14 March this year by two demographers who specialise in Africa. The article was entitled “Africa’s greatest challenge is to reduce fertility”. It particularly highlighted how in many of the poorest African countries the momentum of continuing population growth will jeopardise general development efforts and, in particular, other millennium development goals. We have been hearing recently how shortages of water and food may become even more acute. This issue has more recently been partly downgraded and diminished by its politicisation and by treating sexual health as being of a contentious nature. There is a danger that we will lose the more direct and hard-won language that followed from the Cairo conference if we agree to compromise for the wrong reasons. We should be leading in resisting that, both in Europe and elsewhere, and I hope that we can continue to take the lead with confidence in future European deliberations.

I shall mention two of the indicators for this MDG target, which are ways of judging its success, although there are four altogether. One is the unmet need for family planning. That has long been a recognised measure of how further assistance can usefully and genuinely be given and is framed in terms of the expressed needs of users. The figure for this is accepted to be hundreds of millions of couples. Another indicator is the contraceptive prevalence rate, which in most poor countries is extremely low. Both these indicators testify to the huge sums of money still required to

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begin to come anywhere near this declared target of universal access to reproductive health. I can quote the global annual amount required just to meet MDG 5B: it is billions of dollars, of which our share should be additional hundreds of millions of pounds annually. I am not going to quote, and do not have the time to argue for, particular figures, but I remind noble Lords of the very serious amounts of money required, money that in the opinion of many would be a most valuable investment in achieving this and so many other MDGs.

I understand that the Government should be taking the lead on MDGs in the September UN conference in New York. It is vital that our Government, who have a broadly good record on this in the past, should feel able to speak out in direct language about the increased commitment, both political and financial, needed at the global level to take MDG 5 seriously.

1.24 pm

Baroness Northover: My Lords, I, too, should like to thank the noble Earl, Lord Sandwich, for securing this debate and for all his work in this area. As ever, this has been a debate with enormous depth and range. This is indeed a key time for us to be debating the MDGs as we are over half way through the period they are supposed to cover, and the G8 and the UN meeting in September on the MDGs are coming up. It is time for us to consider where we are going, whether we are on course to get there and where we might need to take urgent corrective action.

The MDGs are, of course, an artificial construct. The noble Baroness, Lady D’Souza, is right to emphasise that they need proper evaluation. Nevertheless, as the noble Lord, Lord Jay, pointed out, they are a useful set of targets. If we meet them, we will save lives, but if we miss them, people will die. They have helped to focus attention on what needs to be done to tackle poverty, streamline country strategy plans and co-ordinate donors, although we clearly have a long way to go in all these areas.

Underlying all the MDGs is, of course, the relief of poverty. There are some welcome developments and perhaps they point to how best to take things forward. Hundreds of millions of people have been pulled out of poverty over the past 10 years in China and India alone, although hardly because of focus on the MDGs. Challenges remain even in those countries where significant numbers of people remain in absolute poverty, as the noble Baroness, Lady Verma, pointed out in the case of India. This has promoted other concerns, such as the environmental consequences of rapid industrialisation and the growth of urban poverty, both of which were experienced in Britain in its own industrial revolution, though not on the scale of what we are currently witnessing.

As my noble friend Lord Chidgey pointed out, there is a risk of a whole continent, Africa, being left behind. Many of the bottom billion, to use Paul Collier’s expression, are there, as the noble Lord, Lord Hannay, pointed out. However, Myles Wickstead, lead author of the Commission for Africa report, argues that we should be encouraged that some of the conditions necessary for progress towards the MDGs, such as

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better governance and peace and security, have already started to feed through into significant economic growth in some parts of Africa. The noble Baroness, Lady Young, rightly gave us hope in this area. As the noble Lord, Lord Graham, pointed out, many noble Lords are playing a key role in this field.

That said, none of the MDGs will be met in sub-Saharan Africa if current trends continue. One-third of sub-Saharan Africa’s population is malnourished and, without decisive action, one in six people globally—almost one billion people—will still live on less than a dollar a day in 2015 according to the UN. The risk to us all is clear. Poverty and unrest in one area of the world help to destabilise others. It is in all our interests to address these problems, as the noble Lord, Lord Hannay, pointed out.

How can we generally promote progress? There is a new and encouraging focus on social provision, which is an interesting development. After all, as Britain industrialised, a welfare safety net was put in place at the beginning of the 20th century with pensions, unemployment and sickness benefit that helped to underpin further development. We already know how microfinance transforms the situation of many poor women and their families, and social protection programmes, now recommended by the World Bank, mean that hunger is reduced and children are more likely to be in school. Families prioritise first survival and then their future interests by educating their children.

However, it is not just money. Gender equality is key, as the noble Baroness, Lady Prosser, emphasised. Educating girls improves the position of families, and encouraging the exercise of reproductive rights is central to the empowerment of women, as the noble Viscount, Lord Craigavon, said. The noble Lord, Lord Patel, gave a moving account of the terrible and needlessly high levels of maternal morbidity and mortality. Addressing this needs a great deal of political will, and I am not yet convinced that DfID through and through, as opposed to in particular parts, fundamentally realises how important this is. I welcome the Minister’s comments.

What are the areas of particular risk? What, besides the lack of will and resources, may undermine future progress towards the MDGs? The fragility of states, civil war and bad governance are fundamental, as the noble Lord, Lord Hannay, the right reverend Prelate the Bishop of Winchester, and others have said.

There are three areas that I should like to highlight: HIV/AIDS, climate change and the scarcity of resources and increasing food prices. There may be 10 years between infection and death, so we cannot yet know whether the AIDS epidemic has peaked. We are all now well aware of the devastating impact on societies—children left without parents and economic and social breakdown—that results from the AIDS epidemic. HIV/AIDS will never be adequately combated without addressing gender inequality. It is not surprising that AIDS in sub-Saharan Africa is becoming particularly a disease of young women.

The G8 pledged universal access to prevention, treatment and support by 2010, including prevention of mother-to-child transmission, paediatric treatment

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and assistance to orphans and vulnerable children, but, with less than two years to go, more than 70 per cent of people are not receiving such treatment. Only 11 per cent of women are receiving treatment to prevent mother-to-child transmission. The noble Lord, Lord Patel of Bradford, emphasised the importance of that in the case of the child to whom he referred.

Will the G8 Governments provide a comprehensive plan with annual funding pledges to meet those commitments, and what are the UK Government doing? When does DfID plan to publish its new AIDS strategy, which has been repeatedly delayed? What can the noble Baroness tell us about current DfID thinking on that? The noble Lord, Lord Crisp, and others, pointed to the extremely important need to strengthen health provision, training and retention of staff. I look forward to hearing the response of the noble Baroness in those areas.

As the right reverend Prelate the Bishop of Southwell and Nottingham and the noble Lord, Lord Joffe, pointed out, we are just waking up to the potential impact of climate change. We now realise that not only is this a global problem, it is the poorest people who are likely to suffer first and most. Livelihoods in the poorest countries are often dependent on subsistence agriculture. It does not take much to knock that off course and for starvation to follow. As International Alert argues, the hardest hit by climate change will be people living in poverty in underdeveloped and unstable states with poor governance. The pressures in those societies are already very great. Add another, and some may reach breaking point. The background of poverty and bad governance means that many of those communities have a low capacity to adapt to climate change and face a high risk of violent conflict. Climate change will wipe out some of the gains made in the fight against poverty if urgent action is not taken.

I want also to consider what appears to be another downside of development: price increases, especially for such basics as food. That is surely partly the result of welcome improvement in the standards of living of populations in China, India and elsewhere, but which, without further agricultural development, will mean that those on the outside—that bottom billion—will be further marginalised. Do the Government think that the World Food Programme is capable of handling the immediate crisis? What proposals do they have for its reorganisation so that it can better tackle new crises? What research will be needed into agricultural production, and what role will the UK play so that the poorest countries can support themselves? What are we doing through the EU, the world's largest aid donor, in this and other regards?

In the 1960s, the development of Asia was despaired of. It would never develop, not least because it had the wrong religions. Africa often causes despair now, yet we see some hopeful, but very fragile, signs of development. We now need to be looking beyond 2015. What will take the place of the MDGs? Promoting good governance and the expansion of trade is surely as important as promoting aid giving. I challenge the noble Baroness to outline what she sees as the most promising trends in both delivering the MDGs and

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going beyond 2015 to bring that bottom billion in from the margins and out of extreme poverty. That extreme poverty is both a threat and an affront, which is why this debate and actions resulting from it are so timely.

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