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Secondly, there is a growing emphasis on human resources and training more health workers in Africa. It is equally important that eye health is part of this, not separate. Training is needed from the most local level of community worker to deal with the most local issues to the specialist. There are a lot of innovative models of mid-level workers in eye care. Thirdly, greater prominence should be given to disability in DfID programmes. Education, employment and rehabilitation need to be addressed to achieve all the millennium development goals. Disability is implicated in, if it is not the cause of, at least 20 per cent of world poverty. These are the three big issues for mainstreaming: ensuring that primary care policies relate to eye health; ensuring that human resources policies relate to eye health; and giving disability greater priority.
Finally, I ask that DfID looks again at its whole support for eye health and Vision 2020. A good start might be a meeting with the Minister and the IAPB-I do not think that this has happened yet but, if it has, it has not happened recently-to demonstrate how seriously committed the Government are to this and to mainstreaming.
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Let me end on hope. This is a big problem, but there are solutions. Most of these conditions are treatable or preventable, and treatment can have quite a quick impact. There is a great deal of interest in this, as shown by those noble Lords who are speaking in this debate, as well as support from the corporate sector in the form of the Standard Chartered Bank and from the WHO. Eye health organisations are also well organised, and we want even clearer government policy working alongside us.
6 pm
Lord Low of Dalston: My Lords, in my maiden speech in this House, I described blindness as one of the severest disabilities and suggested that, considering the critical role that sight plays in enabling us to interact with our environment, couching everything in terms of disability is unhelpful because it obscures the central importance of sight. There is now a pressing need for blindness to be placed higher up the political and social agenda. It therefore gives me great pleasure to be the first to congratulate my noble friend Lord Crisp on bringing these matters to wider attention today and on having secured this opportunity to set out his stall in an already overcrowded marketplace. I am sure all noble Lords will agree that it was an impressive presentation. I am only sorry that I missed his first few sentences in the commotion of the albeit seamless changeover from the previous debate.
In my maiden speech I talked about the domestic agenda, but the problems in the developing world, although not exactly the same, are if anything even more pressing. I therefore join others in paying tribute to organisations, such as Sightsavers International, the Christoffel Blindenmission and the IAPB, which are attempting to tackle them. At a time when it is difficult to find anyone with a good word to say about bankers, it is good to learn that the Standard Chartered Bank is putting so much of its considerable weight behind such endeavours. As my own organisations, the RNIB and Skill, are less active internationally, I do not have quite so much of an interest to declare this afternoon.
It is also very gratifying, as my noble friend has said, to see such an impressive turnout for this short debate. When such an impressive list of speakers is so obviously seized of the issues, it is clear that the message is getting through. I am sure that the Government have got the message; I just hope that the debate will reassure them that they have the support that they need to give this priority, and that it will give them some pointers on how this can be done most effectively.
After the formalities, which are important, it is not possible to say very much of substance in four minutes. I want to make just two points within an overarching framework of rights. Where blindness cannot be prevented, it behoves us to have particular concern for the rights of those who are left to grapple with it. Two of the most important of these are the right to education and to information in a form in which people with little or no sight can access it.
On education, 6 million children worldwide are living with a disabling visual impairment, 80 per cent of them in under-resourced developing countries. Of these, more than 90 per cent-4.4 million-receive no education at all. In 1990, the Education for All programme
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The funding for EFA comes largely from developed countries, so those countries should be asking why children with disabilities are still not being reached effectively by EFA and should be insisting that Governments which receive EFA funding should serve all children, including those with visual impairment. EFA-VI is an initiative led by the International Council for Education of People with Visual Impairment and the World Blind Union-I am a board member of both. The initiative will assist developing countries with technical advice and support to ensure that their EFA national plans include provision for children with visual impairment. Any support which the Government can give to this initiative will represent a very good investment of effort.
On access to information, efforts are under way through the World Intellectual Property Organisation to agree a treaty which will dismantle copyright barriers to the free flow of information between states in forms made accessible to the visually impaired. More than 100 countries have expressed support for such a treaty but some of the big players, like the United States and the EU, are digging their heels in. Any assistance which the Government can give to promote a more positive approach would be very welcome, and I shall be happy to give the Minister a full briefing if he would find that helpful.
6.06 pm
Lord Patel: My Lords, I, too, congratulate my noble friend Lord Crisp on securing this very important debate. I also put on record the great work that his charity, Sightsavers, does. I am pleased to say that a charity of which I am a trustee is pleased to support it year on year. I agree with all that has been said about the burden of blindness and the loss of visual acuity in the developing world. I have seen it at first hand most recently in Cameroon, where 50 per cent of the villagers were blind from black flies attacking their sight.
However, in the few minutes available to me, I would like to speak about the issues we face in our country. One relates to retinopathy of prematurity. In the previous debate we discussed the incidence of cerebral palsy in babies born prematurely-10 per cent of births are premature. Retinopathy of prematurity is emerging as an important cause of visual loss and sometimes blindness. Retinopathy of prematurity is one of the few causes of childhood visual disability which is largely preventable. Many extremely pre-term babies will develop some degree of retinopathy. Although, in the majority, that will never progress beyond mild disease, in some it will become serious and occasionally cause blindness. In the previous debate, the Minister said that the Government have just launched a strategy for neonatal care and I hope that it includes screening of all births in the United Kingdom before 32 weeks, checking for retinopathy of prematurity. That would certainly reduce the incidence of visual impairment in those children.
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Next, I want to focus on diabetic retinopathy. We know that the incidence of obesity and, therefore, diabetes is rising; 30 per cent of our population now has a BMI-unfortunately, including me probably-greater than 30. The incidence of diabetic retinopathy is 5 per cent; 2 per cent of people with diabetes develop blindness after 15 years and 10 per cent develop severe blindness, apart from other things such as hypertension. Diabetic retinopathy is a well recognised complication of diabetes mellitus. Well conducted clinical trials have shown that good control of diabetes and hypertension significantly reduces the risk of diabetic retinopathy. Good services, which provide not only better glucose control for diabetics but rigorous screening for diabetic retinopathy and early detection of it, will reduce significantly the burden of eye problems.
I turn to age-related macular degeneration. As the name implies, it is a common cause of reduced vision in the United Kingdom and it occurs in 30 per cent of people over the age of 60. Probably some of us here today suffer from the condition. Unfortunately, there is no immediate treatment or cure. We require greater research and identification at an earlier stage of development of the disease, because it has been shown that early detection will reduce further deterioration if treatment can be started earlier.
I am pleased to say that recently the first phase of a four-year clinical trial of the use of embryonic stem cells has been launched by MRC and the California Institute of Regenerative Medicine. The trial shows great promise. I have addressed three issues and finish by echoing what the noble Lord, Lord Crisp, said.
6.10 pm
The Earl of Sandwich: My Lords, I, too, thank my noble friend for highlighting one of the most urgent priorities in development assistance. It is not often mentioned in Parliament. I still remember the relief felt by aid agencies when onchocerciasis in Africa was all but conquered. Surgery and medicine have made many advances, and there have been victories along the way; but the combination of disability and poverty described by the Indian novelist Rohinton Mistry is almost unimaginable for us.
I am most grateful to Vision 2020 for its briefing, which helped me to see the facts more clearly. For example, as much 75 per cent of blindness is avoidable. I had not realised that cataracts are by far the most common cause of blindness. I knew that successful operations take place daily to tackle the 15 million or so cases worldwide every year. In the poorest countries, the operations do wonders for the beneficiaries. A survey in Madurai, for example, found that 85 per cent of males and 58 per cent of females who had lost their jobs as a result of blindness got them back again.
The underlying case of blindness is poverty. It is estimated that children born in the world's poorest regions are four times more likely to suffer from blindness than those born in higher-income countries. Conditions associated with childhood blindness, such as measles, rubella and vitamin A deficiency, are also causes of child mortality, and they are preventable. It is a sad
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Many charities are combating blindness, and some smaller ones achieve huge results. The Fred Hollows Foundation has reached thousands in Nepal. One agency for which I have great respect is Sightsavers. I will give an example of its work last year in India. Its local partners treated more than 1.9 million people for sight-related problems. They performed 115,000 cataract operations and provided rehabilitation training for more than 3,000 people with irreversible blindness or low vision.
Rehabilitation is an essential part of the agency's work. One agency related to them, Jana Jagarana in Orissa, tells of a boy called Ravi Nayak who asked his carer, "Aren't you going to be helping me any more?" She was in difficulty, but replied firmly, "Since you are capable of doing things on your own, I should spend more time with those who need me". She gradually reduced her visits to him, but the agency has since helped Ravi with capital to start a cycle repair shop, and offered to send him for vocational training. He is apparently now happy and planning his future.
I end with a short song from a Vietnamese girl in Saigon known to Save the Children whose mother was poisoned by Agent Orange. I will never forget her story, which I have no time to recount now. She sang:
"I dream of seeing the colour of the treesOf seeing the home where I might liveOf seeing the mountain with its waterfallI dream of seeing my mother's smile"6.14 pm
Lord Bilimoria: My Lords, the unfortunate reality is that levels of poverty are higher among the blind than among those suffering from any other disability. We are all grateful to the noble Lord, Lord Crisp, for securing a debate in this crucial area. Vision 2020 has been a shining example of how partnerships-and in particular public-private partnerships-can be so effective. There is no better example of this, as noble Lords mentioned, than the Seeing is Believing campaign launched by Standard Chartered Bank in 2003. What a difference it is making.
We are also fortunate that we have with us my noble friend Lord Low, who is such a tremendous inspiration to us all in the amazing work that he has carried out with the RNIB, which he led for so many years. I have personally seen the power of public-private partnerships in founding the UK India Business Council, which is supported by UK Trade and Investment-the Government working together with business in promoting the UK-India relationship.
India, which was mentioned by the noble Earl, Lord Sandwich, has the highest population of visually impaired people in the world by far. One-third of the world's blind people live in India. A study performed by the Prasard Eye Institute in my birthplace of Hyderabad at the turn of the millennium calculated the direct and indirect economic loss due to blindness in India at $4.5 billion per year. To put that figure in perspective, in the year of the study, it would have cost a tiny fraction of that to treat all the cataract cases in India.
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I have seen in India institutions such as the Happy Home and School for the Blind in Mumbai, run by the inspirational Meher Banaji, and the amazing, positive impact that they have. Childhood blindness accounts for 28 per cent of the lifetime economic loss. Those children are robbed of a start in life, their disability hindering their primary education and with family members coming to stay at home as caretakers, poverty becomes a real prospect. An investment in developing nations and in their children is an investment in the future, and the future of the children.
The problem of disability, and, more specifically, blindness, not only causes hardship at the level of the individual but has a domino effect. The scope of that knock-on effect is hard to grasp. As the noble Lord, Lord Crisp, said, 90 per cent of those living with blindness live in low-income countries. We can see how real the effects are. It is not only the blind who feel the desperate grip of hardship, but the families of the blind and the communities in which those families live.
Access to healthcare is a human right and there is no question that under that principle, every possible action should be taken to ensure that those living with impaired sight are given the treatment that they need. If that is not incentive enough, the global economic burden of blindness is shocking. The global impact due to low vision and lost productivity was estimated at $42 billion in 2000. In the UK, once you reach the age of 40, an annual glaucoma test is provided free, funded by the Government. Just imagine how many unnecessary cases of impaired sight could be avoided if that were available in developing countries throughout the world.
In our work at the UK India Business Council, we have realised, with British companies working in India, that corporate social responsibility is not a nice thing to do, it is a must. I believe that, through the power of government, and governments working together with the private sector and NGOs, we can eliminate unnecessary blindness forever throughout the world. I urge the Minister and the Government to do everything that they can to make that a reality.
6.18 pm
Lord Joffe: My Lords, most of what I wanted to say has already been addressed more eloquently by other Peers, especially by the noble Lord, Lord Crisp, whom I congratulate for introducing the debate. I intended to quote something that he stated in another report. At the risk of repetition, he said that there is a huge shortage of health workers globally and what is needed is a powerful and co-ordinated international response to address that shortage, with the developed countries, including the UK, supporting the scaling-up of training, education and employment of health workers.
The UK Government have made an important start with their initiative in Malawi, which provided $99 million over six years to address urgent health and human resource problems. This was a most welcome development and, combined with increased support for health from other donors, has produced some excellent results and is an indication of what can be achieved when such an investment is made. It showed
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As I have said, the relatively small expenditure of $99 million over six years on this initiative has made a huge difference and provided such an excellent return on the investment that I would suggest to the Minister that consideration should be given to reordering the priorities of DfID's aid budget so as to ensure that a greater proportion is allocated towards eye care services. We should bear in mind that this concerns about 300 million individuals in the developing world and the fact that with the increase in population and life expectancy, this problem could well get worse rather than better, despite all the progress that has been made.
6.21 pm
Lord Jay of Ewelme: I join others in congratulating my noble friend Lord Crisp on initiating this debate, and I, too, declare an interest, as chair of the medical aid charity Merlin, which I am glad to say works closely with Sightsavers in some of the poorest countries in the world, including Liberia, which I recently visited. The key point that struck me in my noble friend's opening remarks was that 80 per cent of the world's blindness is avoidable and can either be treated or prevented by known, cost-effective means. Some progress has been made, of course, but nothing like enough, and there is a real risk that without major and effective intervention, the number of avoidably blind people worldwide will increase rather than decrease as we approach 2020. That is why the Vision 2020 programme is so important.
I want to stress three or four points which put the issue of blindness into a broader context than just its treatment. First, avoidable blindness is best eliminated when eye health programmes are embedded in health systems and underpinned by effective government policy. Efforts to tackle blindness and visual impairment must be made within an approach that supports and strengthens national health systems. It is particularly important, as my noble friend Lord Crisp said, that that should be done at the primary healthcare level because it provides the best means of reaching the greatest number of people.
My second point was also made by my noble friend Lord Joffe: the importance of adequately trained eye care personnel and the lack of those staff, which is a sub-sector of the broader issue of the chronic lack of effective health workers in developing countries. My noble friend Lord Crisp has done a terrific amount himself on that, on which I congratulate him, but it is a crucial element in treating blindness.
Thirdly, disabled people, including blind people, are among those most affected by natural disasters and conflicts. Refugees with disabilities are among the most isolated, socially excluded and marginalised of all displaced populations, which means that efforts to respond to emergencies both acute and chronic must address the issue of people with disabilities.
Finally, but most important, is the fact that eye disease is no respecter of national boundaries. Initiatives such as onchocerciasis control are dependent on cross-border collaboration in political and health terms
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6.24 pm
Lord St John of Bletso: My Lords, I join in thanking my noble friend Lord Crisp for introducing this very important and topical debate. I would like to devote my allotted few minutes to addressing the problem of river blindness in Africa, where I have spent most of my life. A number of rather chilling statistics exist and one reads that more than 100 million people are at risk in 30 African countries, with almost 18 million already infected with the disease.
In researching for this debate I read the initiatives of Vision 2020 to prevent avoidable blindness. I was encouraged to read that between 75 and 80 per cent of the world's blindness is avoidable, 60 per cent is treatable and 20 per cent is preventable. I returned last week from a visit to Ghana where the health authorities have been fighting the scourge of river blindness for almost 50 years. West Africa, particularly Nigeria, has been worst affected. Despite treatment with ivermectin, concerns are growing that this crippling disease is endemic and may be developing a resistance to the drug. It is encouraging that its mass administration has been effective in preventing nearly 40,000 cases of river blindness a year, but that figure could be considerably increased with better management. I was pleased to hear that phase three trials have recently been launched in the Democratic Republic of the Congo, Ghana and Liberia to assess the effectiveness of moxidectin in preventing transmission from the worms that cause river blindness. It is also encouraging that scientists in Cameroon and Ghana have identified the first biological agent, a midge, which can be cultivated, that eats the pupae of the blackfly that cause river blindness. Like my noble friend Lord Bilimoria, I also support the work of public-private partnerships in preventing avoidable blindness.
I have always been a firm believer in prevention rather than cure. While it is unlikely that the scourge of river blindness will be eradicated, it is encouraging that there are cost-effective solutions to the problem. In a recent article on combating river blindness in Cameroon, my noble friend's charity, Sightsavers International, has estimated that for an average cost of just 5p, the drug ivermectin can protect an individual against the devastating effects of the disease for a whole year. However, 15 years of such protection would be needed because that is the period during which the river blindness bug stays in the system. Getting the treatment to remote communities and training people to distribute it is a challenging task. As most speakers have already mentioned, river blindness predominantly affects poor people in remote areas. In many cases, children have missed out on education because they are forced to stay at home to act as
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It is well known that lack of eye care can have a severe economic impact by perpetuating poverty or pushing a family into poverty. Clearly, effective and low-cost solutions exist to eradicate avoidable blindness. To this end, I wholeheartedly support the aims of the Vision 2020 initiative.
6.28 pm
Lord Dholakia: My Lords, we come to the concluding part of this debate. I thank all those whose contributions have highlighted the scale of blindness worldwide. I thank the noble Lord, Lord Crisp, for his excellent contribution, in which he set out the statistics.
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