I must also declare not just an interest in this matter but a very great enthusiasm because, like my noble friend Lord Goddard, I was at the start of what has become the first devolution deal for Greater Manchester, and it is a great pleasure to talk about it today. I pay tribute to all noble Lords who have made their maiden speeches. I am delighted that so many—my noble friend Lord Goddard, the noble Lord, Lord Scriven, and the noble Baroness, Lady Janke—have chosen to make them in this debate. All are from a local government background, which is great.

My noble friend Lord Shipley’s comments were very helpful and very constructive, as were those of many noble Lords. He talked first about not disempowering London. I think this is a crucial point. In the conversations that we were having in local government 10 or 15 years ago, we did have a bit of a tendency to whinge about how much London got and how we were so badly done to. I think the narrative has moved on in a far more mature way, to be not about how much London has got and how much it has grown—because, actually, that bodes well for all of us in this country—but how cities outside London can punch above their weight in terms of progressing growth and unlocking their growth potential. I think that was a very good point to make at this stage.

Many noble Lords, including my noble friend Lord Shipley, have talked about not creating city-states and about the link with the rural areas and the inner cities. As the noble Lord, Lord Adonis, said, we should all collaborate to create a better economic outlook for our country. My noble friend also talked about how this is not just about posting out cheques from Whitehall —if any noble Lord has studied the devolution deal for Manchester, that is very clear. It is based primarily on a proposition to government about growth, based on making better use of the funding that would be coming down to Greater Manchester anyway. It is about not just using it more efficiently but getting to the point where city regions like Greater Manchester are not recipients of public funds but actually become net contributors to the Treasury.

This is very much about accountability. Several noble Lords have asked, “Do we want a mayor? Do we have to have a mayor?” What I think the Government expect is a very clear accountability and leadership role. Certainly, in Greater Manchester, the advent of a mayor in 2017 is not going to create another layer of government. It was very clear that that was what Greater Manchester did not want, and in fact the Government did not want to create another layer of bureaucracy but to enhance what was already there, to create clear leadership.

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My noble friend Lord Shipley also talked about underperforming cities. The figures are stark when one compares the different regions of this country with the south-east. The north-west is the second most productive region outside the south-east, but its productivity lags behind by some £30 billion, and that figure is not shrinking, so something does need to be done. This is a radical proposition, but it will be done by increment. We hope it will help to enable areas outside the south-east to punch above their weight and to unlock their potential to do so and to shrink that gap.

My noble friend also asked about the government commitment to devolution to cities. I do not think there needs to be any greater demonstration of this Government’s commitment to devolution to cities, certainly in starting with Greater Manchester. I do not think that, by this time next year, every single city in the country will have a devolution deal; there needs to be a step-by-step process where this agenda is advanced. My noble friend also talked about the pace quickening. I would like to see a sort of point of no return, whereby—a hopefully successful—devolution to Greater Manchester paves the way for other cities and, indeed, rural areas to follow.

My noble friend also talked about responsibilities—I think we have covered this—and also about functional economic geography. Certain things have to be done at scale and across local authority boundaries. In fact, that already happens, as it did with the regional development agencies with things like transport. It is very difficult to deal with transport in a single local authority area, because it transcends authorities and authority boundaries. He also talked about Newcastle’s success and introduced what for me is a new term, “the boomerang Geordies”. I may be one of them, because I left Geordieland 30 years ago; I may return after my retirement—I do not know.

My noble friend Lord Lyell talked about his walk through Liverpool in November 1967 and about the renewal that it has enjoyed. He talked in particular about the port and the waterfront. I declare an interest, which is outlined in the register, in that I was executive director of Atlantic Gateway. There is no doubt that the recent developments of the superport in Liverpool, which is being developed in response to the expansion of the Panama Canal, will provide a fantastic post-Panamax terminal that will be able to receive those massive vessels that will cross the world. It will enable round-the-world shipping again and a huge potential in logistics and distribution and, going back to some of the papers that have been produced in the last few months, it will very much enable those east-west links to be taken forward.

My noble friend also talked about private sector employment. He mentioned Halewood and the Range Rover Evoque; if he has been there recently, he will have seen them all lined up, waiting to be shipped off. I understand that you now have to wait six months for a Range Rover Evoque, such is the demand for them. However, it also has such great potential to revitalise that area of Liverpool and indeed the whole Liverpool city region.

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My noble friend also talked about the Liverpool waterfront, which is the most wonderful asset—Liverpool is so lucky. As somebody—I think it was Noel Gallagher —once said, “Manchester’s got everything apart from a beach”, and it is true. Manchester has plenty of assets, but Liverpool has that beautiful waterfront. He also talked about governance. Here I pay tribute to Mayor Joe Anderson, who has shown such strong leadership in Liverpool, and to how Liverpool and Manchester work so brilliantly together to take forward that whole agenda for growth in the north-west.

The noble Lord, Lord McKenzie, talked about not allowing the Treasury to stymie progress. The proposition between local government or groups of local governments and the Treasury has to be crystal clear so that there is no room for manoeuvring as regards what was promised and what was promised to be delivered. As far as I know from Greater Manchester, which was the first deal to be done, the expectations and the expectations of the outcomes are very clear. The noble Lord also talked about how local authority cuts hit the poorest most. In fact, as I said in answer to a question the other day, the bottom 10%—in terms of the most deprived local authorities—receive on average 50% more money, so I must disagree with him on that. He also asked whether any area will be allowed devolution. There is a challenge to groups of local authorities to put forward propositions to government, and I think that the Government do not rule anything out as regards what they want to see put before them. As far as I know, there is no bar to propositions going to government.

I come to my noble friend Lord Goddard. I would say that we were “partners in crime”, but I do not mean that. We served on the Association of Greater Manchester Authorities for some time, both as deputy leaders, and we led the journey to become a combined authority that took place in 2011—I had gone by then, but he was still there. In his very amusing maiden speech he also talked about going to the wrong Benches. I nearly did that, but realised my mistake when I did not recognise any of the faces on the Labour Benches. He talked about the collaboration we enjoyed. That collaboration, which was mentioned by the noble Lord, Lord Adonis, and other noble Lords, has been absolutely essential to our getting where we are today. We would not be here if we did not collaborate.

Another noble Lord made a very good point, which I want to bring out. I think it was the noble Lord, Lord Graham of Edmonton—

Lord Graham of Edmonton: Yes, it was.

Baroness Williams of Trafford: It was, and there he is. He talked about a common purpose, and having sometimes to swallow the fact that you do not get everything that you want. That has been key to how we have worked together. If there was ever a handy tip I could give local authorities that wanted to achieve devolutionary status, it would be that: collaborate, co-operate, allow for the fact that you might have to compromise slightly, but you will get there in the end.

My noble friend Lady Eaton talked about skills and about local areas being best placed to respond to local need. That is crucial in devolution deals, and it is interesting that skills were mentioned in the first devolution deal we got. If local authorities do not engage both

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with employer need and therefore with those learning institutions, those skills will just not be there and we will have to import them from elsewhere, whether that is from home or abroad.

I am very conscious that I am running out of time and that I am not even half way through what I wanted to say. The noble Lord, Lord McFall, I think, made a point about the Glasgow and Clyde Valley city deal, which I think is one of the largest ever under the city deals—we wish it well.

I pay tribute to my noble friend Lord Scriven’s maiden speech. It was uncontroversial, coming from a controversial man, as he promised us he is, and a young man—you sometimes feel very young when you come here. He mentioned the Sheffield city deal, which we wish well.

I will just try to pick up on some more points. My noble friend Lord True talked about avoiding faddish political structures in bringing forward devolution. I totally agree with that; to come back to a point I made earlier, Greater Manchester was very much against doing that—I realise that I am now completely out of time. I thank noble Lords who have taken part in this debate—

A noble Lord: Two more minutes.

Baroness Williams of Trafford: Oh, I have two more minutes.

I totally agree with that, and in fact, Greater Manchester was very clear that it did not want a layering-on of structure, so it has decided to go to the model of having an 11th leader until 2017, when it will elect a mayor, but it will still keep that core of 10 local authority leaders. The noble Lord also asked about the imposition of local structures. That is not true in the sense that, as I have said, it is a proposition to government; whether it is agreed or not will be the result of a dialogue between local authorities. Therefore nothing will be imposed upon anyone unless they want it.

The noble Baroness, Lady Armstrong, talked about being born in Sunderland. I was brought up in Hetton-le-Hole, so we have more in common than she thinks. You could not vote Tory there if you wanted to, because—well, they did not want to. The noble Baroness also talked about the size of the state and asked a crucial question about where we want it to lie. I think that trust has to be given by central government to local government. It is no small wonder that central government have taken what is probably the best and most worked-up proposition forward first. Hopefully, that will lead incrementally to such trust being built up between central and local government. The coalition are a Government who want to decentralise, not to create more state intervention—the noble Baroness clearly does not agree with me there. She talked about the back of a fag packet. This is not the back of a fag packet; it has taken years.

But I realise that my time really is up now. I thank all noble Lords, and I will write to anyone whom I have not answered fully.

The Deputy Speaker (Baroness Fookes) (Con): My Lords, the time allowed for this debate has now elapsed, and I must put the Question that the Motion be agreed.

Motion agreed.

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AIDS, Tuberculosis and Malaria

Question for Short Debate

2.10 pm

Asked by Lord Fowler

To ask Her Majesty’s Government what action they are taking to support the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Lord Fowler (Con): My Lords, one of my major purposes in raising this short debate is to emphasise a crucial point about public health across the globe. Currently there is vast concern about Ebola, and rightly so. It must be met with all the resources at our disposal. But at the same time we must not forget the even greater challenge posed by the three diseases that the Global Fund was formed to fight—AIDS, TB and malaria.

The figures for deaths tell their own story. In 2013 an estimated 1.5 million people died from HIV/AIDS; 584,000 people died from malaria, and an additional 1.1 million people died from tuberculosis. The burden is heaviest in sub-Saharan Africa, where an estimated 90% of all malaria deaths occur, and—this is perhaps the most disgraceful statistic—in children under five. So, currently, three diseases account for more than 3 million deaths a year, to add to the mountainous totals over the past 25 years. AIDS is an example: the death toll so far is 35 million people. In addition, 36 million people are living with HIV, and in 2013 almost 200 million cases of malaria, and 9 million new tuberculosis cases, were detected.

Having said that, I do not want to downplay or understate the progress made, or the vast contribution that the Global Fund, and the President’s fund from the United States, have made. Without them the world would be in even greater crisis. The latest figures for the Global Fund show that 7.3 million people are on antiretroviral therapy for AIDS. It has tested and treated, or helped to test and treat, more than 12 million people for TB, and has distributed 450 million insecticide-treated nets to protect families against malaria. We have therefore made vast progress since those dismal and tragic days in the 1980s, when AIDS patients died and there was absolutely nothing we could do about it. I pay tribute to the clinicians, the nurses, the volunteers, and all those working for NGOs, throughout the world, who have made this progress possible.

Now we come to what is perhaps the most difficult challenge for any Government. In spite of the progress made, much more needs to be made, and it needs to be made urgently. As UNAIDS says in its latest report, only about three-fifths of countries have risk reduction programmes for sex workers, and 88 countries report that fewer than half of men who have sex with men know their HIV status. Most countries fail to provide drug substitution therapy, or access to sterile needles and syringes for people who inject drugs—even though that is something we started in this country back in the 1980s. Again, most disgracefully of all, antiretroviral treatment for children lags very substantially behind that for adults.

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Not all the steps to combat these factors imply increased financial help. If the 80 countries that currently—and disgracefully—criminalise homosexuality were to reform that policy, we would take a massive step forward and reduce one enormous barrier to testing and treatment around the world. There is no question but that that could have a profound effect. I very much hope that in this debate the Government will underline their determination and commitment to do as much as they can to persuade those countries to reform their legal processes.

Just as certainly as that, sustained and increasing financial help is necessary from the nations of the world. Here I pay tribute to the Government for honouring the important pledge, made by Andrew Mitchell when he was Secretary of State for International Development, to add a further £0.5 billion for the Global Fund, as long as other nations join in. There is a slight question about that at the moment, because the total aimed at has not been reached.

Having just praised the Government, if I had a criticism of them it would be that that message about the increased aid should be made loud and clear. At the recent international AIDS conference in Melbourne, where there were Ministers and civil servants—it is by far the most important meeting in the AIDS calendar—we could manage no Minister or civil servant from DfID, and as far as I know, unless he attended very secretly, no British high commissioner. And that was in a Commonwealth country. We need to explain to the world what we are doing and why, and not allow other countries to paint us in terms of the British policy of the Victorian years.

I shall make one last point. With AIDS, antiretroviral drugs have saved millions of lives, but I wonder whether we should put all our eggs in one basket. I believe we should take heed of the warning given today by the review of drug resistance set up by the Prime Minister. Drug resistance can have a profound effect on HIV, TB and malaria. According to Jim O’Neill, who headed the review, drug-resistant infections already kill hundreds of thousands of people a year globally, and by 2050 that figure could be more than 10 million.

There will be further reviews, and I see that it is said, and emphasised, that the role of vaccines to prevent infections, in particular, will be examined. I declare an interest at this point, as a board member of the International AIDS Vaccine Initiative, a non-profit organisation, based in New York, dedicated to developing a vaccine for AIDS. It has been consistently supported by both parties—although this Government’s recent decision to cut help from £10 million a year to £1 million a year in one slash has not exactly helped. I could say more, but I will not, unless I am provoked, because the point I am making is a rather broader one than that.

Vaccines can take, and almost always have taken, decades to develop. This is not necessarily a natural area for Governments, with their four-year time limits—and perhaps even less so for Ministers, whose time limits are usually rather shorter than that. That is why it is so significant that the President’s fund in the United States, which obviously has a much longer timescale, is now devoting a small part of its substantial resources to research into prevention and vaccines.

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That is an extraordinarily important move and underlines the importance of prevention. Following that, I wonder whether the Global Fund should not do exactly the same thing and provide a more certain source of finance as well as underlining the crucial importance of prevention as well as treatment. That is the point about moving in that direction.

The Global Fund has made amazing progress but it is dependent on government resources from and around the world. The message for all those Governments is: for goodness’ sake, don’t stop now, for we are dealing with three of the main killer diseases in the world today.

2.20 pm

Lord Cashman (Lab): My Lords, I thank the noble Lord, Lord Fowler, for initiating this extremely important debate and, indeed, for his long and distinguished record on these very important issues.

The Global Fund is a 21st century partnership. It works because it combines Governments, civil society, the private sector and people affected by these diseases. The genuine nature of this partnership ensures that there is unquestionable success. We should be proud that the UK contributed £1 billion to the fund in December 2013. This contribution will save a life every three minutes.

HIV/AIDS, TB and malaria disproportionately affect certain groups known as key populations. Despite progress within general populations accessing antiretroviral drugs for HIV treatment, key populations are being left behind in terms of access. TB disproportionately affects those working or living in overcrowded conditions, such as prisoners and labour migrants, particularly mining communities in South Africa. Also at risk are people living with HIV. They are over 20 times more likely to develop TB, and one in five AIDS deaths is from TB alone. HIV poses an increased risk to groups including young women, men who have sex with men, transgender people, who are often forgotten, injecting drug users, those in prison, migrant or mobile workers and sex workers.

Recently, the excellent report of the All-Party Parliamentary Group on HIV and AIDS, Access Denied, published last week, highlighted as a key issue the lack of political prioritisation of key populations. Problems happen, particularly in so-called upper middle income countries, when global funders withdraw support and this happens before domestic Governments are able to pay market prices for antiretroviral drugs. So, will the Government encourage the Global Fund to reassess its decision to withdraw funding from key population groups in middle-income countries unless there is clear evidence of how funding for services and treatment will be provided to key populations? Will the Government pledge to work with the pharmaceutical industry and multilateral organisations to make newer and more effective ARV drugs available and affordable to all, including marginalised populations and people living in middle-income countries?

The sad reality is that HIV/AIDS, malaria and TB do not discriminate. HIV/AIDS is the leading cause of death among young women of reproductive age in Africa, and the region’s young women are twice as likely to contract HIV as their male peers. This is

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partly due to their unequal status, which constrains women’s ability to negotiate condom use. It is therefore vital to develop a range of HIV prevention tools that can be used by diverse populations, such as female-initiated microbicides. Will the Government continue their support for product development partnerships and other approaches that are developing products targeted at such groups as women in low-income countries?

As I said earlier, sex workers are also at great risk from an increased number of sexual partners, greater exposure to sexual violence and the economic incentive to offer unprotected sex. Will the Government pledge their support for promoting health services and harm reduction globally as the most effective approach for addressing HIV and other diseases among sex workers and drug-using populations?

Much has been said in earlier debates about men who have sex with men, but the sad truth is that they are 13 times more likely to be living with HIV than the general population. The current slide towards criminalisation in certain countries of people accessing HIV services does no good whatever. These include countries within the Commonwealth, such as Uganda, where a Bill is pending. Therefore, I would be interested to know what the Government are doing to promote—we have to promote this; we cannot impose it—a change of direction as regards homosexuality within these countries. Will they follow the recommendation of the report of the All-Party Parliamentary Group on HIV and AIDS to significantly increase the funding of advocacy groups within these countries that need the resources, such as the Robert Carr network or the Stop TB Partnership?

Finally, and probably most importantly, will the Government desist from trying to prevent the Global Fund working in so-called middle-income countries, where the poorest and marginalised are those most in need and where the Global Fund must continue to work if we are to eradicate malaria, TB and HIV? Make no mistake, the weight and influence of the UK on the Global Fund board is significant. Many middle-income countries are facing a perfect storm of bilateral donors and the Global Fund pulling out of funding very rapidly before national Governments have the time, support or money to replace essential HIV funding and programmes. I thank noble Lords and look forward to the noble Baroness’s response to my questions.

2.26 pm

Lord Chidgey (LD): My Lords, I add my congratulations to the noble Lord, Lord Fowler. I also congratulate him on consistently pursuing these issues and the work he is doing month after month, year after year. We owe him a great debt for that. I applaud the remarks made by the noble Lord opposite on middle-income countries and the Global Fund. I cannot remember his name. I do not watch television. You know where I am coming from. The noble Lord raised an important issue. In that context, we should remind ourselves that the Global Fund is a 21st century partnership designed to accelerate the end of the AIDS, TB and malaria epidemics. It is a partnership between Governments, civil society, the private sector and people affected by the diseases. The genuine nature of the partnerships it fosters is critical to the fund’s successes.

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The Global Fund mobilises and invests nearly $4 billion a year to support programmes run by local experts in more than 140 countries. Following on from the points made by the noble Lord, Lord Fowler, thanks to the Global Fund, 7.3 million people are on antiretroviral treatment, 1.3 million of whom have been put on the treatment this year. Some 12.3 million people have been tested and treated for TB, 1.1 million of whom have been tested this year. Some 450 million mosquito nets have been delivered, 90 million of which were delivered over the course of this year. This has contributed to tens of millions of lives being saved in the decade since the Global Fund was founded. The Global Fund has set a number of goals in relation to its work on HIV, TB and malaria. These goals are due for delivery in 2016. It has already achieved 100% of its HIV goal, 115% of its malaria goal, but only 58.5% of its TB goal. The fund provides over 80% of international financing for TB, over 20% of all HIV funding and 50% of global malaria spend. As the noble Lord, Lord Cashman, mentioned, the UK contributed £1 billion to the fund in December 2013. This contribution will save a life every three minutes.

I want to talk a little about the UK Government’s pledge. They made a renewed commitment to Gavi to invest up to £200 million a year for the period 2016 to 2020 to ensure that 76 million children can access life-saving immunisation programmes. The UK’s contribution will save another 1.4 million lives and will help Gavi to move closer to its overall replenishment target of—would you believe?—$7.5 billion.

Despite the shift in the burden of disease, and indeed the population, from low to middle-income, funding allocations from the Global Fund appear to be moving in the other direction, as the noble Lord, Lord Cashman, mentioned. The application of new funding methodology in Kyrgyzstan—a country with significant HIV and TB burdens—has resulted in an almost 50% cut in total funding for HIV prevention and treatment. Funding for HIV and harm reduction programmes in Ukraine is predicted to fall by about $30 million from 2014 to 2015, on top of a 71% reduction in domestic funding for the HIV epidemic.

Another eastern European country, Romania, was allocated no HIV funding for 2014-16 because it was perceived that there were no political barriers to providing services for people living with infectious diseases, and there is no political will for funding harm reduction. Despite countries having greater GDP, it does not necessarily mean that they are choosing to invest more resources in disease-control programmes. I cannot say this loudly enough: a reduction in Global Fund support can result in the closure of key programmes. That threatens a resurgence of disease in countries where there has been a general reduction in rates over recent years. HIV and TB are prevalent in middle-income countries in our neighbourhood. They are infectious diseases and do not respect national boundaries. Growth of these diseases in central Asia and eastern Europe could impact on the broader region. If we inadvertently facilitate a reduction of disease control in countries just because their GDP has increased to place them in a different World Bank income category, we risk a resurgence in the epidemics.

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Finally, I want to talk a little about DfID’s role. We must recognise that our Government, as a major supporter of the Global Fund, should be congratulated on the work they do. Accordingly, the UK has significant influence on the Global Fund board. DfID has made a move to close programmes in middle-income countries and focus its efforts on a smaller group of low-income and fragile states. We should be using our influence on the Global Fund to ensure that it continues to support programmes in countries that receive from few or no other external donors, and not try to influence the fund to focus its efforts on the same countries that DfID currently targets.

I hope that our Minister will commit to work with UK representatives on the Global Fund board and with the Global Fund to develop a more gradual taper of support for countries with increasing domestic resources. It is important to remember that access to treatment is still being denied to too many people, with a total of 29 million now estimated to be eligible. As a final quote, Michel Sidibe, the executive director of UNAIDS has said:

“HIV has transformed from a death sentence to a chronic condition”,

that is treatable, enabling millions of people to live long, healthy lives. However, this is far from enough to end AIDS by 2030, let alone ever.

2.33 pm

Lord Lexden (Con): My Lords, in political affairs there are always a number of things that cannot be repeated too often. As regards global health issues, it is impossible to overemphasise either the importance of the work done by my noble friend Lord Fowler over the past 30 years or the value of the leadership that he has provided and continues to provide to politicians across party dividing lines who have committed themselves to doing all they can to support those on the front line—the doctors, scientists, academic authorities, health workers and volunteers—leading a battle against three diseases, malaria, tuberculosis and AIDS, that wreak such havoc in large parts of the world today. Some of us taking part in the debate had the great good fortune to hear a few days ago from a number of experts who have dedicated themselves selflessly to releasing as many as they can from suffering and achieving immensely impressive results, particularly in Africa.

However, there are those who succumb to the illusion that the battle is far advanced and final success is in sight. My noble friend Lord Fowler is tireless in pointing out how much remains to be done. He has made that clear again today, as he did in his recent influential—and, I am sure, best-selling—book, in which he stressed the essential uncomfortable truth that we all need to bear constantly in mind. This is how he put it:

“The central problem that the world faces with HIV and AIDS today is this: it is the millions of people infected with HIV who, in spite of the medical advances and all the money poured in, remain untreated”.

There are millions of people united with us in the brotherhood of man who desperately need the treatment to hold their HIV in check but who are denied it.

That fundamental point was underlined in the authoritative report published on World AIDS Day last week by the All-Party Parliamentary Group on

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HIV and AIDS, referred to by the noble Lord, Lord Cashman. How welcome he is in this debate and the others that will follow. The all-party parliamentary group calculates that less than two-thirds of adults with HIV and three-quarters of the children living with it today are not receiving the treatment they require. Immense progress has been made, not least through the Global Fund, to which I, like other noble Lords, pay tribute, in extending access to the treatment that contains and controls HIV, and yet so much more remains to be done. The all-party report last week estimated that 55 million people will need HIV treatment by 2030.

It would be an immense tragedy if this country, which has made such a marked contribution to the progress so far, should falter now. However, without adequate funding our contribution is bound to falter, and the inimitably long period of experiment and trial needed to find an HIV vaccine will be extended further. That, I think, is the main cross-party message that this important debate seeks to deliver. Surely we cannot allow the defeat of pandemics that condemn millions to misery to be set back and weakened because of short-term factors in Britain connected with the coming general election. Rather, the main parties must stand firmly together, explaining, as my noble friend Lord Fowler constantly does, why the skills of our doctors and the breakthroughs achieved by our research scientists must continue to be placed at the service of mankind as a whole. We belong at the centre of the Global Fund, this remarkable international partnership that brings together Governments and the private sector.

The all-party report is entitled Access Denied. In her speech in response to it on World AIDS Day, my noble friend Lady Northover, who understands these issues so fully, referred to the need to address the numerous barriers that limit access to medicines. One of the most formidable of these barriers is the criminalisation of homosexuality in so many countries. In nearly 80 countries—too many of them members of the Commonwealth—it is a crime to be gay. In circumstances of such grotesque discrimination, gay people with HIV are not going to draw attention to themselves by seeking treatment, assuming that it is available. We have referred to this intolerable barrier to treatment—indeed, to simple human equality and dignity—often in our debates on global health and Commonwealth affairs in recent years. Like my noble friend Lord Fowler and the noble Lord, Lord Cashman, I believe that we should emphasise this again and again. The statistics are stark. In Caribbean countries where homosexuality is not against the law, of every 15 men who have sex with other men, one is infected with HIV. In Caribbean countries where it is a crime to be gay, the rate of infection is one in four.

It is, of course, the Commonwealth countries that are most prominent in our minds. They are closest to us, united by ties of kinship, friendship and history. The Commonwealth’s collective institutions produced clear evidence in 2011 that where homosexuality has been decriminalised, HIV infection had failed. To the infinite sadness of us all, that has not led to widespread reform, even though the criminalisation of homosexuality is plainly incompatible with the Commonwealth’s new charter, to which all its members nominally subscribe.

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Some Commonwealth countries glory in oppressing gay people, as we heard from the noble Lord, Lord Cashman, in relation to Uganda. As for the Commonwealth as a whole, does it want to be seen as upholding or blatantly ignoring fundamental human rights? It cannot dodge that question.

2.39 pm

Baroness Barker (LD): My Lords, I, too, want to thank the noble Lord, Lord Fowler, for today’s debate. It is an opportunity to thank this Government for their continuing commitment—a commitment started by the previous Labour Government—to funding for international aid. In times of austerity, there are those cheap political point-scorers who will say that international aid is a luxury which we cannot afford. They could not be more wrong. As today’s report on anti-microbial resistance shows, health issues are now global, and investment in the health of people in countries around the globe is an act of self-preservation for people here, too. Any political party that says it will cut foreign aid is not acting in the best interests of its own citizens.

That said, tackling these three big issues is very complicated. We have all sorts of different actors: academics, national Governments, researchers, scientists and not least the people themselves. By far the agents with the biggest impact are the global funders: the UK and the United States Governments are the biggest contributors to them. They have the most profound impact on what happens to everybody else.

I, too, want to echo the points that have been made by a number of speakers about the Global Fund’s current strategy towards middle-income countries. It is right that the Global Fund has gone through a process of refining its funding models. It is important that it should fund work in countries in ways which are compatible with the development of proper national health systems in those countries, including basic health systems, such as access to clean water. However, it is an unfortunate reality that, having gone at such a pace, the Global Fund is withdrawing funding from middle-income countries, such as Ukraine and Vietnam. It is having a devastating impact on those countries, not least on their marginal communities.

I want to echo what was said by the noble Lords, Lord Cashman and Lord Lexden: it is groups within those countries that can have the biggest impact on their own Governments. I would therefore encourage the noble Baroness to commit to working with civil society groups to achieve that. I say that because of the searing experience I had of standing in a top AIDS clinic in New Delhi watching a line of women queuing up for their HIV and TB treatments. They were among the most powerless people I have ever seen. Recognising that they are in the position that they are in through absolutely no fault of their own makes a compelling case not to abandon them, just because they live in a country the economy of which is increasing.

I am proud to be part of the group that produced the Access Denied report. It covers a number of matters in tremendous detail, not least the matters of intellectual property rights and TRIPS agreements. I am not going to talk about that in great depth today, but I would welcome the opportunity to do so some other time.

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The Global Fund, as noble Lords have said, is an important player when it comes to research. Underlying the whole of the work to deal with these diseases is the issue of research, funding for basic research, funding for translational research, and funding for new medicines. We had the experience in India of talking to generic manufacturers who explained to us, as the commercial people that they are, that there was no market for paediatric formulations for HIV. That makes it even more important that Governments and funds, such as the Global Fund, continue to make the sorts of structural investment over a long term which enables other people to maximise their efforts.

Noble Lords will know that in the last 50 years there have been no new drugs for TB. There have been loads of new drugs for allergies and so on, because they are diseases of the west and there is a market. In the case of drugs for TB, there largely is not a market. It is therefore really important that the Global Fund continues to fund research.

In answering the Question asked by the noble Lord, Lord Collins, on 1 December, the Minister made some remarks about the funding of research which have caused some alarm among the lobby groups and civil society groups that work in this area. Will she commit to meet a cross-party group from both Houses along with some of those groups so that we can talk about that?

I think that we all understand that, now more than ever, there is cause to be efficient and effective in the way in which resources are deployed, but there are some decisions that we need to take, not just for the present moment but for years to come, which will, I hope, bind future Governments. As the noble Lord, Lord Fowler, epitomises in his work, this is something for the long haul. Things that are for the long haul require exceptional political commitment. Will the noble Baroness make that commitment so that we can all rest safe in the knowledge that the investment which has been made over the last 30 years will not be lost?

2.45 pm

Lord Avebury (LD): My Lords, I begin by joining in the congratulations which have been expressed to the noble Lord, Lord Fowler, on his outstanding record over several decades campaigning against homophobia and for the eradication of HIV/AIDS. He continues with this work effectively here in your Lordships’ House, in his book, AIDS: Don’t Die of Prejudice, and in his many speeches and articles on what the world needs to do to eradicate a scourge that my noble friend rightly describes as the greatest public health threat in the world today.

The noble Lord rightly castigated the 80 countries that criminalise homosexuality and the noble Lords, Lord Cashman and Lord Lexden, mentioned Uganda in particular as having an anti-homosexuality Bill currently before its Parliament. It was not for this reason, I think, that we cancelled our budgetary aid to Uganda, but perhaps we ought to review our non-humanitarian aid to all the 80 countries to see whether any pressure can be brought to bear on them through fiscal means.

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As has been said, the Global Fund invests some $4 billion a year, of which the UK provides nearly £1 billion as its share. This is a cost-effective partnership, bringing together Governments, civil society, the private sector, philanthropists and patients affected by the diseases. It mobilises programmes run by local experts in 140 countries, avoiding duplication or overlapping.

As your Lordships know, HIV and TB are closely linked and TB is the leading cause of death worldwide for people living with HIV. Last year, the Global Fund provided that all applications for support from countries with high incidences of both diseases should present integrated programmes to qualify for assistance. This is a great step forward in the response to TB, because country HIV programmes have often been significantly more developed than their counterparts that address TB. TB patients will benefit from the greater resourcing, expertise and reach of country HIV programmes. For some reason, DflD currently does not integrate TB into any of its bilateral HIV programmes. This needs to change. I would like my noble friend, when she comes to wind up, to say that we will follow the Global Fund’s example by requiring recipients of our bilateral assistance for HIV/AIDS also to integrate their TB/HIV programming.

There is also a case for the co-ordination of delivery systems for malaria diagnosis and treatment with programmes for TB and HIV. The APPG on Malaria and Neglected Tropical Diseases points out in its latest report that,

“HIV and malaria frequently co-exist and the treatments most commonly used for each are now known to interact with each other”.

This would not be the case, I hope, with the first ever vaccine against malaria, RTS,S, developed over the last 20 years by GSK with additional funding by the Gates Foundation in one of the product development partnerships which are proving to be so successful in addressing the lack of commercial incentive to undertake R&D for vaccines, diagnostics and drugs for neglected diseases of the developing world. Does my noble friend the Minister think that we are likely to be able to eliminate these three diseases by 2030? On malaria, the APPG says that the Medicines for Malaria Venture has,

“the strongest anti-malaria … development pipeline that has ever existed”.

The rollout of the RTS,S vaccine before the end of the decade will be a significant milestone on the road to eradication. However, targets are needed for the post-2015 agenda, which is to be discussed shortly.

For HIV/AIDS, the fast-track approach of UNAIDS to ending the epidemic by 2030 is supported by a strong consensus, according to UNAIDS, which has identified headline intermediate targets for 2020. It recalls that African countries committed in the 2001 Abuja declaration to spend 15% of their budgets on health, but only six of them have met that commitment. Additional funding—the amount not specified—would be needed from donor countries; presumably, as the third-largest donor to the Global Fund, we are entitled to ask our EU partners to step up to the plate and contribute proportionately to their national income, as we do.

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In conclusion, I am sorry to note that there was not a word about DfID in the Chancellor’s Autumn Statement, still less any mention of our commitment to the Global Fund over the next five years as we embark on the post-2015 agenda. The fund’s three-year pledging cycle does not fit with our five-year Parliaments, but it would be useful to hear from my noble friend what Mr Osborne has pencilled in for the 2016 round.

2.51 pm

Lord Collins of Highbury (Lab): My Lords, I, too, thank the noble Lord, Lord Fowler, for initiating the debate. I also thank him for his lifetime commitment to the battle against HIV and AIDS, and, more importantly, against the prejudice and stigma that all too often hinder treatment and prevention.

The Global Fund mobilises and invests nearly $4 billion a year to support programmes run by local experts in more than 140 countries. As noble Lords have said, thanks to the Global Fund, 7.3 million people are on antiretroviral treatment. About 12.3 million people have been tested and treated for TB. Some 450 million mosquito nets have been delivered. Of the goals it set in relation to its work on HIV, TB and malaria for delivery in 2016, the fund has already achieved 100% of its HIV goal, 115% of its malaria goal, but, regrettably, only 58.5% of its TB goal. As we have heard, despite the huge progress on malaria in particular, still more needs to be done. I was shocked to hear yesterday a DfID scientific adviser state that half the children in high-risk areas still sleep without nets.

The fund is short of its TB targets because countries do not have the capacity to run programmes of the scale of those for HIV and malaria. As the noble Lord, Lord Chidgey, said, the fund provides more than 80% of international financing for TB, more than 20% for HIV and 50% for global malaria. As my noble friend Lord Cashman said, the UK contributed £1 billion to the fund in December 2013, saving a life every three minutes. Again as we have heard, the UK has pledged £1 billion to the Global Fund for the next 2014-16 round, but this funding is capped at a total of 10% of the total sum raised. The US contribution, which is huge, is also capped at 33% of the total funds pledged.

Sadly, as the noble Lord, Lord Fowler, said, the Global Fund is still short of its funding target. Given its importance to the global response to these three diseases, what action have the Government taken to ensure others step up to the mark in this round of funding? Also, if these fail, will the Government commit to disbursing the full £1 billion, regardless of whether other countries pledge or not? As the noble Lord said, the Global Fund has led the way on integrating TB and HIV programmes as recommended by the World Health Organization. When I raised in an Oral Question last December just how integrated DfID’s bilateral HIV programmes were, the Minister agreed to write to me. In fact, in her subsequent letter the noble Baroness stated that DfID,

“responds to partner countries’ health priorities”,

including tackling TB/HIV co-infections. The noble Baroness assured me that DfID will ensure that this approach is followed where we have bilateral TB/HIV programmes.

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Of the 28 countries DfID lists as partners, 14 are on the list of high-burden TB countries and two are on the list of high-burden drug-resistant TB countries. In which case, I am concerned as to why TB is not identified as a health priority in any of those countries. Does the Minister accept that DfID could better integrate its TB/HIV programme in its bilateral arrangements and help to build the capacity of national TB programmes? Further, there is a £2 billion a year funding gap for TB that the Global Fund cannot fill. TB is an infectious disease that does not recognise national boundaries. Failure to control the disease in one country can and will lead to resurgence in others that have successfully tackled the disease.

The Global Fund helps countries purchase drugs, diagnostics and vaccines to tackle the three diseases. However, for many conditions, such as paediatric HIV, as we heard from the noble Baroness, Lady Barker, and TB—particularly drug-resistant TB—we do not have drugs of sufficient quality. I conclude by stressing the point I made on Monday in Grand Committee: there is a strong case for DfID to scale up its investment in R&D for TB, HIV and malaria to develop the treatments needed to eliminate these three diseases. I, too, would welcome the meeting suggested by the noble Baroness, Lady Barker, to raise these issues and the concerns of many people.

2.57 pm

The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD): My Lords, I also thank my noble friend Lord Fowler for putting this issue once again on the Order Paper, for his passionate and informative introduction of it, and for his long campaigning history in this field. He makes the point that, although progress has been made, there is still much to do. I fully agree with that. I also congratulate him on the publication of his book AIDS: Dont Die of Prejudice, as was noted by my noble friends Lord Lexden and Lord Avebury. The concerns he raises in that book and elsewhere—the noble Lord, Lord Cashman, and my noble friend Lord Lexden referred to this—about the discrimination and bigotry that surround this issue are, as noble Lords have indicated, of tragic significance.

Various noble Lords addressed the legal and societal barriers to human rights in this field. I can assure them that the Government are at the forefront of promoting human rights around the world. We regularly engage with Governments that violate these rights. We also support civil society groups that advocate for the relevant groups. I have just come from a meeting with Stonewall and the Kaleidoscope Trust. We explored how best to support voices in this area. I assure noble Lords that we will continue to engage in as effective a way as we possibly can.

Clearly, the level of prejudice is very striking. I saw that at first hand, when I visited South Africa recently. Representatives of the lesbian, gay, bisexual and trans -gender community told me of the difficulty they had, even in an environment where the law would seem to protect their rights, in accessing specialised services geared to their needs. I learnt also of the terrible plight of rape survivors in South Africa and southern Africa, about 30% of whom become infected with HIV, and

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who risk rejection from society. It is enormously challenging. AIDS, TB and malaria remain among the biggest causes of death and illness in developing countries. In 2013 alone HIV/AIDS killed 1.5 million people, malaria killed 584,000 people and TB killed 1.5 million people.

Progress has been made: new HIV infections are declining in many of the worst-affected countries; there has been a significant reduction in malaria incidence and deaths; and the world is on course to halve TB deaths by 2015, compared with 1990 levels. Clearly, the Global Fund has played a major part in this and that is why we are so strongly supportive of it. As my noble friend Lord Chidgey spelt out, since 2002, Global Fund-supported programmes have kept 7.3 million people alive with HIV therapy, distributed 450 million insecticide-treated nets, and detected and treated 12.3 million TB cases. These efforts to end the AIDS epidemic accelerated last year, with increases of 20% in the number of people being treated for HIV and malaria through Global Fund-supported programmes, and smaller increases in numbers being treated for TB. That is a truly remarkable achievement.

The UK has played, and continues to play, a critically important part in these successes. I can assure the noble Lord, Lord Collins, that we are very active in seeking others’ help; that is one of the reasons why we have used the help as we have, in order to lever the other assistance that needs to come in internationally. We worked with the Global Fund to develop a new funding model that prioritises investments in countries with low incomes and a high burden of disease—countries such as the Democratic Republic of Congo, where over 11% of all global malaria deaths take place. The model has increased allocations to these countries by 40%. It is worth noble Lords bearing that in mind, as we seek to tackle the high burden of very poor countries that the Global Fund has identified.

One year ago, the UK pledged up to £1 billion to the Global Fund for 2014-16, but our contribution does not end there. For example, last year the UK worked with the Global Fund and others to pool our procurement of insecticide-treated nets—the most effective intervention to prevent deaths from malaria—and used our market power to drive sustainable reductions in prices. Noble Lords rightly highlighted the challenge of cost here: that is saving $140 million over two years. The Global Fund is now rolling out similar approaches across a range of commodities. Savings will be used to enable the Global Fund to reach more people with life-saving interventions.

However, although these achievements are impressive —and I think they are worth noting, as noble Lords flag up what else needs to be done—clearly we are not complacent. Improvements are not uniform in all countries; we have heard that referred to in this debate. Resistance to effective medicines is indeed a growing threat and devastating rebounds can occur quickly if there is any let-up in prevention and treatment efforts.

One issue in particular that is concerning is the impact of the AIDS epidemic on women and girls. The noble Lord, Lord Cashman, referred to this. Every hour, 50 young women are newly infected by HIV. The

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infection rates are twice as high as in young men. The Global Fund, with UK support, has made a strong commitment to the health of women and girls, and we are very pleased that that is the case. It is increasing its own capacity and building capacity at country level to mainstream women’s and girls’ concerns into programme design. But the power dynamics within societies that underlie these problems will not be easily tackled, and we look to the Global Fund to redouble its efforts. Of course, programmes such as the use of microbicides are also relevant here, as the noble Lord, Lord Cashman, said.

There were a number of specific issues that noble Lords mentioned. The noble Lord, Lord Fowler, mentioned the AIDS conference in 2014. That happened to be held in the same week in July as the Girl Summit —which I hope the noble Lord was acutely aware of—and at which Malala spoke, among others, as I referred to yesterday. It was a stunning occasion and I was very glad to be able to be there. I was also happy to go to Australia; my noble friend will have to ask the previous Chief Whip about why I was not allowed to. Nevertheless, I was the beneficiary, therefore, of being able to attend the Girl Summit here, in Simon Hughes’s constituency. FCO colleagues from the high commission in Canberra attended the meeting in Australia on behalf of the United Kingdom. The noble Lord will know how committed we are in terms of the Global Fund and as far as tackling HIV, malaria and TB is concerned.

The noble Lords, Lord Cashman and Lord Chidgey, and my noble friend Lady Barker challenged us on lower-income countries. We support the Global Fund’s new funding model, which funds the most cost-effective interventions where the need is greatest, which is in the low-income, high-burden countries; but we do ask the fund to focus more heavily on key populations in the middle-income countries, where they are investing. I hear what noble Lords say; but it is also important that we all galvanise here, to ensure that Governments themselves—such as the Government of India, where the noble Baroness, Lady Barker, saw what she saw and I have seen it, too—step up to provide those services. They cannot simply be underpinned because we have the Global Fund; we must make sure that we are not neglecting the poorest in the poorest countries for the sake of those countries in which something more can, and must, be done.

The noble Lord, Lord Cashman, referred to harm reduction. Clearly, we are firmly committed to supporting harm reduction to reduce HIV transmission in injecting drug users. My noble friend Lord Fowler referred to that as well. The United Kingdom has indeed—no doubt, chivvied along by my noble friend Lord Fowler—led in this regard.

We are supporting market shaping, which I think we have spoken about before. The noble Lord, Lord Cashman, and my noble friends referred to ARVs. We are working with others to try to ensure that we have got reduction in prices, to get ARVs to as many people who need them as we possibly can.

My noble friend Lord Avebury and the noble Lord, Lord Collins, asked about bringing together TB and HIV. We are well aware of that as a co-infection and it

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is part of our ongoing work. In 2011, when we reviewed this, that was one of the issues we particularly focused on. As noble Lords will know, we are working through UNITAID, UNAIDS and also the Stop TB Partnership and are seeking further product development research and market shaping for TB vaccines as well as HIV drugs and diagnostic tools.

My noble friend Lord Avebury invited me to suggest what the Chancellor might do in the future—in the year, I think, beyond the general election—which is an interesting suggestion. I am afraid that I cannot foresee exactly what will happen in that general election, though perhaps he can. But he will know that the Department for International Development’s budget is ring-fenced until 2015-16, and therefore the commitment that he might have wanted to see in the Autumn Statement was already in place in terms of the funding for DfID.

I am extremely happy to meet Peers and CSOs in the way my noble friend Lady Barker suggested, and if the noble Lord, Lord Collins, wants to join, I am very happy to talk about that and our support for research. I hear what noble Lords are saying about drug-resistant diseases. I have a personal interest in this issue, in that one of my children is currently being treated in hospital for such a thing. It brings into focus exactly what Jim O’Neill is saying. Looking at this whole area will be exceedingly important.

The Global Fund has made a fantastic difference. We have been a major support of it in terms of tackling TB, malaria and HIV. We will continue in that way. We welcome people’s engagement in ensuring that we are focusing as we should. We listened carefully to what noble Lords are saying but they should not doubt our commitment in this area.

Global Development Goals

Motion to Take Note

3.11 pm

Moved by Lord McConnell of Glenscorrodale

That this House takes note of the case for establishing new global development goals in 2015.

Lord McConnell of Glenscorrodale (Lab): My Lords, I should start by referencing the register of interests, in which my interests in a number of development and charitable organisations are recorded.

On 8 September 2000, the member states of the United Nations agreed the millennium declaration and set out the millennium development goals, which aspired to transform the lives of those living with poverty, disease and lack of basic human rights around the world at the start of the 21st century. Those present affirmed their collective responsibility to uphold the principles of human dignity, equality and equity, and they set out key values that should underpin their collective action to support peace, development and human rights.

Those values of freedom, equity and solidarity, tolerance, non-violence, respect for nature and shared responsibility were to drive the international community to action in the hope of eradicating many of the worst conditions in the world by 2015. In the 15 years that have followed, much has been achieved. By tackling disease, achieving gender parity in primary education,

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improving access to clean water and reducing extreme poverty, the lives of more than 2 billion people have been transformed. But of course much remains to be done. Progress has been inconsistent: around 1 billion people still live on less than £1 a day; millions of girls miss out on secondary school; safe sanitation is absent for hundreds of millions; and too many die or suffer from the impact of violent conflict.

So in 2015, we will not only celebrate the significant, if incomplete, success of the MDGs—and, indeed, the 10th anniversary of the G8 summit in Gleneagles, which did so much to prioritise change in Africa—but the global community through the United Nations will, I hope, agree a new set of goals, the sustainable development goals, which will be the engine for development over the next 15 years, with the aim of eradicating extreme poverty and delivering basic human rights for all.

Much of our political debate in the UK and globally over 2014 has been dominated by fears about migration, security, economic uncertainty, our climate and our planet. These fears cross national boundaries and are shared by people of different cultures and nationalities, and their solutions are truly global, not national. Surely we can agree, though, as we look ahead to 2015, that fundamental to tackling these fears, to help ensure a more peaceful, stable, prosperous and equitable world for future generations, is the need to lift those living in extreme poverty or in fear of extreme weather conditions, or lacking in basic human rights or provisions, out of those conditions and into a better future.

Surely a world that is more equitable, where more have opportunities, where women and men have the same rights and opportunities, where those marginalised as a result of their physical condition, their identity, their sexuality or location are recognised as having the same basic rights as others, would be a world in which it would be easier to deal with these great fears and uncertainties of our times. While the SDGs are ultimately about justice and solidarity, they are also about tackling these great fears of the 21st century and helping all of us live better, safer and more fulfilling lives.

For the first time, in 2015 the global community has a unique opportunity to bring together in one set of agreements goals about our climate, environment, development and inequality with the financial mechanisms and partnerships that are required to deliver those goals. For the first time—because any agreement will be built on years of consultation and involvement, with the record of what works and what does not, with access to 21st century technology and the means of accountability to ensure delivery and results—these goals will surely be built upon greater ownership and partnership than ever before. Tackling inequality must run like a thread through the new SDGs to ensure that all have access and rights. Reducing inequality between and within nations is fundamental to eradicating extreme poverty.

Just as tackling economic inequality will affect the delivery of every SDG, so too will the position of women. It is undoubtedly the case that on a local, national and international level, where women’s participation is guaranteed and women leaders can flourish, development is more successful and sustainable. The participation and empowerment of women, and the eradication of

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gender inequality in relation to property ownership, income and basic rights will be fundamental if the SDGs are to have the impact we demand.

Earlier this year, I experienced in the Philippines, as so many others experience every year of their lives, how extreme weather events and natural disasters can destroy years of hard work in economic and social development. Programmes that develop and strengthen resilience to such events must be built into the delivery of these SDGs so that the most affected and sometimes most marginalised communities can plan their development for the future, safe in the knowledge that their work will reap results for future generations.

Across all this, the principle of universality of rights will underpin the 2015 agreement on sustainable development goals, and the rallying cry will be, “Leave no one behind”. However, I should like to focus particularly on two key aspects that will no doubt be controversial and challenging in 2015 but must be central to the final commitment if it is to make a difference for the poorest people on the planet. The United Nations Secretary-General published on 4 December his synthesis report, The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet. It brings together all the work carried out so far on the SDGs and sets out six essential elements that must guide the work to strengthen, prioritise and deliver an agreement by September 2015. These elements—dignity, people, prosperity, the planet, justice and partnerships—are our pipelines to peace and sustainable development.

However, the delivery of the goals that we agree will be achieved only if we invest seriously in capacity in regional and continental organisations, and in national institutions and governments in the developing world. This includes: proper taxation systems and revenue authorities that can collect and disperse funds; courts and justice systems that protect the weakest and assert the fair and transparent rule of law; strong parliaments that hold Governments to account and government ministries that can deliver in education and health, and in the creation of jobs; and reliable, independent data collection on which to base decisions and measure success. Therefore, as part of the agreement on financing that will run alongside the newly agreed sustainable development goals after 2015, there must be genuinely concerted and consistent effort to invest in capacity and a willingness, in those nations where the vast majority of the extreme poor live, to support that capacity building and respect, accountable, open, fair and transparent systems and institutions that put people before those in power.

The second key aspect is peace and security. The draft sustainable development goals include, for the first time, a firm commitment to peacebuilding and a recognition of the importance of freedom from conflict and violence if those living in the most extreme poverty and with the worst level of human rights are to see their living conditions transformed. Draft goal 16 of the 17 published by the United Nations last Thursday states that the goal is to,

“promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels”.

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As Saferworld, with its particularly strong research and campaigning over recent months, and UNICEF, with its campaign on violence against children, have shown, implementing and agreeing this goal is going to be perhaps one of the toughest challenges of all. There will be many states in the UN that will see such a commitment as a threat to their national sovereignty and as opening the door to interference and intervention from Europe and North America. The UK can play a key role this year in reassuring these nations that this goal and this understanding are instead about delivering justice for those who live in the worst conditions in the worst places on earth.

Current projections are that, by 2030, more than 50% of those living in extreme poverty will be living in the most violent and fragile places. As many of us know from our experience in these places, access to schooling, access to health services, access to clean water and access to justice can be almost non-existent. The United Nations cannot only be about peacekeeping and other uniformed forms of security around the world. The member states and their global leaders must address these fundamental issues on the rule of law, with strong but accountable and open institutions, and they must give priority to those living in fear of violence, with the impact of conflict around them every day.

In conclusion, I want to stress the important role of the United Kingdom. As a permanent member of the United Nations Security Council, a leading member in the European Union and an active participant in the Commonwealth, the IMF, the World Bank, the G8 and the G20, we are uniquely placed to influence, even lead, this debate. I hope that the Government will do so, and I will ask four questions here today. First, what mechanisms have been set up to integrate and then promote our intervention towards the best possible agreement on sustainable development goals in September 2015? Secondly, what response have we given to the report of the UN Secretary-General, published last week on 4 December? Thirdly, what will we demand at the European Union Council meeting next Tuesday, given its responsibility to help shape the best outcome in 2015? Fourthly, will we insist that commitments on peacebuilding, on inequality, on gender and on resilience to extreme events be upfront in the final agreement? If we do, we will help to usher in an era of transformation that will deliver a safer, more prosperous and more just 21st century. I beg to move.

3.23 pm

Viscount Eccles (Con): My Lords, I am sure that everybody in the House is truly grateful to the noble Lord, Lord McConnell, for introducing this subject. We do not have enough debates—at least not in my view—about development, aid and the best way of going about these connected, but different, activities. I am grateful to him for his synoptic view of the scene. I confess that I approach the subject with a certain humility—and that perhaps makes me not the best possible person to follow the noble Lord—because I am a retired practitioner. I have to remember that I was a practitioner in the 1980s and 1990s and that the world has moved on, but in those days I was deeply involved with aid and economic development.

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My interest in the subject arose a long time ago. There were two economists, Tom Bauer and Thomas Balogh: they were both immigrants—which is interesting —and both became Members of your Lordships’ House. They used to debate the philosophy of aid and development passionately on the Floor of this House, in a way that I have not seen us debating lately. Bauer was a market man. He believed in economic opportunities —a seizing of opportunities to trade and invest achieving a satisfactory return. His philosophy has been demonstrated to work in certain places, such as Malaysia and Brazil. His conclusion was that there was no reason to suppose that development could not be achieved all over the world in much the same way as it was achieved in western Europe and in the United Kingdom during the industrial revolution.

Balogh was much more a top-down Government-to-Government aid supporter. He was an adviser for a number of years to Harold Wilson. The aid orthodoxy of today is much more on the Balogh theme than the Bauer theme. As I said before, we do not have that much debate about it; we seem to hold similar views about the orthodoxy, which is probably something that makes me unsuitable to follow, because I am a Bauer man, not a Balogh man, and therefore in a minority—a quite familiar position.

My second interest in the subject arises because 30 years ago, I started about a dozen years with what was then the Commonwealth Development Corporation. At that time, it was a classic development finance institution: state owned and funded by Treasury capital, funding private sector economic opportunities and making modest profits that were liable to corporation tax. What it did was, in general, unattractive to fully market players, either because of the political risk or the risk of low returns. Therefore, what the CDC was doing then was filling gaps—doing things that other people did not quite want to do. That is my definition of a development finance institution: for it to be a DFI, it has to be prepared to do things that the market is not prepared to do—and of course to do them successfully.

My third interest, which is much smaller, is with the Hospital for Tropical Diseases—this relates back to the previous debate. CDC had some 250 people in 65 different locations, many of them tropical, and we needed the services of HTD. After retirement, I did quite a lot of work for HTD, including fundraising in order to move the hospital into more satisfactory premises.

I was, therefore, a bottom-up player in both senses. I respected and knew about millennium goals, in the sense that although I was pre-millennium, we were still aiming at much the same things that were codified in 2000. The problem is that bottom-up players cannot cope with millennium goals: they simply do not have the time. They are too big, too abstract and too distant from their lives. Take mobile phones in Ghana, tea in Malawi or marine offloading facilities in Papua New Guinea: while you are carrying out those projects and making sure that they are sustainable and generate returns, it is difficult to take time to think about the great, wide issues of the millennium goals.

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With our experience as front-line operators, how should we think about the millennium goals and the aid programme? For my part, I think about striking a better balance in our aid programme between aid and economic development, as well as the contributions to the development goals. I will illustrate that briefly by taking the example of tea. The Commonwealth Development Corporation was responsible for starting the Kenya Tea Development Agency, which now has more than half a million growers and 64 tea factories. It has definitely been a sustainable enterprise and Kenya is now the third largest producer of tea in the world. But after that we went elsewhere.

I shall also mention Malawi, which is not a word-for-word accurate experience, but a good illustration. Malawi with its 17 million people is not abounding in economic potential. It is a difficult place with no access to the sea, and market players find it difficult to achieve returns there. So we started a tea property. We did our due diligence and saw that we had land with good soil, that water was available and that the climate was right—all of which would allow tea to be grown successfully. Tea needs a medium-term capital input. Tea plants are trees, but they are allowed to grow to only 30 inches high. However, they need time to develop, so you cannot pluck the leaves for tea for some years. You also need to build a tea processing factory, and therefore you must have capital. However, capital in Malawi was then and still is in very short supply.

We set up a nursery for the tea plants and for woodlots—because without timber for fuel, you cannot operate a tea factory. Immediately, we were creating jobs. We needed to make a road because you can bet your life that a lorry cannot get in and out of a remote place easily. Again, that is economic development and it creates jobs. Then there was the matter of housing and gardens for the people working on the plantation, as well as the school and the clinic, both of which we would build. We needed communications in the form of mobile telephones to contact the market in Mombasa and sell the tea. Lastly, women are very important in tea plantations because they are much better at plucking the leaves than men will ever be.

I should like to say in conclusion that this kind of activity is a way of fulfilling from the bottom up the millennium development goals. If I had to choose between aid and economic development, I judge that the contribution of economic development is the greater.

3.32 pm

Lord Judd (Lab): My Lords, I thank my noble friend Lord McConnell for introducing this debate. His commitment to these issues is impressive, and I was particularly pleased that he emphasised the indispensability of solidarity. He is a living example of what solidarity means. We are having this debate in the context of another debate that is taking place about the 0.7% of GDP. Of course it is clear to me that if we are going to opt for 0.7% at least and maintain it, we have to be very clear about our objectives and what the money is for.

Against that background, there is also a certain amount of discussion about the relative merits of disaggregated targets and global targets. I believe that there is a matrix of interrelated issues and that we

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need both. Perhaps I may make two points to set the context. We cannot give too much priority to peace, security, conflict prevention and conflict resolution. Often, conflict disrupts any chance of meaningful development. We also desperately need security sector reform so that those who are responsible for ensuring security are accountable and treated with respect, and have a culture to which human rights are absolutely central. I also happen to believe that the recent arms trade treaty is highly relevant because the availability and circulation of arms across the world is undoubtedly aggravating conflict and increasing its damage.

The UN Secretary-General recent report on post-2015 development spoke of “dignity”, “people”, “prosperity”, “the planet”, “justice” and “partnership”. The objectives were to end poverty and fight inequality, to ensure healthy lives, knowledge and the inclusion of women and children, to grow a strong, inclusive—I emphasise that word—and transformative economy, to protect our ecosystems for all societies and for our children, and to promote safe and peaceful societies and strong institutions. We should seek to capitalise global solidarity for sustainable development. Perhaps in its concern for justice, it would have been good to see even more effectively spelt out the importance of peace and the inescapable significance of fair and just international financial and trade systems, as well as the need for human rights to be seen at all times as the cornerstone of any lasting well-being.

Saferworld, of which I am a trustee, has argued that while the disciplined and essential concentration on disaggregated indicators with benchmarks so that progress can be ensured at national level is important, it is equally vital to emphasise the indispensability of a shared set of common and universal indicators. They are central to creating a monitoring system that enables the evaluation of progress at a global level.

As the principal NGOs stress in the excellent briefs with which they have supplied us, rooted as they are in their authority of engagement and experience, what is now clear beyond doubt is the inseparability of sustainable development from climate change issues. Christian Aid, Oxfam, Bond and the others all speak out unequivocally on this, and they are certainly right. Already the poorest and most vulnerable people of the world—women, children, the elderly and sick—are suffering acutely from floods, landslides, coastal erosion, drought, famine and conflict. We may not be able to stop climate change—our unforgiveable inaction and prevarication for too long has accentuated this—but we can still moderate it. However, we can do so only with urgent and decisive action.

What the World Wildlife Fund has said is certainly challenging. Its report stated that,

“currently we are consuming globally 1.5 times what our planet can replenish. If everyone globally had the same living standards as the UK, we would need three times the resources that our planet can provide. However it is the biodiversity in low income countries that has experienced the greatest decline over the last 40 years, averaging 58% and reaching 83% in Latin America. A major contributory factor to this decline is from the high consumption patterns in wealthier countries, which relies on the exploitation of natural resources in the low income countries. By taking timber, fish and agricultural products such as soy and palm oil, we are exporting our environmental impacts”.

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Of course, there are specific issues to be effectively addressed. UNICEF UK underlines that, while poverty and its lifelong physical and mental stunting effect on children is bad enough, there are still the issues of trafficking, exploitation, violence, torture and child soldiers. I sometimes wonder how on earth we can live with ourselves when we are able to contemplate trips into space for the rich or, indeed, garden bridges across the Thames, when millions upon millions of children are going prematurely to their graves, never having had the opportunity to begin to be what they might have been.

Age International graphically brings home that by 2050 there will be more people over 60 in the world than children under 15. Today’s 868 million older people will have become 2 billion. It estimates that 71% of those who die of non-communicable diseases are over 60, and some 80% of non-communicable diseases occur in low-income and middle-income countries. Like other NGOs, VSO brings home that women are two-thirds of the people globally who live in extreme poverty. While women undertake two-thirds of the world’s work and produce 50% of the food, they earn only 10% of the income and own only 1% of the property of the world.

I am convinced that if we talk about 0.7%, we must talk as passionately about what is necessary to make effective use of it. The people of Wales, Scotland, England and Northern Ireland desperately need a peaceful, stable world. For our own economic security, health and well-being it is absolutely essential. That is why we should have the post-2015 goals at the centre of our concerns—in whatever party we are—as we approach the general election.

3.42 pm

Lord Chidgey (LD): My Lords, I, too, congratulate the noble Lord, Lord McConnell, on securing this debate on the case for establishing new development goals in 2015. The noble Lord’s contribution to this House, particularly in the All-Party Group on the Great Lakes Region of Africa and other all-party groups, is highly regarded and gives insight into the challenges that face Governments. It also engages with NGOs and civil society in the international efforts to deliver the MDGs by 2015.

I declare my interests, which your Lordships may recall include being the elected chair of the Africa All-Party Group, the UK director of the advisory council for the Association of European Parliamentarians with Africa, and a director of the advisory board of Transparency International in the UK.

In my remarks, I plan to stress the importance of strengthening democracy in the developing world to deliver sustainable development goals post-2015, particularly strengthening parliaments and their ability to establish transparency, accountability and probity in their dealings with the executive arms of their Governments. Before I do that, I should like to refer to a number of the issues raised with me and with other colleagues by various aid and development organisations.

Colleagues have mentioned the Bond organisation. In its paper, Inequality in a Post-2015 Framework, it points out that the new post-2015 sustainable development goals offer a critical opportunity to tackle extreme

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social, economic and structural inequalities, which perpetuate poverty and social exclusion across the world. Saferworld has raised its concerns about security, and UNICEF is campaigning vigorously to tackle violence against children.

The Bond organisation argues that the three dimensions of sustainable development—economic, social and environmental—should be reflected in the target and goal headlines in a balanced way. There is a call to tackle inequality and ensure that no one is left behind, with the belief that a post-2015 framework needs to be specifically aimed at reducing inequality within and between countries, as noble Lords have mentioned, and to tackle its underlying causes. Interestingly, in a recent address to the United Nations, the Pontiff, Pope Francis, raised inequality as a moral issue, condemning the “economy of exclusion” and its consequences, in views echoed around the world by religious and political leaders alike.

In addressing inequality as we seek to achieve the new SDGs by 2030, life chances and opportunities to be rewarded for your efforts and to realise your potential should not be determined solely at birth or be dependent solely on ethnicity or gender, age or geography. In that regard, I would be interested in the Minister’s views on how the UK Government think that the framework for the post-2015 development goals can best tackle inequality. Will the Government champion the proposed inequality goal in next year’s negotiations? What preparations are under away across Whitehall to respond to a global goal to reduce inequality?

As Health Poverty Action stresses in its case for new global development goals in 2015:

“Tackling inequality is fundamental to addressing poverty. This requires inequality to be mainstreamed across the framework, as well as a stand-alone goal on inequality”.

The Intergovernmental Panel on Climate Change said in its recent report that we are running out of time to prevent catastrophic climate change, where average temperature rises exceed 2 degrees, as the noble Lord, Lord Judd, so eloquently described for us. Many developing countries are already experiencing the impacts of climate change and environmental degradation through increased floods and droughts and uncertain weather patterns.

There are substantial opportunities for the new framework to promote win-win outcomes by setting targets for actions that have benefits for environmental and other development outcomes. These include cutting waste, technology transfer and renewable energy. Will the Government support and champion a stand-alone goal on climate change in the new framework? What should a green thread look like in goals such as economic growth and governance? How can the United Kingdom be assured that the Government’s proposed reduction in the number of goals and targets in the framework will still achieve environmental sustainability and contribute to action against climate change and sustainable development?

The Bond Beyond 2015 UK group puts forward a strong case for accountability and participation, calling for a more comprehensive system, with the post-2015 framework underpinned by a robust and comprehensive

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accountability mechanism, incorporating commitments to monitor, evaluate and report on progress, applying to all countries, to all participants and to all people.

That brings me to engagement with parliaments. Throughout the United Nations Development Programme, through the Paris and Accra conferences, through the fourth High-Level Forum on Aid Effectiveness in Busan, and now through the first High-Level Meeting of the Global Partnership for Effective Development Co-operation in Mexico City, there has been a running dialogue on the role of parliaments in the development process. It has to be said that in some quarters of civil society, NGOs and the aid establishment, there has been a strong resistance to recognising any role at all for parliaments—the assumption being that donor and recipient nations need only work with them to achieve the aid and development goals.

Let us be clear: the only body that has the authority to approve and ratify state development—the only body that has a mandate from the people over development and state expenditure—is the parliament and the elected representatives of the country concerned. Only parliaments can insist on transparency, accountability and probity from the executive branch of government in actions taken on behalf of the people. That is why the brief on democratic governance issued by the United Nations Development Programme in January 2013 is encouraging.

In setting out the role of parliaments in defining and promoting the post-2015 development agenda, the UNDP makes the point that parliaments have often been sidelined in discussions on official development assistance—ODA—resulting in low accountability for budgeting of aid and its allocation to MDG achievement. The need for country ownership, government accountability and national policy was not sufficiently taken into account during the design and implementation of the MDGs and must now be highlighted as a requirement to ensure that a new set of objectives is attained. Those are not my words. They are the words of the United Nations Development Programme. We should listen to them.

Parliaments are at the forefront of these imperatives, because the play a critical role in meeting those requirements through their lawmaking, budgeting, and oversight functions.

3.50 pm

Lord Low of Dalston (CB): My Lords, I join other noble Lords in congratulating the noble Lord, Lord McConnell, on securing this debate, which could not be more timely given the stage we have reached in the negotiations towards a new set of development goals to replace the millennium development goals in 2015. I declare my interests as president of the International Council for Education of People with Visual Impairment and vice-chair of the All-Party Parliamentary Group on Global Education for All. I would like to focus on what role Ministers are playing in ensuring that the post-2015 framework secures a good quality education for all and leaves no one behind by including and prioritising children and adults with disabilities.

I would like to start by commending Ministers on the way in which they have so far championed the concept of “leave no one behind”, which was such a powerful

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part of the report produced by the UN high-level panel co-chaired by the Prime Minister. I add to this a strong welcome for DfID’s new disability framework, which was launched last week at an event I chaired. I believe this will help to keep driving this agenda forward as it relates to disability. I also welcome the fact that the Government have maintained their commitment to spending 0.7% of gross national income on overseas aid. I look forward to supporting the Private Member’s Bill on this issue, which I hope will shortly reach this House.

The UK’s commitment to 0.7% has enabled us to become a leading donor to support education for the most marginalised children and young people in the world. Between 2011-12 and 2014-15, DfID will support 11 million girls and boys in school and a further 1 million of the most marginalised girls to receive a basic education. Education is fundamental to ending the poverty, discrimination and exclusion faced by disabled people in developing countries. Yet it is estimated that in most countries disabled children are more likely to be out of school than any other group of children. In Nepal, it is estimated that 85% of all children out of school are disabled. In Ethiopia, less than 3% of disabled children have access to primary education. In some countries, being disabled more than doubles the chance of never enrolling in school. Disabled children are also less likely to remain in school and transition to the next grade. The exclusion of disabled children not only denies their human right to education but makes it impossible for the world to reach the millennium development goal of universal primary education, which was due to be achieved next year. Fifty-eight million children of primary age are still out of school around the world, and progress has all but stalled. It is estimated that disabled children may make up over one-third of the out-of-school population.

Disability has long been neglected as a niche area of development, deemed by many to be too complex or too small an issue to be core to development efforts. The millennium development goals failed to mention disability at all, yet we now know that disabled people make up an estimated 15% of the global population—approximately 1 billion disabled people. Disability is both a cause and a consequence of poverty. Fully 80% of disabled people live in developing countries, and the UN calls them “the world’s largest minority”.

The ongoing negotiations towards post-2015 development goals, to replace the millennium development goals, therefore represent a unique opportunity to reverse the neglect of disabled people by ensuring that the new framework explicitly includes disability as a core issue, and that the framework leaves no one behind, by measuring the achievement of targets by whether they are being achieved for all, including marginalised social groups such as disabled people, girls and women, the poorest or those living in vulnerable locations.

Last week, as we have heard, the UN Secretary-General published his synthesis report, The Road to Dignity by 2030: Ending Poverty, Transforming All Lives and Protecting the Planet. I would be grateful to hear the Minister’s comments about this crucial report and the extent to which she feels it lays the groundwork for

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successful intergovernmental negotiations next year—in particular, whether the Secretary-General has done enough to push forward the “leave no one behind” principle, which was somewhat lacking from the UN open working group’s final report.

With regard to education specifically, I am also conscious that twin negotiations are happening in parallel next year with the Education for All process, led by UNESCO, and other negotiations on education as part of the main post-2015 sustainable development goal negotiation. There is thus a real risk of confusion, duplication and mismatch between what these two negotiation processes come up with. What is the UK’s position on that? What do the Government want to see happen? The obvious answer is that what the two processes produce in terms of education, goals and targets should become one and the same thing, but that is not what happened last time with the Education for All goals and the millennium development goals. Millennium development goal 2, on universal primary education, was only one of the Education for All goals that covered secondary education, adult literacy, quality of education, early childhood and so on, which has resulted in a lot of focus on primary education but much less on other areas of education. I would welcome hearing the Minister’s views on these negotiation processes and how the Government are ensuring that the goals, targets and indicators agreed reflect the need to ensure both that all people get a good quality education and that no one is left behind from development and aid efforts.

After months of deliberation, the open working group outcome report includes 17 proposed goals, including one on inequality. However, many countries are pushing for these to be reduced to possibly between 10 and 12, so that the goal on inequality is thought to be at risk. Oxfam has estimated that seven out of 10 people now live in countries where inequality is growing fast, so I strongly support the retention of a goal on inequality and I very much hope that the Government will as well.

3.58 pm

The Lord Bishop of Sheffield: My Lords, I welcome this debate. With others, I passionately support the case for establishing new global development goals in 2015. I note with appreciation the part played by the Government and the Prime Minister in the international dialogue, and I offer my sincere thanks to the noble Lord, Lord McConnell, for tabling this debate. I welcome the passion and learning displayed in this House today.

I share the view that much has been achieved through the millennium development goals. Extreme poverty has been reduced by as much as half; there has been clear progress in the battles against malaria, tuberculosis and HIV; access to drinking water and sanitation has been improved; the participation of women politically has increased; and 90% of children in developing regions are attending primary school.

These are major achievements and should be celebrated and communicated much more effectively than is the case at present. There is a story to be told here. I have had conversations even in this House questioning the value of our overseas aid and what it can achieve. It is

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vital that the story be told to build hope and to present the case for change. My first call to the Government, to the charities and to the media is to use 2015, the end of the millennium development goals period, as an opportunity to tell the story more imaginatively and to describe in clear and imaginative ways the change that has happened. I ask the Minister in reply to offer us some reflection on the ways in which the Government will communicate all that has happened.

The Church of England is part of the worldwide Anglican communion. Bishops and other senior leaders are daily in touch with churches all over the world. Two days ago, I heard a vivid presentation from eight of our senior Anglican women leaders, who recently spent 10 days living and working in Kerala in India with Christian Aid. They were inspired by the progress they saw there, particularly in gender participation and its effect on development, and they inspired others. Last year I had the privilege of spending time with a church in the West Indies and observed it still wrestling with extremes of poverty and deprivation and the rebuilding of a society still profoundly affected by generations of past slavery.

As to communication, the new global development goals clearly call for a fresh way of seeing the world. For much of the 20th century, development has been about the rich giving to the poor in charitable aid. The world was seen and described for these purposes in a series of binary categories: rich and poor nations; the one-third or two-thirds world; the global north and the global south; the haves and the have-nots. These binary categories are now outdated, though they still have a powerful hold on our minds and our vocabularies. Our mental maps of the way the world is and the way it could be both need to be redrawn. The vision for the new global development goals needs to be and is of one world that is interdependent, developing and searching for pathways to sustainable, equitable growth and the flourishing of all.

The threat of climate change, the desire for sustainable growth, digital communications and the movements of peoples have all contributed to this sense of one world and the desire for a good globalisation. It is a vision profoundly rooted in the Judaeo-Christian vision of the world: a family of diverse nations, cherishing peace, seeking justice, nurturing wisdom and looking for the flourishing of all.

Finally, I highlight four vital themes for the new global development goals, also pointed to by others. I support and commend these four key principles developed by Christian Aid in a most helpful briefing paper which I commend to your Lordships’ House. First, I have already mentioned the need to battle the evil giant of climate change and to seek carbon reduction as a major goal immediately and for the next generation. If we fail to place this sustainable development front and centre, the effects on life on earth will be profound. Secondly, I would urge that gender justice must be a stand-alone goal. There must be targets to end violence against women and girls, increase participation and ensure economic justice for women. Thirdly, I support with others the principle that no one should be left behind in the eradication of poverty and the pursuit of justice. In particular, the world needs still better and swifter

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ways of responding to human and natural disasters and building resilience in the poorest communities. Fourthly and finally, there should be a renewed focus on global equity with a stand-alone goal of a fair global economic system and with targets on illicit financial flows and on global tax justice.

Many years before the Christian era, the remarkable prophet Isaiah of Jerusalem shared a radical vision of what it would mean to end poverty and live in peace. He prophesied:

“they shall beat their swords into plowshares, and their spears into pruninghooks”.

Conflict resolution, as other noble Lords have said, is closely related to sustainable prosperity.

We are citizens of one world. Much has been achieved; we need to tell that story. However, there is still much to be done. We need to set goals for gender justice, for global equity, to leave no one behind, and to close the gap still further between rich and poor.

4.05 pm

Baroness Jenkin of Kennington (Con): My Lords, I, too, am most grateful to the noble Lord, Lord McConnell, for securing this debate, and congratulate him on the timing, which comes just a few days after the UN Secretary-General’s much anticipated synthesis report. There can be no more consistent and committed friend of international development than the noble Lord.

The topic of today’s debate is very similar to that of one I initiated in October last year, and the intervening year has been both momentous and challenging for the world, with a number of highs and lows. In June, the UK hosted the Global Summit to End Sexual Violence in Conflict, and here I take the opportunity to pay tribute to my noble friend Lady Helic, who was the inspiration behind the event and who remains committed to driving the agenda forward. We look forward to hearing from her in this Chamber before long.

In July the UK hosted the first and very successful Girl Summit, aimed at mobilising domestic and international efforts to end female genital mutilation and child, early and forced marriage within a generation. UNICEF co-hosted the event, and I declare my interest and pride as a board member of UNICEF UK. The noble Lord, Lord Judd, has said much of what I had intended to say about the current UNICEF campaign on ending child violence. The emergence of the Ebola outbreak and the rising threat of extremism have demonstrated the need to continue with a sustainable development agenda to ensure that the risk of disease and terrorism are lessened through education and equality for both men and women.

I take this opportunity also to thank the many NGOs and their staff and partners who are working in the field to beat Ebola, and in particular to commend Restless Development, of whom I am proud to be a patron, whose efforts in Sierra Leone are growing day by day. Its 1,700 volunteer mobilisers have gone through extensive training, equipping them with vital skills to bring life-saving messages to more than 3 million people in the largest social mobilisation ever to take place in Sierra Leone.

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To return the topic of the debate, no speech about the successor agenda can be delivered without referencing the historic impact of the MDGs. In 1990, a decade before they were launched, more than 12 million children died each year before reaching the age of five; in 2013, fewer than seven million did. As other noble Lords mentioned, maternal and child mortality has fallen by almost 50% since 1990, and 2.3 billion people have gained access to clean drinking water during that time.

The reason the MDGs have been so successful is that they served to focus world attention on a handful of goals: eight of them, to be precise, articulated in 374 words. They communicated to the world that these eight objectives would be the world’s priorities between 2000 and 2015, and as a result, billions of dollars in development funds flowed into efforts to tackle the challenges. That said, there is much more to do, and we should not be distracted from the need to finish the job.

International development combined with globalisation has opened up many doors into and out of the developing world, as other noble Lords have said, and significant progress has been made to reduce the number of people living in poverty. However, the opportunities have not always been equally shared. Many people are still locked out. Many women, children and disabled people, as the noble Lord, Lord Low, so eloquently said, and many others have been prevented from taking advantage of the progress that has been made.

I mentioned the Girl Summit and I pay tribute to the Secretary of State for her commitment to gender empowerment and to advancing the rights of girls and women as a top priority. I also welcome the fact that the UK is campaigning for a dedicated gender goal that addresses the causes of gender inequality and gender-sensitive targets integrated in that goal.

Earlier this year, in September, I was in a remote village in Zambia, where two young girls were reporting to the village elders what their hopes, worries and concerns were. They were the only girls in the room—and I was the only woman in the room. The chief and the other elders were, I thought, rather dismissive of what the girls wanted. I said to them, “I think that you should take these women, these young girls, on to your council in order to better reflect what girls really want in their community”. They said they would—and I hope they did.

Of 163 million illiterate young people in the world, 63% are female. Each year almost 5.5 million girls aged 16 to 19 give birth, effectively ending their chances of getting an education and earning a living. The World Bank study of 100 countries showed that every 1% increase in the proportion of women with secondary education boosts a country’s annual per capita income growth by about 0.3%.

As we know, DfID’s record on assisting women throughout the world has been exceptionally strong. Due to the department’s focus on the women and girls development agenda, more than 14 million women now have access to financial services, almost 3 million girls are in primary education and more than 4 million women are using modern methods of family planning. As an officer of the APPG on Population, Development

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and Reproductive Health, I would be remiss not to focus a few remarks on sexual and reproductive health and rights and the significant economic and social gains for individuals and families.

There are 225 million women and young girls living in developing countries who want to avoid pregnancy but are not able to use modern contraception. The consequences are huge: 754 million unintended pregnancies, 28 million unplanned births and 20 million unsafe abortions every year. Investing in SRHR has one of the highest rates of return in international development. For every additional dollar invested in preventing an unintended pregnancy, nearly $1.50 is saved in pregnancy-related care. Additional savings accrue across all sectors, from healthcare to education and employment. As Governments and international agencies consider and negotiate the goals for 2015 and beyond, I urge them to prioritise universal access to SRHR.

To sum up, the UK objective for post-2015 is to agree a simple, inspiring, measurable set of goals centred on eradicating extreme poverty. The goals should have sustainable development integrated across the framework, and should include what is referred to as the golden thread—conflict and corruption, justice and the rule of law, property rights, and open and accountable government. These goals should be supported by a new global partnership that ensures that together we mobilise a range of actors with sufficient resources from both public and private organisations.

The 17 goals and 169 targets produced by the Open Working Group are too diffuse, and the UK’s priority should be to define a more concise and compelling goals framework. We should beware a kitchen-sink approach that seeks to appease all the interest groups. In a world of increasing resource constraints, such an approach would be a recipe for disaster. The danger that countries will cherry-pick, or be subsumed, or throw up their hands and do nothing at all, must be avoided. Never before has the world had to face such a complex agenda in a single year. This unique opportunity will not come again in our generation. It must not be wasted.

4.13 pm

Lord Cashman (Lab): My Lords, I too thank my noble friend Lord McConnell for this debate, and for the enormous dedication that he has given over the years to this important subject. I would like to bring to the debate my experience as a former member of the Development Committee of the European Parliament, as the European Parliament’s rapporteur on the mid-term review of the MDGs, and as the leader of the delegation to the UN on the post-2015 MDGs.

I shall start by going away from my text and saying that if we bring forward the achievable and the attainable, we shall leave behind the majority of those who look to us to ensure that no one is left behind. Arguably, the MDGs have raised awareness of ending global poverty as an urgent challenge and a priority for global action. Assessments of the progress made in attaining the current MDGs show that, in the new post-2015 framework, a strong linkage between poverty eradication, fighting inequalities—all of them—and the promotion of sustainable development, as well as a single and universal set of goals with differentiated approaches, are crucial.

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Poverty reduction is uneven and inequalities exist within countries, let alone between countries. This represents a major challenge, especially with the dubious concept of labelling countries “middle income” according to their GDP rather than real poverty, gender and inequality indexes. Access to early childhood development, education and training of the highest attainable quality for every child, young person and adult is an essential prerequisite for breaking cycles of intergenerational poverty and inequality. Yet sadly, as has been said, little progress has been made regarding gender equality and the empowerment of women. Globally, women and girls constitute a majority of those living in extreme poverty. Gender equality and women’s rights are necessary conditions for the success of the post-2015 global development framework. It is staggering—indeed, shameful—that every day an estimated 800 women in the world die due solely to complications during pregnancy or childbirth.

Ownership of all the millennium development goals and the post-2015 development goals is essential. The EU and its member states, such as our own country, are the largest donors of development aid and should remain the driving force during the next phase of the negotiations under the UN, promoting in particular the human rights-based approach, based on equality, non-discrimination, participation and inclusion in the design and implementation of the post-2015 framework. A human rights-based approach is the only way forward. That is why I welcome the inclusion of the promotion of a human rights-based and people-centred approach among the SDGs proposed by the UN open working group, reinforcing the principles of the universality, indivisibility and interdependence of all human rights of all people, without discrimination on any grounds, starting with the fundamental right to dignity of all human beings, with particular attention paid to: the human rights of women and girls, including the promotion of universal access to sexual and reproductive health and rights; the protection of and respect for the rights of migrants and minorities, including LGBTI people and people living with HIV; and the importance of respecting and promoting the rights of disabled people.

Now is not the time to fail. That is why, sadly, I have to express real concern about the approach and attitude taken by the Government in advance of the UN September summit both at EU level and in New York. We have achieved much before because the EU took a single approach after long and timely discussions. That is not happening now. I am reliably informed—although I hope the Minister will inform me that I am reliably misinformed—that the Government’s intention is to reduce the number of goals proposed by the open working group, and to cluster them. That would not be helpful.

The UK Government are also not happy with the universality of the framework, which means that it would apply—this is extremely important—to all states and that targets would be fixed for every single state, including the United Kingdom. I cannot see the problem with such an approach: that which we demand of others, we should demand of ourselves and for ourselves.

To have weight in the debate at the UN, where there will be much opposition, it is important that the EU speaks with one voice on the issue. The United Kingdom

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Government are preventing that at the moment as they bypass the EU representatives in the negotiations in New York. It is one thing to complement influence, quite another to undermine it. I look forward to the detailed response of the Minister on these issues.

The draft conclusions are to be adopted imminently. They are very ambitious, especially when it comes to human rights and fighting inequalities. These conclusions need our support. However, I am again reliably informed that there are suggestions that the UK Government want to remove references to fighting inequalities. Sadly, I must end on this note: it is regrettable that on 25 November Conservative Members of the European Parliament voted against such an approach as I have outlined in a plenary session of the European Parliament in Strasbourg. I hope, indeed, that this is not a foretaste of what is to come.

4.20 pm

Lord Avebury (LD): My Lords, I agree with the noble Lord, Lord Cashman, that if we reduce the number of goals and the number of tasks, we may be in danger of losing some very important principles. I also agree with him on the need to tackle inequality, as a fan of the Equality Trust, and on the proposition that he carefully enunciated that unequal societies are not happy societies. Many of the evils that we suffer in the developed world are a product of our failure to tackle inequalities in our own society.

I also regret that, although the Secretary-General refers to this in his report, The Road to Dignity by 2030, published last week, there is an omission in the main goals, and even in the subsidiary tasks that are set out before us in the SDGs, of any reference to the greatest threat to the objectives of ending poverty, addressing climate change and keeping the rise in global temperature below 2 degrees centigrade, which is the inexorable rise in the number of human beings. I do not see any explicit recognition of that in the Secretary-General’s report.

In the draft sustainable development goals, also published last week by the UN open working group, goal 13 is to take,

“urgent action to combat climate change and its impacts


This is recognised as the primary responsibility of the UN Framework Convention on Climate Change, and I think there needs to be stronger linkage between the two strategies. Is it really possible to achieve 7% GDP growth in the least developed countries, and should we not distinguish between growth that requires consumption of energy, such as manned space travel or Formula 1 or nice garden bridges over the River Thames, and beneficial growth, such as the development of tidal power which could provide 42% of Scotland’s electricity?

On the continued growth of the human race, goal 3.7 calls for,

“universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes”.

If we coupled that with goal 5, which aims to:

“Achieve gender equality and empower all women and girls”,

women would have the right to control their own fertility, and have access to the means of doing so. As

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the noble Baroness, Lady Jenkin, said, 225 million women in the world do not have access to the means of controlling their own fertility. I am very glad to see that that is part of the new SDGs. In the developed world people have control of their own fertility. The problem is that there are religious and cultural obstacles to women’s equality in sub-Saharan Africa and the Islamic world that will not be easily overcome. There is good evidence to show that as women get better educated they will begin to take control of their own fertility, but where there is a long history of male dominance, that is not going to be easy to achieve.

I entirely agreed with the noble Lord, Lord Judd, when he said that conflict prevents any meaningful development. The emergence of extremist organisations such as al-Shabaab, AQAP, the Daesh and Boko Haram should be recognised explicitly as a major obstacle to women’s emancipation. Former members of the Secretary-General’s high-level panel, in an open letter in September, stressed:

“Freedom from fear and violence is the most basic human entitlement, and people demand peace and good governance as a core component of their well-being, not an optional extra”.

The nearest we get to this is goal 16, calling for “peaceful and inclusive societies”, but the language does not spell it out. The necessity of combating ideologies of hatred, murder and the subjection of women, and blasphemously claiming to be the true voice of Islam, needs to be on the final version of the SDGs presented to the General Assembly for approval next September.

My grandfather, who was born in 1834, had 12 children. They had large families in the 19th century because they expected high infant mortality. That is no doubt one of the factors behind the huge birth rates today in many less developed countries. But we know what needs to be done to complete the reduction by two-thirds, between 1990 and 2015, in the under-five mortality rate—goal 4 of the MDGs—in the countries that have not got there and to take the process much further. The WHO recommends 11 antigens for universal infant use and this should be incorporated in the post-2015 agenda.

That goal should be achievable even for the poorest countries with the help of the Global Alliance for Vaccines and Immunisation, to which I am proud to say this country is one of the largest contributors. But can my noble friend explain why in the five years 2011 to 2016 we contributed £1.3 billion, and now that has been reduced to £1 billion in the next funding round for the years 2016 to 2020? If I may refer to the previous debate, the Chancellor has had no difficulty in signing up to the renewal of the contribution to the former fund for AIDS, TB and malaria, so he ought to be able to do the same for GAVI.

I note that Germany, Canada, Norway and the Netherlands have all announced larger increases in the pledges they intend to make at the replenishment conference chaired by Chancellor Merkel in January. Are we really going to be the only country to give less this time, when the Secretary of State says:

“Investing in immunisation is one of the most cost-effective ways of saving lives and improving living standards, health and the global economy”?

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The APPG on Child Health and Vaccine Preventable Diseases, of which I am co-chair, would like to see in the next 15 years the adoption of a more holistic approach to child health, integrating the vaccination programmes with the delivery of the WASH agenda for clean water, sanitation and hygiene, where there is still huge potential for disease prevention. Half the girls who drop out of school in sub-Saharan Africa do so because WASH is not provided. Many more drop out or miss school when they reach the age of menstruation for the same reason. We would like to see hygiene added to goal 6. This would be the place to refer to the co-ordination of the delivery of the WHO antigens with the WASH programme.

We also believe that there is tremendous potential in product development partnerships. I mentioned in the previous debate the example of GSK’s development, with the help of the Gates Foundation and many others in the PATH Malaria Vaccine Initiative, of the world’s first anti-malaria drug RTS,S. In phase three trials, the drug reduced incidence of the disease by a quarter in six to 12 week-old infants at first vaccination, and by half in young children aged five to 17 months at first vaccination. In July, GSK sought an opinion from the European Medicines Agency on the quality, safety and efficiency of the drug. Assuming that the reply is positive, the WHO is likely to issue a policy recommendation before the end of next year, allowing African countries to develop schedules for the delivery of RTS,S and for their national regulatory agencies to consider applications from the manufacturers. Children could receive the vaccine by 2016, saving hundreds of lives.

There is broad reference to multi-stakeholder partnerships at the very end of the open working group’s draft list of sustainable development goals. My final plea to my noble friend, when she comes to wind up, is whether DfID would consider proposing that a reference to PDPs, which have such enormous potential, be added to goal 17 as a shining example of what these partnerships can achieve.

4.30 pm

Lord Hannay of Chiswick (CB): My Lords, 2015 is set to be an important year for the UN in what is already proving to be an exceptionally testing period for the organisation. Two major sets of decisions will need to be taken next year: those on the policy framework to succeed the millennium development goals, which we are debating today, and those on climate change. Those two sets of decisions will have crucial implications for all the world’s citizens, whether they live in developed or developing countries. That is what makes today’s debate in the name of the noble Lord, Lord McConnell, so timely, topical and welcome, certainly to me. Inadequate policy prescriptions—or, worse still, failure to agree on anything meaningful at all in either of these negotiations—would have seriously negative consequences for the world’s prosperity and its security for a long period ahead.

When the millennium development goals were set 15 years ago in 2000, many regarded them, with a cynical shrug, as just more warm words from an organisation not short of that commodity. Some still take that view. This morning I read an article in Prospect magazine

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which suggested that the setting of these goals was a pretty worthless exercise—an article that completely ignored the distinction between the specificity of the millennium development goals of 2000 and the discredited, very general goals set in previous decades.

In any case, I think the millennium development goals have turned out to be a lot more significant than that prognosis. They set a course that has seen many millions of people lifted out of poverty in some of the world’s poorest countries, which have also seen remarkable improvements in education and health. However, those benefits have been too narrowly spread and too heavily concentrated in the rising economies of Asia, leaving what has been called the “bottom billion” of the world’s population—most of them in Africa—largely unaffected. Daily we are reminded by events—by the Ebola epidemic in west Africa and by the chaos and threats of genocide or violence in the Middle East and in parts of Africa—of how far the world still has to go and how fragile any progress made on development issues can prove to be if basic security cannot be addressed. I join those who have underlined that point in numerous contributions.

The case for setting out recalibrated goals for the period ahead seems, to me, unanswerable. For example, the Ebola outbreak has highlighted how important it is not only to conduct high-profile campaigns such as those against malaria, AIDS and tuberculosis, as the previous debate underlined, but to give far more emphasis to general provision of public health facilities.

In other areas that so far have been either neglected or inadequately treated—for example, removing discrimination against the disabled, on which I support every word that my noble friend Lord Low said, and discrimination against women and girls—clear objectives need to be set out. In some cases, which have emerged in prominence only since 2000—for instance, bringing the benefits of the digital economy and the revolutions in communications technology to a wider range of countries and a wider range of social groups within them—the challenge is to define sensible and sustainable goals. Those are the challenges that I see in 2015 and I hope that whichever Government emerge from next May’s general election will measure up to them.

However, we also need to realise that if we cannot respond effectively to the challenges of the climate change conference in Paris at the end of next year, much of what we set out to achieve in the form of development goals will prove to be unrealisable. A world beset by coastal flooding from rising sea levels, desertification and catastrophic climatic events will not be a world capable of achieving sustainable development. A world in which civil and sectarian strife spreads across whole regions, uncontrolled by the rules-based institutions that we have so laboriously built up since the end of the Second World War and the end of the Cold War, will fare no better. So the agenda that we face goes a lot wider than the simple setting of development goals. If a new policy framework of development goals is to be worth while, I suggest that we will need to ensure, in addition, that it does not just consist of words on paper but that the commitments subscribed to in New York in 2015 are implemented and monitored. Surely, there needs to be

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effective monitoring of the way in which both developed and developing countries, and both donors and recipients, fulfil the commitments they have undertaken.

Our own record in recent years, in particular the action taken by the coalition Government to ensure, even in a period of austerity, that we achieved the target of 0.7% of gross national income for our official development aid, is one of which we should be proud; but it is not unchallenged. No doubt, as the political debate hots up before the election and concentrates on future public spending projections, it will come under threat again. I very much hope that this House will now match the action taken in the other place by passing into law our commitment to the figure of 0.7% and that when she replies the noble Baroness will say that the Government—as they did in the other place—will lend their support to such a measure. I suggest, too, that it would be good if all three main parties in Parliament were to make sticking to that commitment a non-partisan objective in their manifestos. After all, it is a lot easier to sustain the commitment to 0.7% than it ever was to reach it in the first place. If we can do that, we will be well placed to give the lead in the debates over the 2015 development goals that will take place in the European Union, at the G8, at the G20 and, of course, at the United Nations for final decision. I hope that we will be there, giving that lead.

4.38 pm

Baroness Hodgson of Abinger (Con): My Lords, like others, I congratulate the noble Lord, Lord McConnell, on raising this very important issue today. As the UN Secretary-General Ban Ki-moon himself has said, the millennium development goals have been the most successful global anti-poverty push in history. During the past 14 years, we have witnessed enormous progress in tackling some of the world’s most prevalent ills and providing for the needs of those in the very poorest and most disadvantaged communities. As other noble Lords have said, the setting of these ambitious and measurable targets has resulted in a worldwide halving of the numbers living in extreme poverty. Fatal diseases have been tackled and millions more people today have access to sanitation, clean water and primary education. It is important, therefore, that the progress made is strongly acknowledged and celebrated, but this is not a job finished; this is work in progress.

Although the targets were projected to be met by 2015, still around 700 million people across the world live in abject poverty and without many of the things such as healthcare and secondary education that we in the UK take for granted. As Amina Mohammed, Ban Ki-moon’s special adviser on the post-2015 development planning acknowledges, the world has changed radically in the last 15 years and we must now expand on progress, build on existing momentum and learn the lessons that the MDGs have given us. This is not the moment to give up the fight.

The UN Secretary-General Ban Ki-moon, in his recently released synthesis report, stressed the need for a renewed global partnership for development between the rich and poor nations in the context of the post-2015 agenda. Thus we need to look ahead, establish new goals and finish the job in hand. This will need a new

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approach, which needs to include caring for the environment and protecting the world that we live in —as the Secretary-General has made clear, you cannot have true economic development that does not recognise the importance of the earth’s natural systems, because climate change causes crops to fail and people to starve in poor countries.

At Rio+20, member states agreed to launch a process to develop a set of sustainable development goals—the SDGs—to build upon the MDGs and converge with the post-2015 development agenda. Whereas the MDGs concentrated just on developing countries, to really create a sustainable agenda we will need to treat people as active partners in development rather than passive beneficiaries of aid. It will need all countries, both developing and developed, to commit to good governance, rule of law and the fight against corruption, with targets and indicators relevant to every country and region. It will need everyone to be engaged to help deliver this: Governments, civil society, all ages—the young and old—and especially the marginalised groups, because we must ensure that no one is left behind, regardless of age, gender or ability. It is only by working together that we can deliver a truly transformational approach.

Some of the MDGs have delivered more progress than others, but one of the areas in which we still have a significant way to go is that of gender equality and the empowerment of women, which was millennium development goal number three. Globally, women are disproportionately impoverished and, as the noble Lord, Lord Judd, told us, make up two-thirds of those still living in extreme poverty, form 60% of the working poor but earn only 10% of the world’s income and own less than 2% of the world’s property. Sixty-one per cent of the 123 million young people who lack basic reading skills are women. A survey of 63 developing countries also found that girls are more likely to be out of school than boys among both primary and lower secondary age groups.

Why is gender equality so important? It is because women have the ability to transform their communities if they are given the right tools and support. As Brigham Young once famously said:

“You educate a man; you educate a man. You educate a woman; you educate a generation”.

I find it incredible that there is still no country in the world where women are equal in political, economic and social terms, not even in the developed West. This is a missed opportunity. Even here at home, it is projected that by equalising men’s and women’s economic participation rates we could add more than 10% to the size of the British economy by 2030. In developed countries, gender wage gaps also persist. Only one in five parliamentarians worldwide is a woman; and VSO tells me that on current rates of progress women will not be equally represented until 2065 and will not make up half the world’s leaders until 2134. Domestic violence everywhere is often all too commonplace, with 35% of women across the world having experienced violence. A woman who has to fight for her existence at home has no prospect of working towards greater rights, higher status within society or helping her community.

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In some countries, violence has become a pandemic and, where conflict occurs, rape is all too often used as a weapon of war. Sexual violence destroys lives, shatters families and breaks up communities. I therefore congratulate William Hague on his initiative to end sexual violence in conflict. He has put the spotlight on a war crime that has been ignored for years.

Today in war, 90% of the casualties are civilian—mostly women and children, yet women are nearly always excluded from the peace processes. Some 125 million women and girls have undergone FGM and one in nine girls in developing countries is married before the age of 15. The reality of this usually means that their education is finished and their prospects curtailed; many are condemned to a life of domestic servitude. Still, every day globally, around 800 women die in childbirth.

This was brought home to me when I visited Mali last week. Mali is one of the poorest countries in the world; it has a very high illiteracy rate and many women are married off at an extremely young age. Most girls there have undergone FGM and, as there is little access to contraception, they will end up having a large number of children. It is hard for the women there to do anything but just concentrate on their survival and that of their children.

Too many countries today still have a patriarchal society, with men dominating all the leadership positions, and with the societal norms and values working against women. I therefore welcome the recommendation of the open working group—established to develop the sustainable development goals for future consideration by the UN General Assembly—for a standalone goal on gender equality and the empowerment of women, a goal that so many of us have been calling for.

This new gender goal—goal number 5—unlike that of the MDG, has targets aiming to create policies and laws to ensure an end to discrimination and the elimination of violence and harmful practices, such as forced marriage and female genital mutilation. They also aim to ensure women’s full participation in decision-making at all levels and in ownership of land and economic resources. In particular, I welcome the reference to universal access to sexual and reproductive healthcare and reproductive rights, on which there has been pushback from some countries in recent years. This goal also emphasises the need to address stereotypes, mindsets and attitudes that reinforce traditional gender roles. I am delighted that not only has our own Government Equalities Office stated its support for this but it has also been championed by our Secretary of State for International Development and very much welcomed by NGOs and women’s groups.

We all hope that this strong and explicit goal on gender equality will remain in the final post-2015 framework. However, we are not there yet and intergovernmental negotiations will continue into next year when the final post-2015 development agenda is to be adopted at the summit scheduled for September 2015. Therefore, things can still change—and slip backwards—and some fear that global leadership is not strong enough. We look to the UK to provide a strong lead by setting out an inspirational vision for the future so that agreement can be reached for a

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renewed global partnership for development, which will enable us all, together, to meet the challenges facing us around the world today and help to transform the lives of those who live in poverty.

4.47 pm

Viscount Craigavon (CB): My Lords, in thanking the noble Lord, Lord McConnell of Glenscorrodale, for this opportunity to bring us up to date on the language and methodology of development goals, I wish to concentrate on what I believe to be one of the most important areas. That is the population factor, which in many parts of the world is the key element—but not the only contributor—affecting development. It is also a key to sustainability in the long term. I shall focus on two aspects of this. The first is the recent responsible prediction, endorsed by the United Nations Population Fund—UNFPA—that world population is not expected to level off this century, as previously expected, but will reach a much higher total before beginning to come down in the next century.

The other aspect I will highlight is the recent report by the Guttmacher Institute—again, together with the UNFPA—called Adding It Up, which deals with the costs and benefits of investing in sexual and reproductive health. I am hoping that in both of these areas, the final version of the development goals will be framed to emphasise the importance of these aspects.

On the first, I have always tried to avoid trading numbers in population matters. The concept of world population has limited use, as there are so many regional and local variables. A new prediction in a recent paper in Science, with UNFPA support, is that the present world population of 7.2 billion will increase to 9.6 billion in mid-century and to almost 11 billion by the end of the century. This is against the more conventional scenario until now that the figure would level off at around 9 billion in the mid-century and thereafter decrease. The use of talking in these terms is then to look at how and why the figures have changed. Not everyone would support the new hypothesis leading to that change. All these predictions are expressed in terms of the probability of their being right.

What has changed is that the remarkable rate of fertility decline in both Asia and Latin America has not been copied in Africa, and in particular in sub-Saharan Africa. In some African countries, decline has stopped. The ideal family size there seems to remain on average about 4.6 children, and the level of meeting the unmet need for contraception seems to have remained unimproved for the last 20 years. These are generalisations, but they include populous countries such as Nigeria. The figures are merely signposts to highlight where things are and are not changing, whatever the cause.

The same paper also deals with the related but opposite matter largely in developed countries, and that is the potential support ratio—roughly the number of workers per retiree. Where there have been fast declines in population numbers, support for the older members of a population is put under pressure. The most extreme projected case is Japan, where the proportion will be 1.5 workers for each retiree. Both fast declines and fast increases in population produce their own pressures, but in both rational human intervention is possible, if not simple.

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As I have said, these new and possibly alarming figures have been disputed, partly on the grounds that background assumptions might not remain unchanged over the lengthy projected period. For example, education and even climate change might alter the outcomes. But it is accepted that, over time, the UNFPA population projections, which are updated every two years, have been broadly accurate. I mention all this, and the new increased projection, partly to remind us that the common supposition that the size of the population is somehow magically sorting itself out into a kind of natural equilibrium is almost certainly not the case. In sub-Saharan Africa in particular there is still a large, unmet need for modern contraceptive services.

That brings me to the recent Guttmacher Institute report, also supported by UNFPA, on the costs and benefits of reproductive services. The commonly accepted figure for unmet need is around 200 million women wanting to avoid pregnancy but not being able to access contraception. Here the figure is confirmed in some detail as around 225 million. That is apparently one-quarter of all such women of reproductive age and is the same for the whole range of reproductive services and related health benefits. The report quantifies the investment needed to provide proper health services and the savings that would be made by so doing. The situation varies widely region by region. Providing all women with the healthcare they need would be cost-effective. The general conclusion is that for every £1 invested in contraceptive services, £1.50 is saved in consequential outcomes.

Finally, I urge that the ultimate version of the new development goals should emphasise the need for greater investment in sexual and reproductive health services. These investments are cost-effective, save lives and are the cornerstone of sustainable development.

4.53 pm

Lord Collins of Highbury (Lab): My Lords, I, too, thank my noble friend Lord McConnell for initiating this timely debate. The EU is calling 2015 the European Year for Development, with the intergovernmental negotiations commencing in January and with a view to finalising work in July ahead of the September summit to determine global plans for the next 15 years. As my noble friend said, last week the United Nations Secretary-General published an advance copy of his synthesis report which draws upon the Open Working Group proposals for 17 goals and 169 targets. Six essential elements are identified, although the Secretary-General does not detail explicitly how these elements should be used in the negotiations. I ask the Minister: what initial assessment the Government have made of the implications of the UN Secretary-General’s report? I share the concerns of my noble friend Lord Cashman. Given that the Secretary of State and the Prime Minister have both commented on a number of occasions that 17 goals and 169 targets are “too many”, what will the Minister’s priorities be in the post-2015 negotiations? Which goals would she be happy to see either merged or discarded from the final list?

As my noble friends have said, our country’s commitment to the world’s poorest and most vulnerable is not just morally right; it is in Britain’s national interest. Just as important is how our actions can help

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shape global opinion. We need to convince those who are able to do much more and empower others to stand on their own two feet. We need global agreement on tax transparency, need to ensure that companies pay their tax in-country, and need to support Governments to collect their own taxes to reduce aid dependency and foster good government. If we are to unlock development, the UK must push for bold and visionary global agreement on development over the next 15 years.

As we have heard in today’s debate, there are three vital areas that are the greatest areas of inequality that the world faces. First, we must set new global priorities to give everyone universal access to healthcare. Secondly, climate change is a development issue and must form an integral part of global effort over the next 15 years. Finally, we must protect human rights, as my noble friend Lord Judd so ably argued, working to help eliminate exploitation, to protect the rights of women and girls and to protect workers’ rights.

Ensuring that everyone in the world has access to affordable healthcare is essential to end poverty. It is deeply unfair that 3 million people die every year because of a lack of vaccine for preventable illnesses. As we heard in the previous debate, there have been 1.5 million AIDS-related deaths, when we have treatments that could have kept those people alive. Three-quarters of those living in low-income countries lack access to decent healthcare. In India, a middle-income country, the situation is the same. Universal health coverage reduces inequality and would prevent 100 million people a year from falling into poverty. It is the bedrock of human development. This year the Ebola virus has killed thousands across west Africa. The UK’s response to the humanitarian health crisis has been strong. However, the main issue here was health systems not being resourced or strong enough to deal with the issue. Universal health coverage, whereby there is access for all without people having to suffer financial hardship when accessing it, is the key way that we can make countries more resilient to health concerns such as Ebola before they become widespread emergencies. UHC is a clear and quantifiable goal. Will the Minister support UHC in the language of the health goal in the SDGs?

I turn now to climate change, which hits the world’s poorest people the hardest. It causes severe weather events. The poor live in areas that are most affected by climate change and lack the resilience to cope with drought, flood and food insecurity. Given the clear links between climate change, inequality, poverty and economic development—the most recent example, which my noble friend Lord McConnell referred to, being Typhoon Hagupit, or Ruby as it is known in the Philippines—yet again it appears that those who had the least were those who have lost the most. Does the Minister agree that a post-2015 agenda without a stand-alone goal on climate change will undermine the potential of the entire agenda?

Empowering countries to stand on their own two feet is not just about new powers for more Governments; it should result in changes for working people as well. Decent jobs under decent conditions for decent pay are a vital part of development, providing a permanent

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route out of poverty. But there are 168 million child labourers working across the world, and those who work in developing countries often work in ill defined jobs in the so-called grey economy. Formal employment would better ensure workers’ rights and avoid exploitation at the hands of unscrupulous companies. We need to stop clothing made by people working in horrendous conditions reaching our markets and we must demand action from major companies to stamp out child labour from their supply chains. Labour will reverse this Government’s decision to withdraw funding from the International Labour Organization and we will work with the International Trade Union Confederation to ensure that those who want to work hard can get on.

Finally, as we have heard in the debate, almost half the world’s wealth, totalling $110 trillion, is now owned by just 1% of the population. Seven out of 10 people live in countries where economic inequality has increased in the past 30 years. As we have also heard, gender inequality is the most persistent form of prejudice but inequalities can occur across urban/rural divides or have different ethnic, religious or racial group dimensions. Discrimination on the grounds of disability is also a critical factor fuelling inequality, as was pointed out by the noble Lord, Lord Low. Given that inequality is an issue of pandemic proportions—which goes beyond simply ensuring that no one is left behind—I ask the Minister whether her Government are willing to commit to the need for a stand-alone goal on inequality in the post-2015 agenda.

5.02 pm

The Parliamentary Under-Secretary of State, Department for International Development (Baroness Northover) (LD): My Lords, I, too, thank the noble Lord, Lord McConnell, for securing this debate. He has a formidable record in this field, as have all others who have participated in the debate. I knew that it would be an extremely well informed and deeply thoughtful debate, and it has proved to be so. What shines through is an understanding of why this is so important. The right reverend Prelate urges us on in communicating what has been achieved since 2000, even with the financial crash of 2008 onwards, in the relief of poverty. He is surely right.

As noble Lords know, the year ahead of us is absolutely key—as the noble Lord, Lord Hannay, made clear, not only on MDGs but on climate change and many other issues. A key moment, and the culmination of the subject of this debate, will be the summit in September 2015, where the world will seek to come together to agree a new set of sustainable development goals to take us to 2030. We believe that the international community has a duty to produce an inspiring framework that will put us on a sustainable development pathway to eradicate extreme poverty within a generation, building on the successes of the MDGs.

The United Kingdom has played an active role in the post-2015 development process to date. From my right honourable friend the Prime Minister’s co-chairmanship of the high-level panel to the recent Open Working Group on Sustainable Development Goals, we have been extremely active. With the formal intergovernmental consultations on post-2015 running from January to

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July 2015, and with the report of the UN Secretary-General on post-2015 released last week, today has been a timely opportunity to reflect on the progress the international community has made so far.

First, I will touch on the work of the open working group. Over 13 sessions, member states in the group discussed a range of issues and inputs into the post-2015 agenda, and ultimately its July report proposed a framework of 17 sustainable development goals and 169 targets. The UK Government have welcomed the breadth and balance of this report and there are a number of extremely positive aspects to it. There is a strong focus in the proposals on the eradication of extreme poverty, and welcome goals on gender equality, peaceful and inclusive societies, and access to justice. There are some useful objectives on environmental sustainability and we will continue to work so that this is integrated within the agenda.

As my noble friend Lady Jenkin pointed out, the power of the MDGs was in their simplicity, and the ability for planning and finance ministries to take them in their entirety and to help define their national plans, rather than to pick and choose which targets were most politically expedient. We have heard from statistical experts and implementing ministries in developing countries that turning the current 169 targets into meaningful, measurable and manageable action on the ground would be nearly impossible. Making long lists—and we know this very well in this House—can result in whatever is missed out not being counted. This is why there is an argument for an overarching inclusive approach. Over the coming months, we look forward to working with other member states, civil society and technical experts to ensure that what we agree in September is a genuinely workable framework.

As the noble Lord, Lord Hannay, said, what we surely cannot allow is failing to agree something meaningful. As noble Lords have noted, the UN Secretary-General released his report, The Road to Dignity by 2030. Tasked with synthesising the many contributions to the post-2015 discussions to date, the Secretary-General has called on member states to strive, with the highest level of ambition, to end poverty, transform all lives and protect the planet. As the noble Lord, Lord McConnell, and others have said, he set out the six essential elements that member states should strive towards: dignity, people, prosperity, planet, justice, and partnership. The elements can provide a helpful organising framework for the negotiations to come, and they point towards a focused outcome on post-2015. It is important that the final framework is inspiring and that we can communicate it. That certainly provides food for thought.

We have also been clear on the need for a framework that can be monitored and implemented—again, as the noble Lord, Lord Hannay, said. I note the Secretary-General’s proposal for a technical review of targets to ensure that each is framed in language that is specific, measurable and achievable. One of the downsides of the MDGs was in effect the use of averages, which left many behind—although that was never intended. The UK remains a strong advocate of the principle “leave no one behind” and it is notable that the Secretary-General’s report also supports this approach.

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Leaving no one behind must be, in our view, a key to the new goals. The noble Lord, Lord Judd, flagged an ageing world population. We know that around the world, as the world of work changes and as cities grow, there is a serious danger of older people, possibly increasingly infirm, being left out as economies may grow. Women are so often left behind, as we have heard. LGBT people may be left behind. Those with disabilities may be left behind. I thank the noble Lord, Lord Low, for his tribute for what we have done in terms of disabilities, particularly what my right honourable friend Lynne Featherstone has done to ensure that we include those with disabilities. As the noble Lord, Lord Low, notes, 15% of the global population has a disability and 80% of those with disabilities live in developing countries. That is why leaving no one behind is so essential.

Many noble Lords will recall the high-level panel’s proposal that no post-2015 target should be considered achieved unless met by all relevant social and economic groups and we are pleased that this has been reinforced in this latest report. Building on this, the report also emphasises the importance of data to the post-2015 agenda. The UK has been clear throughout that a data revolution is needed better to collect, use and open up data for maximum effect, bringing together all those who are relevant in this area. The noble Lords, Lord McConnell and Lord Judd, and others have noted that as being a vital tool in this regard.

I note what the noble Lord, Lord McConnell, said in his opening remarks—others echoed this—about how essential it is that women are central to these goals. My noble friends Lady Jenkin and Lady Hodgson put the case extremely effectively for why women and girls must be front and centre. The UK Government have argued strongly for a dedicated goal that addresses the causes of gender inequality, as well as for gender-sensitive targets and indicators throughout.

I am also very glad that climate change and the environment have been integrated into the whole process of these goals, as there was a danger that the issue was just going to be running alongside. That integration is clearly essential, as noble Lords have pointed out; the noble Lords, Lord McConnell, Lord Judd, Lord Hannay and Lord Collins, my noble friend Lord Chidgey and others have all emphasised it and numerous NGOs have made that case, as the noble Lord, Lord Judd, noted. Those in developing countries, as we have just heard from the noble Lord, Lord Collins, are indeed the most vulnerable to climate change. It is also a matter of global security, as noble Lords have said. It is impossible to consider eradicating poverty by 2030 without addressing climate change, so we firmly believe that the framework must include measures in this regard.

On peace and security, the noble Lord, Lord Hannay, who is a member of another UN high-level panel, knows a great deal about the need to integrate development for global security, and this is all consistent with that. The noble Lord, Lord McConnell, and others mentioned this, and it will indeed be critical to ensure that peace and security, the ruler of law, access to justice and inclusive economic growth are reflected in the final outcome.

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The noble Lord, Lord Collins, mentioned universal health coverage. Health, including sexual and reproductive health rights, is a prerequisite for human and economic development and we are strongly supportive of universal health coverage as an essential means to achieve health outcomes.

The noble Lord, Lord Low, rightly talked about the need to integrate. He flagged education, which of course needs to be properly integrated. We do not want processes that duplicate but ones that are mutually supportive, and we will have to look right across the board as far as that is concerned.

My noble friend Lord Chidgey mentioned working with parliaments. Indeed, we support the need for effective monitoring and accountability at all appropriate levels for this framework and that very much includes parliaments, which play a pivotal role.

On universality, I reassure the noble Lord, Lord Cashman, that the UK is clear that the next framework should be universal and all countries should have responsibilities in it, so it will apply to the UK. Discussions are continuing at the moment between departments in preparation for that.

There is more to the post-2015 agenda than goals and targets alone, of course. In July next year there will be a major conference in Ethiopia at which the international community will decide how best to finance the new framework, and the Secretary-General’s report acknowledges the importance of an ambitious set of means of implementation, including overseas development assistance and other resources.