Health: Women and Low-income Groups

Baroness Flather Excerpts

Thursday 20th March 2014 Grand Committee

[Baroness Flather (CB)]

My Lords, I, too, thank the noble Baroness, Lady Manzoor, for giving us this opportunity to express our views, which is very welcome. I turned 80 last month and I feel that I am on the last lap of life. I have only one passion, which is for poor women, mainly in Africa and India, who get forgotten. There are 1 billion women altogether in Africa and India and what their lives are like we cannot even imagine unless we have gone there and seen it for ourselves. I am not going to talk about that, because it is a huge subject and I have views on what we can do about it, but I just want to tell your Lordships one little story.

I have a Nigerian friend who is from a village in the middle of Nigeria. She said to me that when a woman in her village reaches the age of 40, they have a street party. It is a great thing to reach the age of 40. What does that make us feel? I shall give another, recent example. I had an Indian maid. She does not work for me any more, but she comes to me. She says that I am her mother. I keep telling her that she is not my daughter, but it does not seem to have any effect. She came to me in a terrible worry about some medication that she had been given for her blood pressure. She said, “Oh, it’s not the same as what I had before. I don’t know what they’ve given me. What is it going to do to me?”. So I just read the leaflet. It was blood pressure medication. It was not the same packaging—there are so many different ones.

I want first to say, therefore, that I am much more concerned with ethnic minority women. Secondly, I want to mention a big problem, which is ignorance. Obviously, not everything is available to everyone—we know that—but unfortunately we are not doing anything about improving the awareness and understanding of what is available. A lot of ethnic minority women do not know what is available. They do not understand it. What they can have has not been explained to them.

A report for the All-Party Parliamentary Group on Sexual and Reproductive Health in the UK, launched in 2012, showed the differences in the availability of help in different boroughs of London. The differences were huge. Every woman has the right to have access to family planning, not only for herself—because it affects her health, her thinking and her feelings—but for the children she produces. If you have too many children, you cannot give them the attention they need.

We also do not do anything in schools. We are ambivalent about sex education. We do not teach our children what they need to know about their own bodies and needs. People say, “Oh, they will become more promiscuous”. Well, they will be promiscuous if they want to be promiscuous, whether we teach them or not. Maybe they will be more careful; maybe they will use condoms. Let us do that; let us work towards trying to bring in proper sex education in this country, because that will help the next generation.

We have heard about TB and things like that. There should really be a testing process before people come here. Most countries have testing processes for illness. If you know that somebody has TB, you can still let them come but then you give them treatment right away. You do not wait for them to spread the TB around to other people.

The other thing that is specific to ethnic minority women is depression. They suffer hugely from depression. There was a Chinese Peer called Lord Chan who set up a group, of which I was a member, to look at suicides among ethnic minority women. We have the need for family planning. We have mental health problems in minority groups. People are not trained well enough to manage the bicultural aspect. We need to be aware of that. It is very difficult to treat somebody with mental health problems via an interpreter.

There are so many issues. The noble Baroness, Lady Hayman, quoted Dr Fathalla. Actually, it was in the 1970s, earlier than she said, that he said that we do not treat women—not because we cannot but because we do not think they are worth treating. He was saying how bad it was; he was not saying it for himself. It is true. If you go to African countries, women’s health is right down the agenda. Nobody cares.

FGM was mentioned. Do noble Lords know that if a girl has been cut, the family gets more money for her? We should bear that in mind because quite often some of these ills are perpetrated for financial reasons; child marriage as well—they sell the girl. I said to my friend from Nigeria, “Two goats will buy you a girl of 12”. She said, “No, one goat”. This is the kind of world we are living in and this is the kind of treatment women are getting, so let us not do it here.

--- Later in debate ---

[Baroness Jolly (LD)]

My Lords, I, too, am grateful to my noble friend Lady Manzoor for initiating this important debate. I thank all noble Lords for their excellent and informed contributions. I agree with the noble Lord who said that an hour is just not enough to do justice to the huge canvas of inequalities that there are not only in the UK but across the world. I regret, too, that in the time available I will not be able to answer all queries from noble Lords. I promise to write to all who have taken part in this debate to answer their queries and, I hope, to make them feel more reassured.

Health inequalities are a priority that is shared by this Government and Health Ministers across the whole UK. Worldwide, concern is high on DfID’s agenda and it has been very busy over the past few years implementing millennium development goals and thinking about what should follow on from them, particularly those areas surrounding women and children. For too long, health inequalities have denied many children a good start in life, prevented people realising their full potential and weakened communities. They are deeply rooted and a scourge on society, which is unacceptable. However, the tragedy is that, for the most part, they are avoidable. As the Secretary of State has said, we want to make them a thing of the past.

Health inequalities and the poor health outcomes that result are a focus for the health system, working with Public Health England and NHS England, and backed by new health inequalities duties under the Health and Social Care Act 2012. The Department of Health is ensuring that these bodies work together to overcome these inequalities. However, I have to give a warning that successes in any of these areas are not overnight. We have to be in this for the long haul, which is why strategy is so important. These organisations are barely a year old.

Our strategic approach is underpinned by the evidence in the Marmot review. The noble Baroness, Lady Warwick, was the first of several noble Lords to highlight the importance of the 2010 report, Fair Society, Healthy Lives. It highlighted that life expectancy is spread across a social gradient, a point highlighted by the noble Baroness, Lady Royall; namely, that the lower a person’s position, the worse his or her health. It recommended that action should be proportionate to the level of disadvantage.

Following on from that paper, our public health White Paper, Healthy Lives, Healthy People, accepted the review’s recommendations and we are sponsoring the UCL Institute of Health Equity, led by Sir Michael Marmot, to help implement them. We have adopted its approach. For example, on maternal and child health we are increasing by 50% the number of health visitors by 2015 and more than doubling the number of places on the family nurse partnership programme, which supports vulnerable, first-time young mothers.

Reducing health inequalities is a core Public Health England activity. It will be set out in its business plan to be published shortly, and its health and well-being framework in June. It will identify the action that many stakeholders—notably local government—can take. NHS England set out its proposed priorities in its December board paper Promoting Equality and Tackling Health Inequalities. In addition, NICE continues to provide evidence-based guidance, and the ONS will continue to publish much important data to support our efforts in reducing health inequalities. When I sum up, I will pick up on the issues around data mentioned by the noble Baroness, Lady Warwick of Undercliffe.

The noble Baroness will know of the importance of good health for women during and after pregnancy from her time at Bradford as a previous chair of Bradford Health Authority. Bradford is second only to Birmingham in the number of infant deaths. Responding to that challenge, Bradford established an infant mortality commission, drawing together partners from all corners of the city. Action in Bradford and elsewhere has had a national impact. The health gap in infant mortality was halved between 2004-06 and 2009-11, between the routine and manual group and the whole population, which shows that local focused action can reduce inequalities.

Different communities face different health needs, and it is for local areas to identify those needs. We have sought to empower local areas by transferring public health to local government, giving £5.46 billion of funding over two years. We have made it clear that local areas must take account of health inequalities as a condition of that funding.

Some of the most extreme health inequalities are found among the most vulnerable and socially excluded women, such as street-based sex workers. Open Doors, a Hackney organisation, and the TB team at Homerton Hospital carry out late-night outreach among these women looking for cases of TB and HIV—a fatal combination—and to provide support and care for them. The Homerton TB team also provides housing for homeless people with TB for the duration of their treatment because, as my noble friend Lady Suttie has said, homelessness helps spread TB. The £10 million Homeless Hospital Discharge Fund seeks to ensure safe discharge from hospital and to break the cycle of poor health and homelessness. Public Health England is leading on developing a national TB strategy, including tackling drug resistance.

The NHS is providing a hepatitis information and testing programme in Sheffield, which offers screening for at-risk communities, including the Roma communities, and in Leeds it is seeking to establish the needs of those communities and to improve access to their services. In Salford, the NHS is working with different groups to improve the uptake of vaccines such as MMR, focusing on BME groups where the uptake is low. In Hillingdon, a specialist health visitor and trained volunteers support Afghan and Tamil women on a range of physical and mental health needs, including domestic violence.

As noble Lords will know, access to services is crucial. Women living in deprived areas are less likely to attend for breast cancer screening or present with early symptoms, which leads to lower survival rates. We cannot meet our cancer objectives without reducing these inequalities through programmes such as the National Cancer Equality Initiative, and the work of local areas such as Southwark and Lewisham in reducing inequalities in breast cancer care, and Walsall and the Isle of Wight in promoting cervical cancer screening.

Obesity has a strong social gradient among women. We are encouraging and promoting action on obesity and better nutrition through the responsibility deal and through Change4Life. There is a threefold difference in smoking in pregnancy rates between London and the north-east. Sunderland and other north-east communities, Blackpool and Dudley have responded to these inequalities and are contributing to our national ambition of reducing smoking in pregnancy rates among all women from 15%—where it is now—to 11% by 2015.

We work—with Public Health England—across government to reinvigorate action on child poverty, raise educational attainment, support families and promote work as a route out of poverty. To pick up a point raised by the noble Baroness, Lady Warwick, a study by the Institute of Health Equity has shown that one of the best things that you can do for a child is to read to them daily. Not only does that raise their educational outcomes but it also raises their cognitive ability from a very early age.

[Baroness Flather]

There are many parents who cannot read.

[Baroness Jolly]

I understand that. I am sure that there are adult education programmes across the country. The noble Baroness shakes her head. Perhaps we can have a conversation about that outside the debate.

We have focused on outcomes rather than on targets to promote action and measure progress, including through the public health outcomes framework, in line with the Marmot review proposal for a national framework of indicators for local areas to draw on to meet their own needs. This strategic approach to reducing health inequalities will help guide local action that is practical, joined up across the causes of ill health, and delivered at a scale to make a difference and improve health outcomes for all our people.

In what time I have, I shall run through points that noble Lords have raised that I have not covered. The noble Baroness, Lady Manzoor, asked about cardiovascular disease, which we know affects millions of people and is one of the largest causes of death and disability in this country. The previous Government made huge strides in this area which this Government have carried on. During the past decade, there has been a 40% reduction in under-75 mortality rates, with a narrowing in the difference between the most deprived and the least deprived areas of England.

Domestic violence is one aspect of violence against women and girls; others include sexual violence, abuse and gang violence. We also heard today at Question Time about FGM, and the Government are working on that issue.

On international health inequalities, raised by the noble Baroness, Lady Hayman, the approach to tackling health inequalities in England is recognised internationally as leading edge. Professor Sir Michael Marmot has chaired the World Health Organisation’s commission on the social determinants of health. Based on the interim analyses of the first phase of this programme, it is estimated that, during the lifetime of the project, more than 9,500 maternal lives will be saved, more than 190,000 maternal disabilities will be avoided, nearly 10,500 new-borns will be saved and more than 12,500 stillbirths will be averted.

The noble Baroness, Lady Warwick, asked about the gap of 20 years in healthy life expectancy. I mentioned earlier that local authorities have been given a £5.4 billion budget to press on that.

I have been informed that I am out of time. I am sorry. I flagged up that I doubted that I would get through all your Lordships’ points during the debate, but I will certainly write to you and answer any outstanding queries.