Millennium Development Goals

Lord Crisp Excerpts

Thursday 22nd November 2012 Lords Chamber

[Lord Crisp]

My Lords, I rise as requested to respond to my noble friend. I congratulate the noble Baroness, Lady Nicholson, on this important and timely debate and on setting out the big picture which, as I interpret it, is really about what sort of world we want to work towards. That is what this is all about. In that context, I am indeed going to talk about health.

Yesterday, I had the privilege of chairing two meetings of five All-Party Parliamentary Groups—Global Health, which I co-chair; HIV/AIDS; TB, Malaria and Neglected Tropical Diseases; and Population, Development and Reproductive Health—where we discussed precisely this issue. What health targets should there be in whatever replaces millennium development goals? A number of noble Lords took part, including the noble Baroness, Lady Tonge, and my noble friends Lady Hayman and Lord Low. We produced a list of principles at the end of the day, and I shall mention a few of them.

The first is that while the Government have talked about economic development being a golden thread throughout all development—and I think that is true—health is another golden thread. Disease, like conflict, destroys growth. It affects, and is affected by, all the other aspects of development. Healthy populations are more productive. We know that the scourge of HIV/AIDS in sub-Saharan Africa has destroyed growth for many years and has reduced the output of that part of the world. We also know that, the other way around, 25% of diseases are affected by the environment and that, of the most effective interventions to improve health, the two perhaps most effective are the education of women and clean water, neither of which are immediately obviously health interventions.

In the meeting, I think that we all felt that health, because of its central role, must be explicitly mentioned in whatever replaces the millennium development goals. We need to maintain momentum on the MDGs. As many noble Lords have said, there is unfinished business. We need to learn the lessons. There has been measurable real value and impetus from the MDGs. But, as the noble Baroness, Lady Nicholson, and others have said, we must be sure that they do not override local priorities, that single-issue disease programmes do not destroy local, more generalised healthcare systems and that they also address the wider issues, such as non-communicable diseases and disability. There is a clear need for a global framework but we also need local decision-making.

Looking forward, the group which met yesterday made the very strong point that, in all aspects of development, we need to focus much more on what women can do and on raising the profile of women in all countries of the world. That was a very strong theme. Linked to it was the management of population growth and contraception. We also spent some time talking about equity and the inverse care law which so many people have mentioned; namely, that in any given population, the poorest, who have the most need, get the least access to services.

We felt, ultimately, that we need one explicit health goal, which may be linked to other goals in other sectors. We discussed universal health coverage—the idea that healthcare should be available to everyone in the world through local health systems. We have not yet resolved exactly how we will want to take this forward. Perhaps I may say to the Minister that we will meet again and will no doubt write to him as part of the contribution to the DfID consultation on this.

On two personal points, first, I echo all the points about disability. I chair Sightsavers, which works on blindness around the world. It is very clear that so much can be done very cheaply to support disabled people. Our research shows us that in Nigeria, for example, people who are prevented from going blind or are treated with cataract surgery return to full economic employment within one year. It is very directly related to economic development.

Secondly, I believe that the goals chosen should reflect the needs of the whole world. It is not just about the rich world looking after the poor world, if I may put it like that. This is one world and there needs to be one-world goals. My personal proposal for the future is that in health terms, we should be looking for a goal that is about improving the health of the poorest 25% in every country. The goal should be linked somehow to measuring this in terms of a healthy life for the poorest 25% in every country. That could link closely to similar goals in education and elsewhere, and would leave the choices of what to do locally. If you happen to be a country in sub-Saharan Africa, HIV/AIDS would be the priority; in other parts of the world, other things would be the priorities. It involves us all and is outcome orientated.

In conclusion, let me return to the theme that the noble Baroness, Lady Nicholson, started with. This debate is about what sort of world we want to work towards. I believe that greater equity in access to healthcare is central to that.