Poverty

Lord Crisp Excerpts

Thursday 14th July 2016 Lords Chamber

[Lord Crisp (CB)]

My Lords, I am delighted that this debate is happening and congratulate my noble friend on securing it and on his passionate opening speech. I shall concentrate on action rather than analysis, bring in a global perspective and make three points. The first is simply the importance of listening to poor people and working with them. Some years ago, the World Bank published a fascinating study covering a number of countries, which demonstrated what I guess we already know: poor people often well understand their predicament, have good ideas about how to get out of it and what needs to be done, and those ideas are often very different from what the authorities think needs to be done. They are simply not heard; other people make decisions about them; they are invisible. As the World Bank concluded, poor people are able partners.

Let me illustrate this. Many poor people have to be ingenious managers of their situation. I was struck by the words of the noble Lord, Lord Ouseley, talking about the situation he was in, where the routes out were begging, borrowing, stealing and blagging. In another recent study, authors looking at poor people’s experiences in three or four countries demonstrated that, on average, they use between eight and 10 financial instruments to get by. What do they mean by that? They borrow from neighbours, friends and microfinance institutions; they use credit with suppliers; they sell and buy assets; they save money with different schemes; they pay in advance; they send remittances to their home village; and they use so-called money guard schemes, whereby you give money to a neighbour for safekeeping, just in case you are tempted to spend it, and they do the same for you. That is an enormous amount to keep up with on top of a very stressful existence. It reminds us that people are endlessly resourceful and that we should work with them, their abilities and perspectives. The central point is that traditional approaches to policy simply do not do that, and need to be adapted to do so.

Grameen Bank, which was the first microfinance institution in the world, providing small loans to poor people to enable them to get on with their lives, was set up largely on the basis of traditional banking rules. After a period it started to fail and, to its great credit, it changed the way it worked, adapting to how poor people actually behaved and thought about their situation, offering loans on a rather different basis from its original intention. In other words, it supported what people were doing rather than seeking to impose different patterns of behaviour. It treated them as able partners. That raises the question whether our systems not only ignore people and make decisions for them, but seek to impose different ways of behaving and do not treat poor people as partners.

My second point concerns joined-up action. By that I could just mean joined-up policy and government, but I mean joined-up action. Let me tell the House about BRAC, a very large local NGO in Bangladesh focused on working with the ultra-poor. It does so by providing education classes for women, offering health services, even though it is not a health institution, and developing microfinance. Every time it discovers a new barrier to people gaining greater prosperity, it develops a new way of approaching it. It realised that people getting microfinance loans needed shops, so it started some. It runs schools, a hospital and a university. It is building up the infrastructure as it recognises the need to do so.

We may well say that that is all very well in Bangladesh because there was not much there in the first place, and it is being built up incrementally. However, this is precisely the approach my noble friend Lord Mawson has been using in St Paul’s Way. I think he will speak to the House about it later. He has moved on from improving education to housing and working with local employers and the local health system. In our case, it is even harder going—I expect my noble friend will talk about it—because of all the barriers put in the way of people trying to build up infrastructure in this way. Central to this approach is learning by doing. It is about small-scale experiments and learning, not a grand plan.

Thirdly, we need good evidence-based policy that enables and facilitates such developments. There is some. Let me illustrate this with health. Poor health often accompanies and can cause poverty. I have a great brief from the Faculty of Public Health, which I am not going to read. I shall highlight one point, which is that recent research by Michael Marmot and others shows that we need a coherent set of interventions throughout the whole life cycle to improve and sustain the population’s health. It is the package that counts; it is not pick and mix, a bit of this and a bit of that. That package needs to include everything from early-years education and family support to reducing inequalities in access to healthcare.

In summary, looking forward, we need the new Government, who say that they aim to leave no one behind, to put a completely new emphasis on the capabilities of poor people, on supporting what people are doing for themselves and on rigorous evidence and understanding. There are models to copy. I have already cited my noble friend Lord Mawson; there is also the noble Lord, Lord Bird, and new approaches are coming along.

Finally, like other noble Lords, I am very much looking forward to the valedictory speech by the noble Baroness, Lady Sharp of Guildford.

Health: Neglected Tropical Diseases

Lord Crisp Excerpts

Thursday 6th February 2014 Grand Committee

[Lord Crisp (CB)]

My Lords, I, too, congratulate my noble friend Lady Hayman on her eloquent speech and for keeping this issue so well highlighted. There has been good progress but there is much more to do. I also congratulate the Government on taking such a strong lead on this. In doing so, I of course encourage them to continue to do so in the future.

I declare an interest as chair of trustees of Sightsavers, which deals with two of the major blinding diseases. Trachoma was endemic in London 400 years ago—so it can be eliminated—and I am delighted that DfID has supported Sightsavers to lead a collaboration of partners who are mapping trachoma worldwide. This will enable us to understand exactly what the level of trachoma is in every community and how we can go about eliminating it. It is a very important programme. DfID has also been supporting us in tackling trachoma in Nigeria in particular, with another project with the Government there. I am also delighted that the Diamond Jubilee Trust has chosen trachoma to be its major target for the funding that has been raised, with the intention of eliminating trachoma from five countries in the Commonwealth.

The other great disease we deal with is onchocerciasis, or river blindness. This reminds me of the wonderful co-operation there is in the world of neglected tropical diseases. It is public-private, as we have heard, and, in the case of onchocerciasis, Merck committed itself 25 years ago to give the drug ivermectin free for as long as it takes to eliminate the disease around the world. There is co-operation between countries and co-operation between academic departments and services, which several noble Lords have highlighted. It is worth remembering that there are people who have been quietly working away for 25 to 30 years on those diseases before they had a high public profile, and it is great to see them now getting some recognition for that tremendous work over those many years.

The other group worth mentioning is the communities themselves in Africa. The African Programme for Onchocerciasis Control, which is one of our partners at Sightsavers, has 100,000 community distributors of drugs, one in each village, who, once a year, deliver the drugs to everyone in the village in an attempt to eliminate the disease. That is an excellent example of community self-help, but it also allows them to distribute drugs for other diseases. A point of co-operation in this field is the way that we in Sightsavers, while focusing on blindness, also distribute drugs through that network for lymphatic filariasis and other things.

Your Lordships will gather that I am proud of what Sightsavers does, but I am also proud as a British citizen of what the UK is doing. That seems to me to be real solidarity between some of the richest people in the world and some of the poorest. Of course, there is more to do. As my noble friend Lord Alton said, the reason why it is so urgent is that, largely, we know what to do. We need money and the priority to do it.

Let me finish on three final points. The first, as other noble Lords have said, is that this programme of dealing with neglected tropical diseases needs to integrate with the wider development push, so that it is not just dealing with those diseases but linking it in with water cleanliness and everything else.

The second point, which has not been raised, is that although this is a fight to eliminate those diseases, many people are disabled by them. On the wider issue of disability, there are about 1 billion people disabled in the world, and 80% live in developing countries. They have not been systematically included in international aid programmes, and we ask DfID to develop a strategic approach to disability-inclusive development to sit alongside the valuable work on preventing disability. I ask the Minister to respond on that point; I would very happy to receive a letter. I hope that he can, because that is very important and would be another example of the UK’s leading the way internationally on development by having disability-inclusive development in all its aspects.

My final point is to add my voice to those continuing to press for inclusion of neglected tropical diseases in the MDG successor framework.

25th Anniversary of the World Wide Web

Lord Crisp Excerpts

Thursday 16th January 2014 Lords Chamber

[Lord Crisp (CB)]

My Lords, I, too, congratulate my noble friend on securing this debate and on setting the scene so brilliantly. In my three minutes I will speak only of health, where the world wide web already contributes enormously but where there is much more to come.

The web enables clinicians to access information where and when they need it, which is ever more important in a world where, for example, there are now more than 6,000 different disease entities. It also enables them to consult colleagues. Organisations such as the Swinfen Charitable Trust, run by the noble Lord, Lord Swinfen, and his wife, allow clinicians in even the most remote and isolated locations in the world to consult a network of clinicians in every discipline. The web also helps meet patients’ demand for information and empowerment. For example, there are 27 million views of NHS Choices a month and 1 million patient reviews of services on the site. It also allows for the remote monitoring of patients where, with the whole system demonstrator, the NHS leads the world in terms of evidence-based use of this technology at significant scale. There is even patient self-treatment. There is an excellent programme called “Beating the Blues”, which is designed to do exactly what its name implies, and I wonder whether this is the first internet-delivered treatment available on NHS prescription. If so, I am sure there will be many more.

A very important point has been made about inclusion, where again there is much to do. The sickest are probably the least able to access help electronically, but conversely the web offers much greater reach to people than otherwise. I pay tribute to the noble Baroness, Lady Lane-Fox, as the nation’s digital inclusion champion.

However, progress in health has not, perhaps, been as a fast as one might have expected because behaviour change is slow in health and redesign involves many other aspects of health systems. This is problematic but not necessarily always a bad thing. It is important that, in a subject as crucial as people’s health, evidence of impact and effectiveness is properly weighed and we should not rush in just because something seems attractive.

I conclude on a point where we need national and international co-ordination. I am privileged to be one of the Global eHealth ambassadors, in a programme chaired by Archbishop Desmond Tutu. It exists to promote telemedicine and e-health globally. It sees e-health as a means of transforming healthcare delivery to make it economically and socially much more sustainable. It campaigns for some standardisation of systems and methodologies in e-health to ensure that data can be properly shared and that every clinician can judge the reliability and effectiveness of the electronic tools they are offered. We need a global framework for this. This is very ambitious but much of the infrastructure to sustain that transformation already exists. The programme gives an example of one of those wonderful internet facts. It asserts that there are now more cell phones in Africa than toothbrushes. I am not sure that we can verify this assertion but we have known for years that toothbrushes are essential for health and we now know that cell phones and the world wide web are even more essential.

Millennium Development Goals

Lord Crisp Excerpts

Thursday 7th November 2013 Grand Committee

[Lord Crisp (CB)]

My Lords, I, too, congratulate the noble Lord, Lord Loomba, on keeping up the pressure and the profile of this fantastically important issue, although I recognise that Her Majesty’s Government obviously understands this issue well. Nevertheless, we should keep the pressure up and keep producing examples of what works.

I want to make three points. The first is to re-emphasise something that the noble Lord, Lord Loomba, said; namely, that girls’ education is not only good in itself but is good as a means for other things. As people probably know, I speak from a background in health and my understanding of the fact that it is empowered women and educated girls who have big impacts in all kinds of areas of life. The noble Baroness, Lady Walmsley, referred to the cultural context. DfID has done some very good work in a number of areas on health where it has engaged traditional leaders, particularly around issues such as maternal mortality. I wonder—simply because I do not know—the extent to which DfID has engaged traditional leaders in Africa and other places to put pressure on their communities to get girls to school, as they have done with maternal mortality.

All my points will repeat what someone else has said because, broadly, we are talking about a common understanding. My second point is about primary education. There is a developing issue in Africa, which is where I notice it, with people who have got primary education asking, “What happens next?”. The issues about higher and further education apply not only to girls of course. It would be good to hear from the Minister the Government’s view on that and on educating people to a certain level but not recognising the whole system.

My final point is on disability. I chair Sightsavers, which is concerned with the blind. We are very conscious of the point made by the noble Lord, Lord Browne of Ladyton, that people who have multiple disadvantages are the least likely to get educated. If girls are less likely to get educated anyway, a disabled girl is going to have a bigger problem.

I believe the issue is even wider than that. A DfID publication states:

“It is principally the poor, rural children, children of uneducated mothers and children with disabilities that are excluded from education”.

There again is the point about this going down the generations and the fact that educating women can help to reverse that cycle.

I know that the Government, the Prime Minister and the high-level panel have made these pledges about leaving nobody behind, but that makes sense only if we can measure it in some way. It will be critical to understand how the Department for International Development and other agencies around the world will help to ensure that there are some measurement processes in place that will record whether girls with a disability are actually being excluded from education or are getting their fair share of it. How will monitoring be undertaken?

Millennium Development Goals

Lord Crisp Excerpts

Wednesday 23rd October 2013 Lords Chamber

[Lord Crisp (CB)]

My Lords, I congratulate the noble Lady, Baroness Jenkin, on setting out so well the background against which we all speak. I want to make two points in two minutes. First, leaving no one behind, or the UN Secretary-General’s version of it, a life of dignity for all, are absolutely wonderful ambitions. I draw attention to how this applies to disabled people. I do so in part as chair of Sightsavers, which deals with blind people. I am very well aware that too often disabled children and blind children in particular are left behind in our current MDGs. The crucial point here is not just the political will. It is also about the data and about gathering the data so that we know how these things are being applied not just to disabled people but to other minorities. What is the Government’s assessment of how these data can be collected and how well they can be collected over the next period?

My second point, following others, is that the MDGs in health have not been fully met. HIV/AIDS is not yet beaten. Child mortality is too high and maternal mortality is absolutely appalling in too many places. I ask the Government two things. First, what are they going to do to ensure the implementation of the recommendations of the independent expert review group chaired by Joy Phumaphi and Richard Horton which is arguing for greater acceleration on progress to the health MDGs, particularly MDGs four and five at the moment? Secondly, how can the Governments of the world collectively ensure that the current MDGs are carried forward and progress continues to be made after 2015, as it will need to be?