Reducing Health Inequality

Alex Cunningham Excerpts

Thursday 24th November 2016 Commons Chamber

[Alex Cunningham (Stockton North) (Lab)]

I, too, thank the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, for bidding with colleagues for this crucial debate and the Backbench Business Committee for granting the time. There is probably no other person in this place who is better placed than her to talk about health inequalities, and her speech demonstrated that clearly. It was both challenging and thorough. It is a pleasure to follow the hon. Member for Erewash (Maggie Throup), and it was good to learn a bit more about obesity.

Many will say that health inequality stems from the overarching inequalities in education and opportunity across the country and even within communities, and that is true. My right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) outlined the historical context of that. However, I would say that health inequality starts even before birth—before a child is born into affluence or poverty; long before they have the opportunity to start at a good nursery or are left to make do with what is left; and years before they start making their own life choices.

Yes, health inequality begins in the womb and the child’s development can be very much restricted or enhanced by the diet of the mother, her tendency to drink alcohol or smoke in pregnancy, and dozens of other factors relating to antenatal care and access to general practitioners. Where people live has a major impact on all those things, but the effect can be mitigated by the actions of the NHS, local authorities and, of course, the Government. They can all, given the resources, make the kind of interventions that are needed to support people where that support is needed. The issue is one of resources, which are needed for everything from mounting campaigns to discourage smoking in pregnancy to providing the best hospital facilities in the areas of greatest need.

I will talk about my area, the borough of Stockton-on-Tees, and the north-east of England to illustrate the reality of health inequalities and the poverty that plays its own part in people’s life chances and life expectancy, and to show just why Government policy is putting the brakes on the progress we made in the years up to 2010. I will start with some facts. There is a life expectancy gap of 17 years between men in the most deprived ward in Stockton and a man in the least deprived ward, and the gap is over 12 years for women. That gap has increased by two years over a five year period, and unless we take immediate measures, I fear it will continue to grow.

Child development is an important contributor to health equity, as the successes and opportunities that children receive contribute to their quality of life later on. The English average for children achieving a good level of development at five years old is 60%, but in Stockton the figure is just 50%. A child who has a low quality of health due to parental lifestyle is more likely to be out of school more often due to illness, especially when it comes to dental health, with 72% of children in the most deprived areas having decayed, missing or filled teeth. My right hon. Friend the Member for Kingston upon Hull West and Hessle offered much more information on that problem and solutions to it.

In my constituency, the biggest causes of early death are cardiovascular disease, cancer and smoking-related diseases. The number of hospital stays due to alcohol-related harm is 808 worse than the average for England. That represents 1,500 stays per year. The rate of self-harm hospital stays is 225 worse than the average for England and the rate of smoking-related deaths is 320 worse.

Sadly, the positon in the north-east region is similar and there are some startling statistics, many of them related to alcohol. Some 57% of people living in the north-east, or about 1.2 million individuals aged 18 or over, have suffered at least once due to the drinking of others in the last 12 months. Some 62% of people know at least one heavy drinker. Males, younger age groups and those who drink the most were more likely to know a greater number of heavy drinkers. A third of north-easterners drink above the Government’s recommended limits on a daily or almost daily basis, and one in five binge drinks on a weekly basis. More than 60% of us worry about violence caused by drinking and 90% of us are concerned about people being drunk and rowdy in public. There is a strong relationship between alcohol and crime. Almost half of all crime is alcohol related and that is having a significant impact on individuals and communities.

While smoking rates in the north-east have declined over the past two decades, Fresh, a great charity, reports that 18.7% of adults still smoke and nearly 9,000 children in the region start smoking every year, according to Cancer Research.

The north-east has the highest rate of economic inactivity in England. Between July 2014 and June 2015, 25.3% of the working-age population in the region was economically inactive, with over a quarter of that inactivity due to ill health. The regional unemployment rate remains the highest in the UK at 7.9%, while life expectancy is lower than the English average. Men and women in the north-east typically live over a year less than the national average.

My constituency and much of the north-east reflect the picture across poorer parts of the country, and the evidence from charities and experts on these issues show them to be highly significant. A British Lung Foundation briefing on health inequalities found that people living in the poorest areas will die, on average, seven years earlier than those in the richest areas. There is a strong correlation, which is backed up by much evidence, that shows that a person’s affluence and opportunities affect their health. Cancer Research UK has carried out research that shows that inequality is linked to 15,000 extra cases of cancer in England and that children from the most deprived groups are twice as likely to be obese than the least deprived groups.

So there is quite a dire picture across the north-east region, but that is not for want of action by health groups, local authorities and charities. They have had some remarkable successes over the years, despite the poor hand dealt them, but they need the support of the Government to make even better progress. To reduce health inequalities, we need to provide more resources to support those who seek help; to invest in our health services to detect illnesses earlier; to ensure that healthcare has a greater role in schools; to stop those 9,000 children a year taking up smoking; and to ensure that the NHS has the means to look after and treat everybody who needs it.

Back to Stockton, how do we ensure that those who live there are not at a significant disadvantage from birth compared with those in more affluent areas? We must start from the beginning. By investing in early years education, we can make sure that all children have the best start in life and reach their key development milestones to the best of their ability. As I suggested earlier, we can start before they are even born.

The borough council has taken a number of measures to address the health inequality within the borough. The delivery of the health and wellbeing strategy is increasingly being targeted at those who most need support. For example, the Stockton seasonal health and wellbeing strategy co-ordinates a targeted approach to make sure that those who need the most support are getting it. Some 18,000 people have received winter warmth assessments to make sure their homes are prepared for the winter months, and Stockton Borough Council is working with Public Health England to implement a child dental health programme in schools, including even in nursery—isn’t that sad!—and for reception children. In our poorest wards, the council runs a community-led initiative focusing on three key outcomes for children up to three years old: cognitive development; speech and language development; and nutrition. These schemes are ensuring that children have more opportunities to break a cycle of health inequality in some areas of my constituency, and some areas in the wider country, and promoting a healthier and safer upbringing.

As I keep repeating, however, all these schemes need resources, but those are sadly diminishing as each year goes by. I could bleat on about the poor deal the north-east got from the coalition and is now getting from the Tory Government—the movement of health resources from the north to the south and the huge cuts to local authority spending, which have impacted on their ability to maintain the services they need in order to close the equality gap—but I will not. I will, however, remind the Government that while new hospital projects in Liberal Democrat and Tory constituencies planned by the last Labour Government went ahead in 2010, the one to serve my own and neighbouring constituencies was axed.

Our health professionals and trusts do a remarkable job in our area in the most difficult of circumstances, and I hope that one day soon they will have the 21st-century hospital and facilities they need to serve our community and help close that inequality gap. Perhaps the provision of that hospital should form part of the sustainability and transformation plan for our region. Instead we face the potential downgrading of our hospital and the potential loss of our accident and emergency department.

The challenge posed by health inequalities, not just in my area, is bigger than any individual parent, and bigger than any local authority or health trust. We must have a unified strategy to ensure that health inequality is a thing of the past and that my constituents, as well as those of many other Members, have the best start in life and a good quality of life. We need earlier intervention in schools, more support for those suffering from mental health problems, and greater action to break the cycle of health inequality in the poorest areas of the country.

I am well aware that we heard one of the gloomiest outlooks for our country from the Chancellor for decades when he delivered his autumn statement yesterday. He spoke of the uncertainty ahead, of rising debt and borrowing and falling growth and tax revenues. My great fear is that in the tough years ahead, partly as a result of the Government’s failure properly to fund public health, the NHS and social care, we will see health inequalities grow, not reduce, and that the huge gap in life expectancy will not be closed for many decades to come.

We should have a country not where the future opportunities and health of children are determined by their socioeconomic status or the availability of resources to tackle the issues of smoking, alcohol, drugs and inactivity, but where children yet to grow up or be born have the freedom to choose whichever path they want to take without negative health implications holding them back.

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[Fiona Bruce (Congleton) (Con)]

On the doorstep of No. 10, our Prime Minister, taking up her leadership mantle, gave an inspirational social justice speech, aimed at ensuring that we reduce health inequalities, including by addressing the stark realities of the mental health challenges that so many families in our communities live with daily. I want to speak about that, about the importance of healthy early relationships in life—even beginning before birth—and about the mental health challenges that can be involved. I would like to conclude with a reference to the implications of alcohol harm, wearing my hat as the chair of the all-party parliamentary group on alcohol harm.

Building healthy relationships—beginning before birth—and establishing them in our earliest years as building blocks in our family and community life are absolutely key for the prevention and reduction of mental health problems in childhood and throughout later life. That starts in the womb.

Let me commence by setting out some key facts from the early lives of our children here in the UK. Depression and anxiety affect from 10 to 15 of every 100 pregnant women. Over a third of domestic violence begins in pregnancy. One million children in the UK suffer from problems such as attention deficit hyperactivity disorder, conduct disorder, emotional problems and vulnerability to chronic illness, which are increased by antenatal depression, anxiety and stress. The UK has the world’s worst record for breastfeeding. Some 50% of three-year-olds experience family breakdown. Some 15,700 under-twos live in families classed as homeless.

By addressing some of those social determinants of health inequality, beginning even before birth, we could help exponentially, in terms of not just the physical but the mental health of so many of our young people, and that help would last their whole life long. We need to support our youngest, so that we can increase their life chances and reduce the health inequalities that get in the way of their achieving their full potential.

Points on the compass of scientific advancement are increasingly showing us the direction of travel in terms of the social determinants of health, and they significantly point towards the experiences of bump, birth and beyond. The top policy recommendation in Marmot’s “Fair Society, Healthy Lives” report, which was referred to by the hon. Member for Glasgow East (Natalie McGarry), and which was published as long ago as February 2010, was to give every child the best start in life. The “1001 Critical Days” manifesto, which is the UK’s only children’s manifesto with the support of eight political parties, was launched three years ago in response to that report.

A child’s development is mainly influenced initially by their primary care giver—usually their mother but often their father—and by others who are engaged with helping with their parenting. Parenting begins before birth. We have known for a long time that how we turn out depends on our genes and on our environment. Scientists now realise that the influence of the environment begins in the womb, and how the mother feels during her pregnancy can change that environment and have a lasting effect on the development of the child. So we all need to support and look after pregnant women, for their sake and that of future generations.

A stable and secure home learning environment is critical in the early months. Children, right from their infancy, need to be protected, nourished, and stimulated to think and explore and to communicate and interact with their parents and others. Babies are primed to be in relationships, and their earliest relationships really matter for the “ABC, 123” building blocks that lead to school-readiness. A young child’s earliest relationships develop their social brain, which will influence their later life. Eighty per cent. of our brain significantly develops in the earliest years and through our earliest relationships. I am focusing on that because it shows that healthy relationships really matter for our health and well being throughout life.

[Alex Cunningham]

I know we are trying to make this a non-partisan debate, but does the hon. Lady recognise that all the things she is talking about require resources? Some of our most needy communities have seen a loss of those resources in recent times, and we need to do something to redress that.

[Fiona Bruce]

I thank the hon. Gentleman for that intervention.

We need to focus on the fact that learning about and enjoying healthy relationships is a key determinant of future health, both physical and mental. Between 1.3 million and 2.5 million years of lives are lost as a result of health inequality in England. Many children never reach their potential throughout their life partly because of a lack of healthy relationships in their early years. Relationship breakdown is a significant driver of poverty and health inequality. A comprehensive cross-departmental strategy to combat health inequality must include measures to strengthen healthy relationships and combat relationship breakdown, which is at epidemic levels in our country.

I am chair of a mental health charity for children in my constituency called Visyon, which is overwhelmed by requests on behalf of children as young as four. When I asked its CEO how many of the problems of the children it helps are the result of poor early relationships in the home, he looked at me and said, “Virtually all of them.” This is an absolutely critical factor in a child’s early development and healthy life, particularly in relation to mental health. Interestingly, a wide-ranging survey by the Marriage Foundation published in May 2016, involving thousands of young people, found a noticeable difference between the self-esteem levels of children who were brought up in stable households and those who were not. Self-esteem acts as a predictor of a range of real-world consequences in later life.

When relationships break down, as they do in all socioeconomic groups, it disproportionately affects children in low-income families because they are less resilient in combating the impact. Half of all children in the 20% of communities that are least advantaged now no longer live in a home where they have healthy relationships—where, for example, both parents are still with them by the time they start school. I am not saying that a child cannot have a healthy relationship with one parent or another, but it is important that we grasp this nettle and appreciate that healthy relationships with a range of people—including, ideally, a mother and a father—are good predictors of early health. We should support that, and the Government and Health Ministers should be brave enough to tackle the issue. For too long, Ministers have shied away from looking at healthy relationships, yet we are happy to help and educate young people about how to build healthy bodies for physical health in life.

Relationship breakdown is a root cause of poverty. When relationship breakdown happens, households often suffer dramatic income reductions. There is also an impact with regard to infant mortality rates, hospital admissions and mothers in poor health.

I agree that we need more funding to strengthen relationships, to provide the early support that is needed in many different ways. We need to consider extending children’s centres so that they can become family hubs that provide support for the whole family. The recent report of the all-party parliamentary group on children’s centres, of which I am the chair, made that recommendation. We need to look at the availability of couple relationship advice, not just parenting advice. Sex and relationship education lessons in schools need a much stronger focus on relationship education. We need to provide a family services transformation fund, so that local authorities can share best practice. We need to do all of that to ensure that we give children the best start in life, and in particular to tackle the serious challenge of the mental health problems experienced by so many schoolchildren. So many headteachers say that it is a major issue with which they have to grapple.

In the final part of my speech, I want to refer to the different but not entirely linked issue of alcohol harm. I say that it is not entirely linked because people who experience or fall into addiction are often looking for a source of comfort in life that is missing from their relationships. I am not saying that it is not right to enjoy drinking, but it needs to be healthy drinking. Alcohol harm is a major issue in our society and I do not believe that the Government are doing enough to address it.

The Government must do more to tackle health inequality. For example, in January the chief medical officer published her recommendation that it is wisest for women not to drink during pregnancy. Pregnant women are advised to make that choice, yet there has been wholly inadequate publicity for that recommendation. I speak as the vice-chair of the all-party parliamentary group on foetal alcohol spectrum disorder. We have heard heartrending evidence of the impact of alcohol on children’s lives, including their physical and mental wellbeing. It is particularly important to note that, according to the evidence that we have heard, women’s bodies tolerate alcohol at different levels, which is why the best advice is to not drink at all during pregnancy. I challenge Health Ministers, particularly in the run-up to Christmas, to get that message out so that pregnant women hear it and can make that choice.

Alcohol harm impacts on the health not just of the individual, but of those around them. One in five children under the age of one live with a parent who drinks hazardously. Alcohol is implicated in 25% to 33% of child abuse cases, and it generates a substantial bill for UK taxpayers with regard to the impact on emergency services. The all-party parliamentary group on alcohol harm will publish a report on that on 6 December, and I am pleased that my hon. Friend the Member for Totnes (Dr Wollaston) has contributed to it. I hope hon. Members will take note of it, because alcohol abuse has a disproportionate impact not only on emergency services, but on the number of accidents and fires in the home. The report will spell that out. The charity Balance has shown that between 2014 and 2015, the rate of alcohol-related admissions in England from the most deprived decile was more than five times greater than the rate for those from the least deprived decile. That puts pressure on already burdened systems.

I want to finish with a point that now arises continually in my work on alcohol harm, namely the impact of cheap alcohol. Let me tell Members a fact that may surprise or even shock them; it shocked me when I first heard it. For the cost of a cinema ticket, it is possible to buy almost 7.5 litres of high-strength white cider, containing as much alcohol as 53 shots of vodka. Many homeless people, and many people who are in a vulnerable state in life, are drinking that product, which has been likened to a death sentence. In the hostels run by the homeless charity Thames Reach, 78% of deaths were attributed to high-strength alcohol. Not for the first time, I urge Ministers, for the sake of the health of the most vulnerable in society, to consider a minimum unit price for all alcoholic drinks. That is a targeted and effective intervention that would save lives and reduce health inequalities considerably. Potentially, according to the Institute of Alcohol Studies, eight out of 10 lives saved as a result would be from the lowest income groups.

We need better education to inform young people about the effects of alcohol harm, so that they can make better choices and so impact on their own health. We need improved alcohol treatment services because they are inadequate. More than half of drug addicts receive treatment, but only one sixteenth of alcohol dependants do. We need to invest more in recovery for those who are suffering the effects of alcohol addiction and harm. We need better and more effective alcoholism diagnosis in our hospitals and better rehab programmes. We need to support education better to help people not to fall into such difficulties in the first place.

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[Alison Thewliss (Glasgow Central) (SNP)]

I am proud to participate in this debate, and I am glad that the Chair of the Health Select Committee, the hon. Member for Totnes (Dr Wollaston) has brought it before the House today. This debate is an important one, in which I have a considerable interest.

The issue of health inequalities was one of the first that I got interested in as a teenager. Sitting in my modern studies class in Lanarkshire, I could not understand why any Government would allow people in less well-off areas to disproportionately suffer ill health and die prematurely. I was frustrated when I read about the Black report and the inverse care law. I was angry then, and I am angry now that the political decisions taken here are the root cause of that mortality and morbidity that still blights too many lives in our country today. It is unacceptable that male life expectancy in parts of Glasgow should vary by 15 years, between the ages of about 66 and 81. In the case of women, the gap is 11 years. I got interested in politics because I wanted to change that: I wanted to understand why it was, and I wanted to know what I could do to help.

I joined the SNP when I was at school. I know that today’s debate has not been too party political, but I think it is important to put this on the record, because it is important to me. I joined the SNP because I could see that the health of Scotland’s people in particular was not a priority at Westminster. When I was at school there was no Scottish Parliament, and there was no way in which we could deal with the issue ourselves.

The hon. Member for Stockton North (Alex Cunningham) mentioned the Black report. The way in which that report was greeted was quite telling, as is the fact that we are still discussing many of the issues now. The Marmot report has not yet been implemented, and the obesity strategy is still not as strong as it could be. It has not been possible to tackle the underlying causes of health inequality, but I believe that if the Scottish Parliament had all the powers of a normal Parliament, we would be able to deal with them more adequately than they have been dealt with in the past. [Interruption.] Some members may disagree with me, but that is what I believe. It is past health inequality that we are dealing with now, because there is a time lag.

[Alex Cunningham]

I do not disagree with the hon. Lady, but I think she must have misinterpreted my action. It was my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) who mentioned the Black report, and I was indicating him. No offence was meant.

[Alison Thewliss]

My apologies. I had to nip out to the loo earlier, and I must have got my wires crossed. I thank both Members for raising those issues. It is important for us to think about the context of the debate and where we are going.

I have been reading the report to which the hon. Member for Glasgow East (Natalie McGarry) referred. I pay credit to the in-depth work and dedication of the Glasgow Centre for Population Health. Its director, Dr Carol Tannahill, along with Bruce Whyte and David Walsh, lead much of that work. Along with their team of researchers, they have laid out the history of health inequality in Glasgow and in Scotland more widely. They have done a huge amount of research, and have come up with not only history, but some solutions.

In 2007, when I was first elected as a Glasgow councillor, the centre’s most recent report was “Let Glasgow Flourish”, but since then it has carried out a great deal of research on Glasgow’s “excess mortality”. It is interesting to note that that excess mortality applies across different causes of death, and across ages, genders and social strata, although it is most pronounced in members of the working-age population living in the poorest neighbourhoods, where the impact of alcohol, drugs and suicide, particularly among men, is stark. In comparison with Manchester and Liverpool, Glasgow experienced an extra 4,500 deaths between 2003 and 2007. In Scotland overall, there were an extra 5,000 deaths in each year between 2010 and 2012.

I shall not repeat what was said by the hon. Member for Glasgow East, but it is important to note that Governments knew that that was happening. The impact of their policies was known. Urban change, particularly in Glasgow, was taking place in a noticeably different way from the way in which it was happening in Liverpool and Manchester. It had a disproportionate effect on the population, and we still see the lag of that today. One of the reports produced by the Glasgow Centre for Population Health quotes from a 1971 Scottish Office report called “The Glasgow Crisis”, which noted that

“Glasgow is in a socially…economically dangerous position.”

However, nothing was done at the time. The urban regeneration in Glasgow took place in the shopping centres in the middle of the town, but did not touch the areas that needed it most.

Poverty and health inequality are incredibly difficult to turn around. They cannot be fixed by a sugar tax or any other individual health measure; a wide-ranging approach is required from all levels of government. Glasgow has worked incredibly hard, and has established a poverty leadership panel to examine some of the issues. The Scottish Government have invested heavily, and have set up a ministerial taskforce on health inequality. However, we must keep working harder and working together if we are to achieve a result.

Clyde Gateway is an urban regeneration company in my constituency. Members may wonder whether an urban regeneration company, which builds things and fixes the ground conditions, should be interested in health, but the company has been working for eight years in Glasgow and Rutherglen, and has learnt lessons from previous regeneration efforts. So far, it has managed to lower the claimant count for out-of-work benefits from 39% to 28% and the claimant count for jobseeker’s allowance from 8.6% to 4.8%. That is pretty remarkable in itself, but the company cannot go any further until it starts to tackle the underlying health issues that are keeping people out of work. It is therefore working closely in partnership with local organisations and local people. It is crucial that local people are part of the process and are not having things done to them, as was the case before. They are now part of the solution and the community is a part of what is happening.

Clyde Gateway recently signalled its intention to seek a means of tackling health inequalities. It wants to work to improve diet and cancer screening, which are both factors in the area’s ill health. There is a lot of worrying evidence that people in areas of deprivation are not taking up the screenings to which they are entitled. Those screenings include tests for cancer and free eye tests, which can also be an indicator of other conditions. I spoke to the Royal National Institute of Blind People yesterday about early intervention and the importance of people going for their eye tests. Clyde Gateway also wants to grow jobs in health and social care in the local community to make people working in the industry part of the community as well, rather than having staff coming in from other areas to “do” health to people.

I wholeheartedly agree with the notion that public health ought to be everybody’s business. It is not just for public health officials to do on their own, because the roots of health inequalities are to be found in income inequalities. So in Scotland we are tackling some of the underlying causes. The living wage uptake in Scotland now far exceeds the uptake in other parts of the country. We are supporting families and helping to improve the physical and social environment and housing. We have invested heavily in housing, because much of the ill health was coming from housing that was damp and substandard. Housing was making people ill and was not being tackled.

We have increased free school meals and continued commitments such as free prescriptions, concessionary travel and free personal care. The hon. Member for Bradford South (Judith Cummins) talked earlier about tooth-brushing and the rates of tooth decay. In the mid-1990s, when I was starting secondary school, just under 40% of children in primary 1 in Scotland—those just entering school—had no dental cavities. That figure is now just under 70%, which is pretty good and marks quite a shift, but we need to go a lot further. Initiatives such as Childsmile, through which all children in Scotland regularly get free toothbrushes and toothpaste, are helpful.

As the hon. Members for Totnes and for Congleton (Fiona Bruce) mentioned, a lot of work is being done on minimum unit pricing to reduce alcohol consumption and deal with many of the issues that lead to people buying low-price cheap alcohol, which is killing them. We have reduced smoking rates, too, by bringing in the smoking ban first, and we are doing a lot of work to encourage active living and healthy eating, and investing to improve mental health services.

As chair of the all-party group on infant feeding and inequalities, I want to take this opportunity to speak about breastfeeding and the impact it can have on health inequalities. James P. Grant, executive director of UNICEF during the 1980s, said that

“exclusive breastfeeding goes a long way towards cancelling out the health difference between being born into poverty or being born into affluence. It is almost as if breastfeeding takes the infant out of poverty for those few vital months in order to give the child a fairer start in life and compensate for the injustices of the world into which it was born.”

That is quite a statement.

Sadly, there is a huge inequality in breastfeeding, particularly in the UK. Women in areas of greater deprivation are far less likely to breastfeed. They are then also often paying for expensive formula milk, which will put a strain on their family budget.

I was once told by a Labour councillor in Glasgow that in his experience there was an inverse perverse stigma: if a woman breastfed, it made her look as though she was too poor and could not afford the formula. The cost is a big issue, however, as I highlighted in my ten-minute rule Bill last week.

Families are being penalised for a societal problem: the UK just does not provide enough support, via midwives, health visitors, peer supporters and local networks, to ensure that mums are able to breastfeed for as long as they want to. Some of the economic agenda is having an impact on those important services, and coverage is fraying, as volunteer services find it harder to cope. It is seen as difficult, and there is so much blame and shame for mums, whatever they do and however they feed their children.

Many younger women have never seen anyone breastfeed. There is also interesting evidence from Sally Etheridge that the longer that black and minority ethnic women who have come to the UK from other countries stay here, the lower their breastfeeding rates become as they begin to assimilate into our bottle-feeding culture. I believe that there is a lot we can do to improve this situation and encourage the Government in that regard. I met the Minister earlier this week and am glad that she is listening and keen to address the breastfeeding rates across the country.

The series on breastfeeding from The Lancet and the UNICEF report on preventing disease and saving resources point out that the NHS could save significant amounts of money by investing in breastfeeding services. They reckon that there would be 3,285 fewer hospital admissions for gastrointestinal issues and 5,916 fewer admissions for respiratory tract infections, which could save £10 million across the country. That is no mean feat. There would also be connected reductions in obesity and sudden infant death syndrome, as well as a reduction in breast and ovarian cancer in the mum. Breastfeeding is a significant public health intervention, as the UNICEF call to action has illustrated.

I should like to summarise a few of the suggestions in the Glasgow Centre for Population Health report, as it is the purpose of our debate today not only to look at the problems. Health interventions on smoking, alcohol and so on have helped, but the report has found that the main means of resolving health inequality is not a health intervention but a wealth redistribution. A widening gap in income has been perpetuated by different Governments over many years. Fair and progressive taxation and fair wages would make a huge difference to the gap. Ensuring that all people have a sufficient income is critical, yet this Government continue to slash social security spending, which is making people not only poor but ill.

An NHS Health Scotland report published this month said that a quarter of lone parents in Scotland rated their health as either fair, bad or very bad. Those parents have to look after children. If their health is fair, bad or very bad, they will not be able to be effective parents. The impact of food banks on health is also clear. If people cannot afford to put food on the table, they have to resort to going to a food bank to get canned meals. They do not get fresh food and vegetables; they get something out of a can that they might not even be able to heat. That will have an impact not only on their physical health but on their mental health.

The GCPH report looks at the cost of living and at how we as a society can support people to live with dignity and live a life in which they have choices. Having choices in life should not be a luxury. If someone does not have any control over what happens to them in life, it will have a huge impact on them and their family for years to come. The report also recommends affordable, warm and appropriate housing. As the hon. Member for Hackney South and Shoreditch (Meg Hillier) said, not having somewhere affordable and warm to live can have a huge impact on people. We need to learn from past mistakes and look more widely at the policies we pursue and the things that we in this House think are important, because they can have long-lasting effects, as we have seen in Glasgow.

Most significant to all of this is the adoption of the World Health Organisation’s principle of including health in all policies. This must run through absolutely everything that the Government do, because of the impact on health. Yesterday, the Chancellor failed to address health spending; indeed, he failed to address the question of health at all. He is failing the people of this country by not acknowledging the significance of health to everything else that the Government wish to achieve.

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[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), on her characteristically thoughtful opening of this debate. I thank the Backbench Business Committee for agreeing to the debate, which has been not only highly informed, but very wide ranging. I will therefore start by apologising for the fact that I will not be able to comment in detail about all the points raised, but I will reply in writing where I am not able to respond. Colleagues are right to say that the Prime Minister has made this issue a national priority, so it is not surprising that the Government share the commitment of the House to having an effective cross-Government policy that will reduce health inequalities.

We are recognised as world leaders in public health, and that has been achieved by avoiding the temptation to put health inequality in a silo. Marmot, as many have pointed out, is clear that an approach to treating health alone will not tackle what we here know are some of the most entrenched problems of our generation. We have avoided a health-only approach in the past, which is why the Chancellor’s autumn statement yesterday announced important and relevant measures such as raising the national minimum wage, raising the income tax threshold and providing, as the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, rightly observed, an additional £1.4 billion to deliver 40,000 extra affordable homes. That provision is in addition to the Homelessness Reduction Bill.

It is right that we also look to the work of industry and non-governmental actors. I am pleased to say that the food and drink industry has made progress in recent years. Its focus under voluntary arrangements has been on calorie reduction. Billions of calories and tonnes of sugar have been removed from products, and portion sizes have been reduced. Some major confectionary manufacturers are committing to cap single-serve confectionary at 250 calories, which is an important step forward. As my hon. Friend the Member for Erewash (Maggie Throup) mentioned, some retailers have played their part by removing sweets from checkouts, while others have cut the sugar in their own-brand drinks. We welcome that and urge others to follow suit. The challenge to industry to make further substantial progress remains. We should praise those who have had success, but we will continue to challenge those who lag behind.

Colleagues are right to highlight the importance of employment, and it is encouraging to see that some gaps are narrowing. As the Chancellor said yesterday,

“over the past year employment grew fastest in the north-east…pay grew most strongly in the west midlands, and every UK nation and region saw a record number of people in work.”—[Official Report, 23 November 2016; Vol. 617, c. 900.]

But there are still some who are left behind, which is why our health and work Green Paper is specifically focused on driving down the disability work gap for those who wish to work. It is this emphasis on the social, economic and environmental causes of inequalities that convinces me that public health responsibilities as they are traditionally understood do rightly sit in local government, where national action can be reinforced and resources can be specifically targeted at pockets of inequality within local populations.

Let me respond to the concerns raised by my hon. Friend the Member for Plymouth, Sutton and Devonport (Oliver Colvile) about his GP practices. When a GP practice closes, NHS England has a responsibility to make sure that patients still have access to services and are not misplaced. I am pleased to hear that he is making some progress on the matter, but if he finds that he reaches a roadblock, I will be happy to raise his concerns with the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), who has responsibility for community health.

Although, as a number of colleagues have said, councils have had to make savings and are acting in tough financial circumstances, they are still accessing £16 billion over the next five years from their public health grant. They have shown that good results can be achieved while efficiencies are found and the greatest effect is generated. There are a number of examples of outstanding practice to which we should pay tribute today. The HIV innovation fund, for example, which is funded by Public Health England in collaboration with local government, provides funding for services that meet local needs and offers the most at-risk populations free, reliable and convenient alternatives to traditional HIV testing. That is happening at a time when driving up HIV testing is a key public health priority.

As my hon. Friend the Member for Totnes rightly noted, however, we must focus on key determinants such as obesity, smoking, suicide and alcohol. That is the core of the challenge that we face, which is why we are working closely with our partners in the NHS, PHE, local government and schools to deliver the childhood obesity plan. That subject has been raised by many speakers today and I assure the House that the delivery of the plan has started. We have consulted on the soft drinks industry levy and launched a broad sugar reduction programme. Those measures will have a positive impact, particularly on lower income groups, which are disproportionately affected. As many colleagues have mentioned, the measures will have secondary benefits, such as better dental health and diabetes prevention.

As was mentioned by my hon. Friends the Members for Erewash and for Taunton Deane (Rebecca Pow), it is particularly important that we focus on effectively delivering a key plank of that obesity plan: the hour of physical activity every day. One of the ways in which we will make sure that is delivered effectively is by introducing a new healthy rating scheme in primary schools to recognise the way in which they deliver this and to provide encouragement. I believe that we have delivered the right approach to secure the future health of our children, but I am determined that we will implement it quickly and effectively, and I am very happy to enter into discussions about how we make sure that that implementation works.

I entirely agree with hon. Members on both sides of the House that mental health must not be forgotten when we are discussing health inequalities. We have made progress, but parity of esteem must be more than just a phrase; it must be backed by increased funding and effective reform. That is why we are investing an additional £1 billion every year by 2020 to help 1 million more people with mental illness to access high-quality care, including in emergency departments, as well as putting in place a record £1 billion of additional investment in children’s mental health. That money is funding every area in the country. We are working hard to make sure we drive these reforms to the frontline, including, as my hon. Friend the Member for Totnes said, by refreshing the suicide strategy with a particular focus on the alarming figures for suicides among young men and for self-harm.

There can be no complacency about the scale of the challenge, as the figures quoted today forcefully remind us. We know that inequalities can be stubborn to tackle. Variations in smoking rates, particularly in pregnancy, persist, and concerted efforts are required to tackle that. That is exactly why I am prioritising the tobacco control strategy so that we can use our combined efforts to target vulnerable groups, including pregnant women, mental health patients and children, and reduce those differences, not least by supporting local areas to use data effectively to understand how best to target their policies.

[Alex Cunningham]

Can the Minister offer us a timescale for the tobacco strategy?

[Nicola Blackwood]

I cannot, because I am not yet satisfied that it is as effective as I want it to be.

In addition, I am pleased with the action we have taken to introduce standardised packaging for cigarettes and other legislative measures. We have also launched the world’s first diabetes prevention programme, as mentioned by the hon. Member for Heywood and Middleton (Liz McInnes), and we had a very good debate just yesterday about how we can improve diabetes care. We also have one of the most effective immunisation programmes in the world. That shows our commitment to take firm action where the evidence guides us, but as I have said, that action must be cross-government, at both a local and a national level.

Our job is to put prevention and population health considerations at the heart of everything we do, as the five year forward view makes clear. Devolution deals are giving local areas more control over many of the social determinants of health, such as economic growth, housing, health and work programmes, and transport. The focus on integrated public health services within devolution promises to remove many of the structural barriers to prevention that we have discussed today, and it makes public health everyone’s business, exactly as the SNP spokesman, the hon. Member for Glasgow Central (Alison Thewliss), said.

However, with devolution, to which the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) referred, and as we move towards business rates retention, transparency will be ever more vital to ensuring that public health outcomes improve. That is happening, but we need to go further, and we need to do more to engage local people and their elected councillors in highlighting the unjustifiable inequalities that persist. Ensuring that transparency translates into accountability is a key priority for me, and I assure the House that I am actively involved in this matter.

Members on both sides of the House are right to launch this challenge today, and I take fully on board their suggestions of how we can collectively reduce health inequalities. However, I hope that I have made it clear that the only way we are going to make progress on this issue is to adopt a whole-Government, whole-society approach. We have to constantly remind ourselves that reducing these inequalities is for not just the NHS or Public Health England, but the whole of Government, as well as local areas, industries and, indeed, all Members of this House. Today I reaffirm my commitment to work together with the widest range of partners, inside and outside Government, to make progress on this agenda. I hope that every Member here will do the same, because we owe our constituents nothing less.