Health: Non-communicable Diseases

Baroness Hayman Excerpts

Thursday 6th October 2011 Lords Chamber

[Baroness Hayman]

My Lords, I have a double reason to be grateful to the noble Lord, Lord Crisp, for his introduction of today’s debate. Not only is it timely and important, it gives me the perfect justification for reversing my intention of keeping a dignified silence in your Lordships’ House until 2012. Instead, I shall use the opportunity of today’s debate to make my first speech after leaving office as Lord Speaker. This is also my first speech from the Cross Benches. In my 15 years in your Lordships’ House I have led a peripatetic life. I have spoken from the Front and the Back Benches, and from the opposition and government Benches. I fear that there is nowhere left for me to go. I look across to the Bishops’ Bench but the obstacles to that are many and insuperable, so I will probably have to stay where I am.

The reason why I feel justified in abandoning that intention of not speaking is because today’s debate chimes with so many of my interests—past and present. For four years I was the founder chair of Cancer Research UK. Having the privilege to do that made me aware of the burden of non-communicable diseases in the UK, particularly cancer, but also the growing threat and damage that those diseases cause in middle-income countries. The issue has already been raised today of their being in a way diseases of growing affluence. One needs look only at the increase in the incidence of lung cancer in China with the increase of smoking there. The noble Lord, Lord McColl, made us very aware of the dangers of diet leading to ill health in those major non-communicable diseases. It is important to recognise the role of public health in countries that are developing their health systems—public health in terms of surveillance, of education and of prevention.

There are often debates on whether health interventions in the developing world should be in terms of programmes or systems but, when DfID is looking at investment, the knowledge that we have gained in this country in terms of public health systems—based very much on having a comprehensive and truly national NHS—is an important gift that we can share with other countries. Another past interest as trustee of the Tropical Health and Education Trust also made me aware that it is not a one-way street when we talk about exchanging knowledge and healthcare professionals and practices with other countries. There is much that we can learn from the developing world in attitudes to medical problems and innovation. You need only look at the recent reports of how technology is being used in Tanzania to transfer by mobile phone the bus fare needed to women who have obstetric fistula. For them the problem is not the cost of the operation, because that is provided through charitable support to hospitals in that country; their problem is not having the bus fare to access that treatment. The innovations in technology being used through mobile phone networks can at a stroke end that problem. In that and many other areas there are possibilities to learn from other countries.

I should declare not a past interest but the only responsibility that I have taken on since leaving office in your Lordships’ House, which is as a trustee of the Sabin Vaccine Institute in the United States. That institute has as its mission:

“To reduce needless human suffering from infectious and neglected tropical diseases through innovative vaccine research and development; and to advocate for improved access to vaccines and essential medicines for citizens around the globe”.

Some noble Lords will have noticed that word “infectious” and perhaps considered that in another place I might be out of order because the debate introduced by the noble Lord, Lord Crisp, is about non-communicable diseases. I shall return to that in a moment because there are links between NCDs and NTDs that need to be explored.

Neglected tropical diseases are a tremendous scourge of the world’s poor. They are diseases of poverty. Of the bottom billion—the 1.4 billion people in the world who exist on less than $1.25 a day—virtually every man, woman and child will be afflicted by one or more of the seven most common neglected tropical diseases. These diseases have been disabling, disfiguring and blinding their victims for centuries. They have enormously debilitating effects on individuals and economies because they cause a lack of growth and well-being, not only for the patient but for the nation concerned. That is an important point to make to follow on from the noble Lord, Lord Roberts of Llandudno, in the argument about investment in overseas aid. At a time of global economic crisis, we need those middle and lower-income countries to be growing their economies, not for them to be ravaged by the effects of the diseases that make many of their citizens unable to contribute economically.

I said that I would deal a little with this interaction between communicable and non-communicable diseases. In many ways, neglected tropical diseases behave like chronic non-communicable diseases. They are chronic; their clinical manifestation—the weakening of the immune system and the resulting long-term disability—is very much the pattern of non-communicable disease. They have the same effects and therefore it is important that we recognise the interactions between them and the fact that those interactions are not only in the parallels that I have made but are in co-morbidities and often in the neglected tropical disease being the catalyst for the non-communicable disease.

There are many examples. Schistosomiasis is one of the areas in which the Sabin Institute is working on the production of a vaccine. We also know that urinary schistosomiasis is a leading cause of bladder cancer in Africa and the Middle East. Significant numbers of cases of anaemia are because of hookworm infections, and liver flukes account for a number of cancers. That connection is there and my plea today is that we do not only look at vertical programmes of health but look at the health systems that we are supporting in the developing world; and at the interaction of the sorts of social factors that have already been described, and of the communicable and the non-communicable diseases, in our attempt to end the scourge and the pain and suffering that are caused worldwide.