Commonwealth

Lord Crisp Excerpts

Thursday 16th March 2017 Lords Chamber

[Lord Crisp (CB)]

My Lords, I very much welcome the debate and appreciated the way in which the Minister introduced it. Over the last 10 years or more, I have worked mainly in Africa and have come to understand the Commonwealth much better—what extraordinarily strong links we have as a member of the Commonwealth; what a powerful voice in the world it is and could be; and how important it is, particularly for the poorest countries and particularly in Africa.

I know that these points are reflected in the Foreign and Commonwealth Office’s priorities for the Commonwealth—I think here particularly of the last three. The third priority is:

“Promoting Human Rights, Democratic Values and the Rule of Law”.


I understand the enormous challenges in all three of those areas. I think in particular of the rights of people who are lesbian, gay, bisexual, transgender or intersex, which were so eloquently discussed by the noble Lords, Lord Scriven and Lord Cashman, and by others. As the UK strengthens its role in the Commonwealth, it is very important that it continues to speak up about these rights and voice its concerns, about not only those rights but other human rights abuses.

The fourth area of priority for the Foreign and Commonwealth Office is:

“Supporting sustainable development and prosperity”.


Those issues are important for the UK, as well as for every other member. Its final area is about “Championing understanding within” this wonderful, worldwide diverse community.

Against this context, I want to speak specifically about health, development and prosperity, and the links between the three. I stress the links because too often they are treated as if they are separate issues, but they are intimately connected. I want to put forward the argument that an emphasis on these three together should be made within the Commonwealth and should feature at the Heads of Government meeting next April. Doing so will contribute enormously to these wider goals.

I will make three main arguments, give a current example that is very effective and put forward a specific proposal for the future. The first argument is about the economic impact of health. This is often neglected and we think about health and health services as a cost. It is time that we showed that that assumption is wrong. There are costs and benefits from investment in health. It is perfectly true that the wealthier a country is, the more it can spend on public services including health, but it is equally true that good health is a driver of productivity and that poor health destroys it. We need only look at the HIV/AIDS epidemic in Africa to understand how it reduced economic growth over many years with detrimental impact throughout the southern part of the continent at least. We equally need to look at other countries where they have had improved health which has led to improved productivity and economic performance. There is also the demographic dividend, which is that as children get healthier and survive more often, families become smaller and the dependency ratio within a country reduces. It is really a health dividend that we should be very conscious of in thinking about policy.

There is more to it than that. The recent UN commission on health employment and the economy demonstrated that employing more health workers is beneficial to the economy, improving health, education and economic prospects in the country as a whole, but there is even more to it than that. Health is the fastest growing major industry in the world. It is growing at 5% globally and at 8% in south-east Asia. Commonwealth countries need to have their share of it. We in the UK know that the biomedical and life sciences need to be a major part of our industrial strategy. We have 4,800 companies in this sector, turning over more than £55 billion. We heard from my noble friend Lord Broers who spoke eloquently about the need to work with Australia and other Commonwealth countries to invest and grow this sector, whether it is through the prosperity fund or other routes.

My second argument is about the links between health and all other aspects of development. There is abundant evidence that health and education are linked. We know that in India the children of girls with five years of education are 40% more likely to survive to the age of five, but we also know that it is the other way round as well and that ill-health impacts on education and opportunities. For example, in some southern African countries about 40% of children are stunted. That impacts on their mental development, all their achievements and subsequently on the economy and everything else. We should not see these issues as separate; the central point here is human development, or human flourishing, as Amartya Sen would call it.

My third argument turns to the House of Lords report on soft power, which was chaired by the noble Lord, Lord Howell. It emphasised that the UK is the best-networked country in the world. He and others have expanded on the idea of the Commonwealth as a network today. Health is an extraordinarily influential network. There are 6 million or so nurses within the Commonwealth and doctors are intimately linked with their partners in other parts of the world. There are any number of partnerships between UK institutions and health institutions throughout the Commonwealth. I am reminded of the health partnership scheme promoted by the Government and hope that it will indeed continue. People care about health; they link with each other and share. Health is one of the streams that will help us to have greater understanding within the Commonwealth. Investment in health provides wide-ranging economic and social benefits and the Commonwealth should see it as a priority.

Let me turn to my examples. The first is the current one: the Queen Elizabeth Diamond Jubilee Trust has money raised from the Commonwealth. It has set up a trachoma initiative with £41 million, which is being managed by Sightsavers. I had the great privilege to chair the organisation at the time, although I no longer do so, and I declare my interest. It is having an extraordinary impact in the Commonwealth: 11 million people have been treated and it has great partnerships. There are all the benefits that have been talked about. It benefits the poorest most, it benefits women most, because women, surprisingly, are more likely to be blind, and it allows people suffering from this disease, and their carers, to return to work.

My second example for the future is to urge that the Commonwealth should play a major role in a new global campaign for the development of nursing. Members of your Lordships’ House will well understand how vital nurses are in every country in the world, but particularly in low and middle-income countries where very often they may be the only health workers that anyone sees. A recent study by the UK’s All-Party Parliamentary Group on Global Health, which includes Members of your Lordships’ House, with the support of the Commonwealth Nursing and Midwives Federation looked at the development of nurses globally. It made three very important points. First, universal health coverage will not be achieved without developing nursing globally. They are the largest part of the profession. Secondly, nurses are very often undervalued and underutilised within the system, perhaps because they are women or perhaps because they are not doctors. We very often train them to a high level and then, in practice, we do not permit them to work to that level. Nurses could have an even more significant impact in the future. Thirdly—and this is a very important point—developing nursing will have a triple impact in contributing to three of the sustainable development goals: improving health, promoting gender equality and strengthening economies.

As the result of the popularity of our report with people around the world, we have decided to launch a global campaign to raise the profile of nursing globally, support the empowerment of women globally through employment and develop local economies. I am delighted to say that the World Health Organization has already given its support, and we are in very positive discussions with the Commonwealth. That has partly been with the Commonwealth Secretariat—I echo the comments of other noble Lords about support for the noble and learned Baroness, Lady Scotland, in the important and very difficult role she is playing at the moment. But we have also had discussions with a large number of members, and already Ministers, senior officials and health leaders in countries as far apart as Jamaica, India and Tanzania have given their support. My noble friend Lady Watkins and I are meeting with the Commonwealth Advisory Committee on Health next week to present this proposal. Planning is under way.

I very much hope that the Government will give serious consideration to including health, development and prosperity, linked together, and in particular this global nursing campaign on future Commonwealth agendas and at the Heads of Government meeting in April next year. I ask the noble Baroness, Lady Anelay, whether she would be willing to meet with my noble friend Lady Watkins and me, and the leaders of the campaign, to take this forward.

Queen’s Speech

Lord Crisp Excerpts

Thursday 28th May 2015 Lords Chamber

[Lord Crisp (CB)]

My Lords, I will use my few minutes to speak about international development. International development is, of course, intimately linked with foreign policy and is fundamentally about the UK’s place in the world and how it is perceived by other Governments and other peoples.

In what has been already described many times as a divided and dangerous world, the UK’s commitment to development is a force for unity and security. Those of us who travel in the poorer parts of Asia and Africa—and there are many in your Lordships’ House who do—know how well the UK and DfID are thought of by many people in those countries, so I first congratulate the Government on their continuing support for development. This is not just about money, although 0.7% sends a very powerful message of support, but about the golden thread that the Prime Minister has referred to of supporting civil society, commerce, the rule of law and so on. It is also about the fact that the UK operates with a degree more flexibility than other large donors—more as a partner while of course keeping proper processes in place.

This flexibility and sense of partnership are vital for the future and need to be further developed. This is happening in a world where power is shifting and to some extent splintering, as so many noble Lords have already said. New approaches are being developed that are more equal, less top-down, less about richer countries imposing solutions—less, if you like, of the West knows best and more about supporting local leaders, local ideas and local innovation, some of which we ourselves can learn from. We are moving towards a time of greater co-development beyond simple aid. As we help to strengthen other countries, we can also strengthen our own.

International development is not the only area where the UK plays this enormously positive and healing role in the world. The arts, science and sports are other obvious areas. I was very struck by the report on soft power produced under the leadership of the noble Lord, Lord Howell, with its analysis of the UK’s strength and its vision for the country as becoming the best networked country, with relationships in all parts of the world. That report rather underplayed the UK’s role in health. Depending on exactly how you calculate it, health is now the biggest industry in the world and the UK plays a massive global role. This is one area where the UK is truly a global power.

The APPG on Global Health, which I co-chaired in the last Parliament, commissioned an exercise to match the UK’s contribution to health globally across the four sectors of commerce, government, academia and the not-for-profit and philanthropy sector. It found, as you might expect, that the UK has a major impact in all sectors, overall coming second only to the US in impact, and doing better than the US in some areas. We will publish the report in a month’s time, with recommendations for maintaining and developing that role. My question to the noble Baroness is very simple: do Her Majesty’s Government recognise the importance of health being part of foreign policy, and what will they do to make it more prominently so?

Let me finish by returning to international development. The sustainable development goals, which we believe will be agreed in New York later this year, will be another force for unity and peace in the world. I want to make three simple points about them. First, during the process of developing them over the last three years, the great statement was that they should “leave no one behind”. I believe that needs to be absolutely central to everything that happens around the SDGs, and that the UK, like others, must ensure that this is not just a nice and pious statement. That means suggesting and ensuring that all the appropriate indicators are identified and measured, so that we have disaggregated data.

The problem is real. Who are the people who get left behind? They are the people you would expect: people with disabilities; women, often; ethnic and cultural minorities; rural populations. For the UK, meeting this commitment also means maintaining the recently launched and very welcome disability framework for UK aid, which has once again put the UK in a leading position globally.

Alongside that principle of leaving nobody behind, I hope and trust that the UK will strongly support the development of universal healthcare and universal health coverage around the world, helping countries to create their plans for doing so. That brings with it the recognition that it will involve a massive increase in the number of health workers needed globally. The UK has an extraordinarily good track record in the education and training of staff, and it could play an even greater part globally in that regard.

Finally, and much more specifically, I turn to a topic in respect of which I ought to declare an interest as the chair of Sightsavers. I request that the Government maintain and enhance the investment they have already made in the elimination of neglected tropical diseases. There is still an enormously long way to go. We have seen around the world many examples of diseases almost being eliminated, only to return because we did not go the last mile. It is fantastically important that we keep up that process. It is also one of the most cost-effective of all health interventions, dealing with diseases that afflict the poorest people. It is an area where the UK plays one of the leading roles in the world; its scientists, as well as its health workers, are making real change happen.