Health

Lord Rea Excerpts

Thursday 26th November 2015 Lords Chamber

[Lord Rea (Lab)]

My Lords, I thank the noble Lord, Lord Crisp, for introducing this important debate and his excellent speech. I declare an interest as a long-time trustee and now honorary president of the UK Health Forum, the public health think tank co-ordinating some 80 national organisations interested in upstream or primary prevention of non-communicable disease. The noble Lord has drawn attention to the wide spread of social and environmental factors behind our current burden of disease, and shown that many causes of those diseases lie outside the remit of the National Health Service. To prevent or delay their onset requires political and economic engagement rather than traditional public health solutions, important though they still are.

Historically, public health measures have been regarded as an imposition on individuals and industry, because they require changes in behaviour or the products of industry. They are regarded pejoratively by some as the “nanny state”—a term particularly favoured by some who may be financially affected by the changes needed to protect public health.

To divert from the general to the particular, the marketing of harmful food products could be curtailed and their composition improved by regulation and taxation—for example, of their sugar content. Here, I echo other noble Lords. The voluntary approach, the responsibility deal, has not worked, although it has been in place for five years. If all sections of society enjoyed the health status of the best off and best educated in the population, the health status of the whole nation would be greatly improved. To achieve the noble Lord’s health-creating society, we should logically consider the factors that favour the upper layer and bring them, as far as possible, to all sections of the population, to bring the bottom section closer to the top.

Most of us know the most common risk factors for heart disease, stroke, obesity, diabetes and some kinds of cancer. These are, of course, cigarette smoking, physical inactivity, poor diet and so on. It is true that the least well off have higher risk scores and that these show a gradation from the poorest to the most favoured groups of the population. A number of studies, particularly those by Sir Michael Marmot—who seems to be the father of this debate—and colleagues, have shown that when all the known risk factors are taken into account, the social gradient of health remains. The NHS can affect only a small part of these health inequalities, which have their roots in the social fabric and economy of the country.

From conception onwards, the odds are stacked against the less privileged in diet, housing, working conditions and social status. Low income is the dominant feature of the lives of the underprivileged. The environment in which children are brought up is particularly important, especially the early years from conception onwards, as other noble Lords have pointed out. Poor nutrition and social deprivation may lead to chronic disease in later life. To protect children from the effects of poverty and deprivation should be number one on the list of any policy to promote health.

In this connection, I ask the Minister about the present status and funding of Sure Start centres. They were beginning to have some effect, but some of them have had to close and others are struggling because of local government cuts. Has the Minister any news for us on Sure Start centres?

To build a resilient society, a wide range of improvements need to be made, and many or most of them have already been mentioned. Nearly every government policy has a health dimension. This should be assessed. I suggest that the Cabinet-level committee looking at the health impact of all government policy should be restored. Here I very much agree with the suggestion of my noble friend Lady Jay that a Cabinet-level Minister should look after public health.

Welfare benefits have been developed over the past century for good reason: to protect the vulnerable. To cut them further, as is still planned despite the Chancellor’s decision to listen to your Lordships’ House on tax credits, will diminish the health and resilience of the population.