Neglected Tropical Diseases

Lord Rea Excerpts

Monday 3rd April 2017 Lords Chamber

[Lord Rea (Lab)]

My Lords, the noble Baroness, Lady Hayman, deserves our thanks for asking this Question and for her persistence with NTDs. She makes sure that these debilitating diseases are not neglected, at least in your Lordships’ House. Because these diseases are now mostly treatable, the accent up to now has been on medication, with less emphasis on prevention. But the underlying causal factors will allow the diseases to return, requiring repeated medication if they are not addressed. An example of this is onchocerciasis, or river blindness, where it is extremely difficult to eliminate the insect vector—a tiny blackfly. Repeated courses to treat river blindness are often necessary.

Tackling the causes, as at least two if not three previous speakers have said, requires the introduction of clean water, sanitation, improved hygiene and vector control where possible. As my noble friend Lord Stone said, this is encapsulated in the acronym WASH, which is now very much part of the NTD programmes of the WHO, DfID and other agencies. Of course, WASH plays a big part in the control of other diseases and the elimination of extreme poverty. We should remember that the provision of clean water and sanitation was and still is a basic part of all public health, dating from the time of our great-grandfathers in the 19th and early 20th centuries. Much earlier, water-borne sanitation was used by the ancient Romans, but with the decline and fall sanitation was also lost. Can the noble Lord, Lord Bates, give us a report on international progress with WASH programmes across the board and DfID’s part in them?

I also repeat the request of the noble Baroness, Lady Hayman, for information about the development of new vaccines for NTDs. In particular, I wonder whether we are having success in developing new point-of-care rapid diagnostic tests. These can greatly increase the cost-effectiveness of treatment programmes because it is possible to identify people who are not carrying the disease.

As a further point, the Leprosy Mission is concerned that not enough is being done to control and eradicate that stigmatising neglected disease. There are still pockets around the world where it is not eliminated. Can the Minister say whether DfID’s role in this will continue—it already plays a certain part—and, I hope, be stepped up?

Finally, I follow other speakers in hoping the Minister can assure us that the UK’s contribution to the international collaboration on NTDs will continue to be adequately funded, Brexit or not, and help to achieve the UN’s sustainable development goals.

UN: Sustainable Development Goals

Lord Rea Excerpts

Tuesday 16th June 2015 Lords Chamber

[Lord Rea (Lab)]

My Lords, we should all be grateful to my noble friend Lord McConnell for initiating this very timely debate on an extremely important subject. Looking back, I think it is fair to say that most people working in international development agree that the millennium development goals, now about to expire, provided a useful framework for action to improve health and, to some extent, reduce poverty in the developing world, whether or not those goals were fully achieved.

The post-2015 SDGs, which we are considering now, have been developed as a result of very wide consultation, which helps explain why there are so many of them—17 goals, with an average of 10 targets each, is a seemingly unmanageable number. It apparently proved difficult to narrow the number down even this far, since every nation had its own set of priorities. For each target, there still needs to be further scrutiny on how to measure and assess whether they have been achieved, how to monitor them in the future and, particularly, how they should be financed. Much of this work is ongoing and will continue until they are finally ratified at the end of the year, and after that too. Until then, there is a window of opportunity to hone the detailed targets further. The noble Baroness, whom I welcome warmly to her seat, will undoubtedly tell us about DfID’s work on the SDGs.

I will concentrate on goal 3, covering health, particularly the fourth part of it which is to,

“reduce by one-third pre-mature mortality from non-communicable diseases (NCDs) through prevention and treatment, and promote mental health and wellbeing”.

NCDs, by which I mean obesity and diabetes leading to heart disease, stroke and cancer, cause most of the deaths and the greatest burden on health services in developed countries such as our own. However, they now also cause more than half of all deaths in the developing world. Unlike the MDGs, which were aimed at the developing world, the post-2015 sustainable development goals have a worldwide application. The determinants of NCDs are wide but can be summarised as being associated with the post-industrial physical and nutritional environment in which most of the world’s population lives or is affected by. Unsuitable, often processed, food leads to obesity, overweight and diabetes, even among the poorest. This, with lack of physical activity, underlies heart disease, stroke and some forms of cancer. Tobacco smoking, the main cause of many cancers as well as heart disease, is still very prevalent, especially in the developing world. Atmospheric pollution also plays a role, particularly in the mega-cities of the developing world, in which an increasing proportion of the world’s population now lives.

Many of these determinants are touched on in the sustainable development goals. Obviously, I will not spell them out as that would be very tedious and take too long, but here are a few examples. Target 4 under goal 3, to,

“reduce … pre-mature mortality from non-communicable diseases”,

is felt by some to be discriminating against older people. The word “avoidable” might be a better word than “pre-mature”. Little changes such as that would improve those targets. Target 3.a, to “strengthen implementation of” the WHO Framework Convention on Tobacco Control, needs to be emphasised. Target 2 of goal 2, to end malnutrition, should also include obesity as well as stunting and wasting; discouragement and, if necessary, regulation to reduce added sugar and fat in processed food and soft drinks should be included at some point.

Physical activity and atmospheric pollution are covered in goal 11, which concerns cities and includes targets on housing and mentions road safety,

“with special attention to the needs of those in vulnerable situations”.

Here I would include cyclists and pedestrians in order to encourage physical activity, and there are many other ways in which urban design can encourage a healthy lifestyle. More places in the draft document could be tweaked beneficially, but a short debate is not the place to lay them out in detail.

I have been briefed for this speech by the UK Health Forum, of which I declare an interest as its honorary president. Its detailed response to the draft SDGs will come shortly to the Department for International Development, Public Health England and the international section of the Department of Health, which I think is now called NHS England.

Earlier, I asked the noble Baroness how DfID is approaching the September summit finalising the SDGs. I hope that she will talk about that. I would also like to ask her how, and at what level, the UK is approaching the imminent Addis Ababa meeting on the financing of the SDGs, because on that everything else depends.