The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, I thank the noble Lord, Lord Crisp, for introducing a debate on an issue of such global importance. Indeed, I am grateful to all noble Lords who have spoken so powerfully and I welcome in particular the noble Lord, Lord Collins of Highbury, to his Front-Bench responsibilities. Non-communicable diseases, or NCDs, kill millions of people across the world every year. Indeed, they are responsible for three in five of all deaths and bring illness and disability to countless more. People with NCDs are high users of health services worldwide. In England alone, around 70p in every £1 spent on health and care is spent caring for people with a long-term condition, the majority of which are as a consequence of the so-called four big killers: cancer, cardiovascular disease, chronic lung diseases and diabetes.
I listened with huge interest to the noble Baroness, Lady Hayman, and I am so glad that she gave way to temptation by joining our debate today. To pick up on what she said, non-communicable and communicable diseases combined can both devastate the lives of individuals and hinder the growth of whole countries. This is particularly the case in developing nations, which face the double burden of communicable and non-communicable diseases. The true prevalence of non-communicable diseases is often hidden in a number of countries, simply due to the lack of data. I shall come on to that in a moment.
The noble Baroness, Lady Masham, is right: the scale of the challenge is huge but it is not insurmountable. We start from a position of collective international commitment to act. The UK, along with other Commonwealth countries, has called for global action. The recent UN high-level meeting about NCDs, which a number of noble Lords referred to, raised awareness of the issue and culminated in a unanimous declaration by all member states stating their commitment to taking concerted action to prevent, manage and treat NCDs. There is a helpful practical focus on tackling the common risk factors and the WHO has introduced the idea of “best buys” that can be introduced by all countries at little cost.
My right honourable friend the Secretary of State for Health participated fully in that meeting. I take note of the disappointment expressed by the noble Lord, Lord May, but at the same time the meeting was an important first step and a sound basis for sustained action in the years and decades to come.
In reply to the noble Baroness, Lady Murphy, I say that mental health is referred to in the political declaration and the UK supported this inclusion, but we wanted to ensure support for the primary focus to be on tackling the common underlying risk factors and wider social and environmental determinants for the four big killers. We do not in the least underestimate the burden of mental ill health. I hope that the mental health strategy is evidence of that, but we believe that, once we see benefits from this initial focus, there will be positive impacts on health and well-being far beyond these four disease groups, including mental health. The linkages in risk factors were highlighted in the UN declaration.
Global health has long been a priority for the UK Government. I can tell the noble Baronesses, Lady Masham and Lady Hayman, that we are trying, working through both the Department of Health and the Department for International Development, to help developing countries to build health systems that can meet today’s challenges, including the problem of NCDs but also all causes of ill health, especially for the poorest in society.
The UK also supports multilateral organisations. We are the third largest donor to the World Health Organization and we support initiatives such as the Global Alliance for Vaccines and Immunisations, GAVI, to which the UK is the largest contributor. Indeed, GAVI has immunised over 250 million children against hepatitis B and saved over 3 million lives as a result. I was interested in the work of the noble Baroness, Lady Hayman, in promoting vaccine uptake in the third world.
Whatever we do, though, I fear that we need to face one unpalatable fact: we will not be able to eradicate NCDs, unlike smallpox. There is no obesity inoculation. Prevention alone, important though it is, cannot be the sole answer either at home or abroad. Globally, we continue to work to strengthen health systems so that they can provide early, cost-effective care to all who need it, including the poor and vulnerable.
I mentioned that we are strengthening the capacity of countries to deliver improved health services. This is a key area of DfID’s work. So, too, is the health partnership scheme, which facilitates links between UK health institutions and professionals from developing countries to improve health outcomes by sharing skills and capacity building. We are also supporting the medical training initiative, designed for doctors from developing countries to benefit from training in the NHS and foster exchange programmes. I pick up the point made by the noble Baroness, Lady Hayman, that we can learn from others overseas.
I can tell the noble Lord, Lord Crisp, that we also support research on global health. For example, DfID has recently launched PRIME, which stands for “programme for improving mental health care”. That is a new multinational research programme that will focus on the development, acceptability and impact of mental health care packages for priority mental disorders. We have also supported research on tobacco, and I can let the noble Lord have further details on those programmes if he is interested.
The noble Lord asked me about access to essential medicines. This is a priority for us. We are supporting countries to develop domestic health financing mechanisms to ensure sustainable and long-term funding for cost-effective interventions to tackle NCDs, not just drugs but diagnostics and vaccines as well.
Health services have a key part to play in reducing health inequalities in terms of access and quality and working with others to improve health outcomes. We need health systems not simply to treat disease but to be reoriented towards preventative action. As ever, as the noble Lords, Lord Crisp and Lord Kennedy, reminded us, prevention is better than cure—preventing the onset of disease rather than merely treating the symptoms.
Our health reforms in the UK are designed to strengthen our approach to improving public health. On the Health and Social Care Bill we will debate how there is a new health improvement duty for local authorities, supported by a ring-fenced public health budget. This will allow local decisions on health improvement to be taken about the interventions that are most suited to local needs. We think that that will represent a very responsive system, more so than we have at the moment. We are committed to reducing health inequalities, which is why for the first time, subject to parliamentary approval, we are putting into legislation a duty on the Secretary of State for Health focused on the need to reduce inequalities. That makes this the strongest health inequalities duty we have ever had.
First and foremost in the UK, we focus on prevention through an integrated approach as the major non-communicable diseases share a number of common risk factors. We address the causes of the causes, the underlying wider social and environmental determinants. The conditions in which people are born, grow, work and age, their education, employment and housing—all these shape the health of individuals and communities. The Public Health Cabinet Sub-Committee, which we established, allows a wide range of Cabinet Ministers to agree how best to respond to the public health challenges. The importance of taking a whole-of-government approach is emphasised in the UN political declaration.
We are a world leader on collecting data on public health, and other countries draw on our approach to surveillance. WHO is looking now to strengthen global monitoring of the prevalence of NCDs and the common risk factors, which is essential if we are to establish the kind of meaningful targets referred to by the noble Lord, Lord Rea. In England we are putting in place a new strategic outcomes framework for public health at national and local levels—again, in an effort to benchmark these matters—which will be based on the evidence of where the biggest challenges are for health and well-being.
On the domestic front, we are making progress on some of the key areas of action highlighted by the UN and we stand ready to share those experiences with others. NCDs share common risk factors—tobacco use, unhealthy diets, physical inactivity and alcohol misuse. Our actions, particularly on tobacco control and reducing salt intake, have been highlighted by WHO as international best practice.
The noble Lords, Lord Rea, Lord May and Lord Collins, rightly lay particular emphasis on tobacco policy. The UK strongly supports the WHO Framework Convention on Tobacco Control, and we take it very seriously. Tobacco use is by far the biggest risk factor for NCDs, so effective policies to reduce smoking rates are essential. We urge all countries that are not yet parties to the treaty to sign up to it as quickly as possible, and equally we urge all those who are signatories to implement the treaty fully, as we have done in this country. The convention encourages parties to take comprehensive action on tobacco control. The Tobacco Control Plan for England, published in March, sets out a range of actions that will bear down on tobacco use.
The noble Lord, Lord Collins, mentioned salt. As he knows, we have made considerable progress in recent years by working in partnership with industry and others to reduce salt intake. It has gone down by about 10 per cent in the past few years, which has served to prevent over 4,000 deaths a year and saved the NHS a great deal of money. We are taking that work forward as one of the pledges contained within the Public Health Responsibility Deal.
As well as these initiatives, which aim to tackle population health here in England, we are working to strengthen our primary care system, putting the patient and their GP at the heart of service delivery. This will reduce the impact of non-communicable diseases through programmes such as the NHS Health Check, which I hope is of particular interest to the noble Lords, Lord Kennedy and Lord Collins. Our NHS Health Check programme assesses people's risk of heart disease, stroke, diabetes and kidney disease. It has the potential to prevent 1,600 heart attacks and strokes a year—so I am told—to prevent over 4,000 people a year from developing diabetes and to detect at least 20,000 cases of diabetes or kidney disease earlier. It is an important programme.
The noble Lord, Lord Crisp, asked me about the training and the DfID programme. He suggested that DfID was too rigid on this, and too focused on NGOs. Health system strengthening includes training as a key part of DfID’s work. Globally, we provide training through a number of different organisations, including government organisations, NGOs and our contributions to multilateral organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. DfID estimates that 25 per cent of its aid to health supports human resources, including training.
The noble Baroness, Lady Hayman, spoke about neglected tropical diseases. I am pleased to tell her that, only yesterday, the UK announced that we would support the final push to eradicate guinea worm from the world. My honourable friend Stephen O’Brien yesterday issued a challenge: we will increase our support to guinea worm eradication and fill up to one-third of the financing gap, provided that others step forward and fill the other two-thirds. This funding would form a vital part of the push from former US President Jimmy Carter to ensure that guinea worm is consigned to the history books alongside smallpox. We have already committed £25 million over five years to tackle schistosomiasis, or bilharzia.
The noble Lords, Lord Crisp and Lord Rea, and my noble friend Lord McColl expressed doubts about engagement with the food industry in this country. We start with the recognition that people’s lifestyle choices are affecting their health. The Government cannot address this challenge alone through central, top-down diktat. Everyone has a part to play, not just government but also business, industry, retailers, the third sector and individuals themselves. The Responsibility Deal is not a substitute for the development of government policy on public health; it complements it. We also know that businesses can reach consumers and deliver information in ways that other organisations, including government organisations, cannot.
My noble friend Lord McColl spoke very powerfully on obesity. I would like to think that he and I are not so far apart as he perhaps indicated. We are clear that the Government cannot tackle obesity alone. It is an issue for society as a whole. We all have a role to play. We will shortly be publishing our plans for how obesity will be tackled in the new public health and NHS systems in England, and the role of key partners. I could not help feeling, listening to my noble friend, that we might be talking at cross purposes. There is surely a distinction between keeping healthy people healthy—and the advice that goes with that—and helping obese people become less unhealthy. For the latter group, my noble friend’s advice is surely spot on. The NICE advice, I suggest, is relevant and accurate for the former group. Diet has an important role, and we are indeed working to improve it, reducing the consumption of fat, sugar and excess calories. However, it is not tenable to suggest that physical activity is not important. I wonder whether my noble friend and I can agree that physical activity helps to balance the energy consumed. I look forward to a little conversation with him about that afterwards.
The noble Lord, Lord Roberts of Llandudno, spoke extremely convincingly about alcohol. Retailers, producers and pubs ought to promote, name, market and sell their products in a responsible way. We need to see leadership from them to produce a radical and better balance between business interests and social harm. I am encouraged to tell him that there has been a wide sign-up to the first set of collective pledges under the Responsibility Deal. Networks are already developing the next tranche of pledges. Again, by working closely with industry, we help it to shoulder its responsibilities and can go further and faster in developing the initiatives that we all want.
The noble Lords, Lord Kennedy and Lord Collins, referred quite rightly to diabetes. Our national diabetes service framework, begun in 2003, has been reinvigorated this year by a new NICE quality standard for diabetes against which future care will be measured. Our national diabetic retinopathy screening programme has been offered to 98 per cent of people with diabetes; that is a great record. A National Health Check programme for 40 to 74 year-olds in England includes an assessment for those at risk of developing type 2 diabetes as well as cardiovascular and kidney disease. That programme has real potential to identify people at risk of diabetes early and prevent its debilitating complications.
Now, I have a few apologies to make; first, to the noble Baroness, Lady Masham, who asked me about the training of doctors for pain control. I do not have information on that in front of me, but I will certainly write to her. I shall also write to the noble Lord, Lord Kakkar, who asked me about the proportion of NIHR funding on cardiovascular disease and any research network that there may be on that disease in the Commonwealth. He also asked me about UK funding for research on cardiovascular disease in developing countries, and I can tell him that the Indian Council for Medical Research is collaborating on several research topics related to NCDs; indeed, there is a collaborative research programme in Mumbai studying the impact of nutrition in pregnancy and early childhood on the risk of heart disease in later life, and its intergenerational effects.
I hope that what I have said will reassure the House that we are taking action on all fronts to prevent and manage NCDs both nationally and globally. However, concerted action is needed across Governments and industry to meet the challenges of NCDs. The human and economic consequences of inaction are too grave for us all to do anything else.