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Faculty Of Community Medicine Report

Volume 478: debated on Friday 18 July 1986

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11.7 a.m.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper.

The Question was as follows: To ask Her Majesty's Government what action they propose to take in the light of the recent report by the Faculty of Community Medicine at the Royal College of Physicians.

The Parliamentary Under-Secretary of State, Department of Health and Social Security
(Baroness Trumpington)

My Lords, the United Kingdom was closely involved in drawing up the European Region's WHO Strategy for Health for All from which the faculty's report is derived. The report draws attention to a number of this country's health problems for which we already have programmes of positive action in hand.

My Lords, I am grateful to the Minister for that reply. However, is she aware that, according to page 3 of the report, in dealing with deaths from heart disease, infant mortality, cervical cancer and lung cancer, we are not anywhere near as successful as other people and that in fact we are slipping considerably down the league? Can the Minister possibly tell your Lordships the reason for this, and say whether the Government have any plans to deal with the matter?

My Lords, we are very concerned at the level of premature deaths from heart disease in this country and have accorded it high priority in our preventative programme. Your Lordships are aware of the measures we are taking to tackle the known risks, such as smoking and diet. With the Health Education Council, we are intensifying the programme of health education through the issue of pamphlets, posters, TV programmes and publications.

With regard to infant mortality, the infant mortality rate in this country has fallen by 28 per cent., from 13.1 in 1978–79 to 9.4 in 1985. From WHO figures, of all the countries in Europe that had a rate lower than that of the United Kingdom in 1970, only three (Finland, Iceland and Switzerland) have shown a greater percentage decrease in mortality over the past 10 years.

My Lords, may I ask the Minister whether the Government have already commissioned a full review on preventative medicine, and whether the positive approach to good health care will cover all government departments?

My Lords, first we have the primary health care consultative process which has started and which is the first of its kind for many years. In recent years health expenditure here has grown faster in real terms than in many other Western European countries. The comparisons between nations are difficult, because methods of financing vary and so do clinical practices and medical costs. The Government are taking full account of this report and are taking all the necessary steps.

My Lords, is the noble Baroness aware that there is increasing scientific evidence showing that good nutrition in infancy and childhood is the basis for good mental and physical health in later life? In view of that, would the Government consider reintroducing nutritional standards for school meals which they abolished in 1980? Also, would they at this late stage consider removing from the Social Security Bill those aspects of it which further damage the school meals service? Is the noble Baroness aware that Sir Douglas Black described this Bill as "Mr. Fowler's diet for disaster"?

My Lords, we are not discussing the Social Security Bill in this Question. Examples of what we are doing to promote healthier eating habits include the revising of our guidance to hospitals and local authorities on catering to reflect recommendations in the 1984 COMA Report on diet and cardiovascular disease. The HEC has issued general guidance on a healthy diet. In conjunction with a planned television series on healthier eating we are issuing new guidance for the general public on nutrition, and we are encouraging the food industry to make available a variety of foods with lower saturated fat and lower salt contents.

My Lords, we are grateful to the noble Baroness for the information she has given us. She has indicated her department's reaction to these aspects of the report. Nevertheless, it would be helpful if she could tell us what her department has done following the publication of the report by the Faculty of Community Medicine. Does she not agree that this is one of the most serious reports on the nation's health that has been published for a very long time? Would she agree that it shows us at a disadvan-tage compared to other nations, in that there has been a decline from a peak of competence in this country to the present very disturbing situation? For example, have her officials met the authors of this report, and what precise action have the Government taken as a direct result of the report to which the Question refers?

My Lords, in answer to the noble Lord, Lord Cledwyn, we have endorsed the general aims of the strategy, the main strands of which are totally in keeping with United Kingdom health policies. We have not yet had time to assess fully the faculty's recommendations. Many of these are not addressed to central government departments and are matters for other authorities, or for the professions or teaching institutions to consider. With regard to the statistics, there is a welter of statistics which can be used to compare health outcomes. The faculty has been very selective in what it has used. For instance, though infant mortality rates may have fallen more proportionately in other countries, many countries were starting from a much worse base.

My Lords, is the Minister also aware that one of the most disturbing features in the report is the fact that, as was predicted over 20 years ago when the first reports were published on the dangers of smoking, increasing numbers of women in this country are now dying of lung cancer? Could the Minister take special note of this and see whether there are any measures that could be introduced which might deal in some way with this increasing problem?

My Lords, we have taken many steps, as the noble Lord will know, to encourage a reduction in smoking. Some examples of this are that on 1st April the new voluntary agreement came into effect, which considerably strengthened the rules governing tobacco advertising and promotion; six new health warnings linking smoking to lung cancer and heart disease were introduced under the voluntary agreement, and the duty on cigarettes was increased by a further 11 pence in the last Budget.

My Lords, is it not considered desirable that a distinction should be made in the House between "preventative", on the one hand, and "preventive" on the other? I suppose that the latter is an adverbal adjective and the former is a noun. An example of a preventative would be a condom. I do not think that that is what is intended.

My Lords, I hardly ever disagree with the noble and learned Lord and I certainly do not on this occasion.