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House of Lords Hansard
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04 November 2009
Volume 714

Question for Short Debate

Tabled By

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To ask Her Majesty’s Government what progress has been made towards implementing the aims of the Vision 2020 initiative to prevent avoidable blindness and support those in developing countries who are unavoidably blind.

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My Lords, it is a privilege and a pleasure to introduce this debate. In asking for it, the aim was to raise the profile and to argue that blindness and eye health should be much more mainstream in international development. It is reasonable to say that we have already got a degree of success in raising the profile by the large number of noble Lords who have decided to speak, to whom I am very grateful. I am very much looking forward to hearing the contributions from so many Peers, including their experience and their concerns. I know that we will be hearing about this in the context of India and Africa. I am only sorry that there is such a short allocation of time.

My task is setting the scene. I will be brief and will ensure that I do not go beyond my more generous time allocation. First, I declare an interest: I am proud to be chair of Sightsavers International, which for almost 60 years has promoted and provided programmes and services to prevent and treat blindness, and to support blind and partially sighted people in partnership with local organisations in 33 countries. Sightsavers International is a founding member of the International Agency for the Prevention of Blindness, which brings together the world's leading eye organisations to deliver Vision 2020: the Right to Sight as a joint programme with the WHO. We are tied in with the IAPB and the WHO. In declaring that interest, perhaps I may also say that Sightsavers International and the IAPB enjoy generous support from the Standard Chartered Bank through its Seeing is Believing campaign, which was launched in 2003, and whose previous chief executive, now the noble Lord, Lord Davies of Abersoch, has been such a personal and prominent supporter. Additionally, Merck, the drug company, has provided large quantities of the drug Mectizan to help control river blindness.

My point is not just to declare an interest and record appreciation, but to say that there is an enormous unity of purpose among eye organisations, excellent corporate support and good support from the World Health Organisation. I would like to see the Government give eye health an even more prominent place in their thinking and give it more support. I understand that the Government have not ignored eye health and that £50 million has been allocated for neglected tropical diseases, which include, for example, onchocerciasis, for which allocations will be made. I am disappointed that they do not also include trachoma, a neglected disease which particularly in many cases affects women.

Let me be clear about what I am asking about progress and Vision 2020. Vision 2020 was launched in 1999 with two aims; first, to eliminate avoidable blindness by 2020 and, secondly, to prevent the projected doubling of avoidable visual impairment by 2020. So there are two very clear aims. This is a big problem but we can deal with it.

I want to describe the problem and make it clear that action can be taken. I shall give a few figures to illustrate why we should act and give this issue greater prominence. Three hundred and fourteen million people live with severe visual impairment, of whom 45 million are blind. Those are very big numbers. Seventy-five per cent of that blindness is treatable or preventable. Most of it comes from cataracts, trachoma and river blindness, all of which are perfectly treatable or preventable. I know that some noble Lords will speak about these diseases and what can be done. My third, and sad, statistic is that 90 per cent of blindness occurs in poorer countries. That statistic speaks for itself. Less well known—I apologise to noble Lords for producing all these statistics—is that this is also a gender issue. The best estimate suggests that two-thirds of blind people in poorer countries are women. The reason for that is twofold. First, they are more likely to be affected by conditions such as trachoma because they look after the children, deal with the dirty water and are exposed to infection. Secondly, in most cases they are, sadly, less likely to get help, so they are hit two ways. As I say, the best estimates suggest that, consequently, twice as many women in poor countries are blind than men.

This is not just about blindness as if blindness were a simple and single thing; it also affects people’s life chances. We need to ensure that we do not see it just in terms of health. According to research from the International Centre for Eye Health, a blind person who gets their cataracts dealt with returns to something like their previous economic status within a year once their blindness is treated. In other words, they are able to resume some kind of economic activity, or at the very least their carer can resume that activity. This is about the economy and employment. It is also about education. A third of the world’s children not attending primary school are disabled, although not necessarily blind. I know that progress is being made—this is all doable—and I shall be interested to hear what the Government say. When I say that it is astonishingly cheap to tackle this problem, I mean that doing so represents astonishing value for money. It is feasible to talk about eliminating trachoma over the timescales that we are talking about. The organisation that I work with, Sightsavers, works with BRAC in Bangladesh and we are looking at how we can eliminate the backlog of cataracts in one of the major provinces. Enormous things can be achieved.

I said at the outset that I wanted to gain greater prominence for this issue within the Government and more widely, and to “mainstream” it, as eye health is too often left out of the thinking. I talked recently in Mali to an American involved in international development who thought it was strange that eye doctors were being trained there when the country had other pressing needs. He ignored the fact that eye health affects so many people in a community. I fear that that sentiment is relatively common. Eye health should be seen as key to the millennium development goals, including education, women's rights and employment. I want to make three suggestions to the Government and I look forward to the Minister's response.

First, there is, rightly, renewed emphasis on primary care. A great deal of eye health disease can be dealt with very easily in primary care; for example, the more minor conditions, not necessarily cataracts or trachoma but diseases arising from poor hygiene, living in dusty and desert conditions and sometimes from using traditional remedies. These are too often missed out. We want to see eye health emphasised as part of primary care, so that when you are pushing forward your policies on primary care, eye health is a central part.

Secondly, there is a growing emphasis on human resources and training more health workers in Africa. It is equally important that eye health is part of this, not separate. Training is needed from the most local level of community worker to deal with the most local issues to the specialist. There are a lot of innovative models of mid-level workers in eye care. Thirdly, greater prominence should be given to disability in DfID programmes. Education, employment and rehabilitation need to be addressed to achieve all the millennium development goals. Disability is implicated in, if it is not the cause of, at least 20 per cent of world poverty. These are the three big issues for mainstreaming: ensuring that primary care policies relate to eye health; ensuring that human resources policies relate to eye health; and giving disability greater priority.

Finally, I ask that DfID looks again at its whole support for eye health and Vision 2020. A good start might be a meeting with the Minister and the IAPB—I do not think that this has happened yet but, if it has, it has not happened recently—to demonstrate how seriously committed the Government are to this and to mainstreaming.

Let me end on hope. This is a big problem, but there are solutions. Most of these conditions are treatable or preventable, and treatment can have quite a quick impact. There is a great deal of interest in this, as shown by those noble Lords who are speaking in this debate, as well as support from the corporate sector in the form of the Standard Chartered Bank and from the WHO. Eye health organisations are also well organised, and we want even clearer government policy working alongside us.

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My Lords, in my maiden speech in this House, I described blindness as one of the severest disabilities and suggested that, considering the critical role that sight plays in enabling us to interact with our environment, couching everything in terms of disability is unhelpful because it obscures the central importance of sight. There is now a pressing need for blindness to be placed higher up the political and social agenda. It therefore gives me great pleasure to be the first to congratulate my noble friend Lord Crisp on bringing these matters to wider attention today and on having secured this opportunity to set out his stall in an already overcrowded marketplace. I am sure all noble Lords will agree that it was an impressive presentation. I am only sorry that I missed his first few sentences in the commotion of the albeit seamless changeover from the previous debate.

In my maiden speech I talked about the domestic agenda, but the problems in the developing world, although not exactly the same, are if anything even more pressing. I therefore join others in paying tribute to organisations, such as Sightsavers International, the Christoffel Blindenmission and the IAPB, which are attempting to tackle them. At a time when it is difficult to find anyone with a good word to say about bankers, it is good to learn that the Standard Chartered Bank is putting so much of its considerable weight behind such endeavours. As my own organisations, the RNIB and Skill, are less active internationally, I do not have quite so much of an interest to declare this afternoon.

It is also very gratifying, as my noble friend has said, to see such an impressive turnout for this short debate. When such an impressive list of speakers is so obviously seized of the issues, it is clear that the message is getting through. I am sure that the Government have got the message; I just hope that the debate will reassure them that they have the support that they need to give this priority, and that it will give them some pointers on how this can be done most effectively.

After the formalities, which are important, it is not possible to say very much of substance in four minutes. I want to make just two points within an overarching framework of rights. Where blindness cannot be prevented, it behoves us to have particular concern for the rights of those who are left to grapple with it. Two of the most important of these are the right to education and to information in a form in which people with little or no sight can access it.

On education, 6 million children worldwide are living with a disabling visual impairment, 80 per cent of them in under-resourced developing countries. Of these, more than 90 per cent—4.4 million—receive no education at all. In 1990, the Education for All programme was launched by the United Nations, with the goal of universal access to education by 2015. EFA has made significant progress in reaching non-disabled children, but I fear that it has in large measure failed to include children with disabilities, particularly those who require alternative modes of communication.

The funding for EFA comes largely from developed countries, so those countries should be asking why children with disabilities are still not being reached effectively by EFA and should be insisting that Governments which receive EFA funding should serve all children, including those with visual impairment. EFA-VI is an initiative led by the International Council for Education of People with Visual Impairment and the World Blind Union—I am a board member of both. The initiative will assist developing countries with technical advice and support to ensure that their EFA national plans include provision for children with visual impairment. Any support which the Government can give to this initiative will represent a very good investment of effort.

On access to information, efforts are under way through the World Intellectual Property Organisation to agree a treaty which will dismantle copyright barriers to the free flow of information between states in forms made accessible to the visually impaired. More than 100 countries have expressed support for such a treaty but some of the big players, like the United States and the EU, are digging their heels in. Any assistance which the Government can give to promote a more positive approach would be very welcome, and I shall be happy to give the Minister a full briefing if he would find that helpful.

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My Lords, I, too, congratulate my noble friend Lord Crisp on securing this very important debate. I also put on record the great work that his charity, Sightsavers, does. I am pleased to say that a charity of which I am a trustee is pleased to support it year on year. I agree with all that has been said about the burden of blindness and the loss of visual acuity in the developing world. I have seen it at first hand most recently in Cameroon, where 50 per cent of the villagers were blind from black flies attacking their sight.

However, in the few minutes available to me, I would like to speak about the issues we face in our country. One relates to retinopathy of prematurity. In the previous debate we discussed the incidence of cerebral palsy in babies born prematurely—10 per cent of births are premature. Retinopathy of prematurity is emerging as an important cause of visual loss and sometimes blindness. Retinopathy of prematurity is one of the few causes of childhood visual disability which is largely preventable. Many extremely pre-term babies will develop some degree of retinopathy. Although, in the majority, that will never progress beyond mild disease, in some it will become serious and occasionally cause blindness. In the previous debate, the Minister said that the Government have just launched a strategy for neonatal care and I hope that it includes screening of all births in the United Kingdom before 32 weeks, checking for retinopathy of prematurity. That would certainly reduce the incidence of visual impairment in those children.

Next, I want to focus on diabetic retinopathy. We know that the incidence of obesity and, therefore, diabetes is rising; 30 per cent of our population now has a BMI—unfortunately, including me probably—greater than 30. The incidence of diabetic retinopathy is 5 per cent; 2 per cent of people with diabetes develop blindness after 15 years and 10 per cent develop severe blindness, apart from other things such as hypertension. Diabetic retinopathy is a well recognised complication of diabetes mellitus. Well conducted clinical trials have shown that good control of diabetes and hypertension significantly reduces the risk of diabetic retinopathy. Good services, which provide not only better glucose control for diabetics but rigorous screening for diabetic retinopathy and early detection of it, will reduce significantly the burden of eye problems.

I turn to age-related macular degeneration. As the name implies, it is a common cause of reduced vision in the United Kingdom and it occurs in 30 per cent of people over the age of 60. Probably some of us here today suffer from the condition. Unfortunately, there is no immediate treatment or cure. We require greater research and identification at an earlier stage of development of the disease, because it has been shown that early detection will reduce further deterioration if treatment can be started earlier.

I am pleased to say that recently the first phase of a four-year clinical trial of the use of embryonic stem cells has been launched by MRC and the California Institute of Regenerative Medicine. The trial shows great promise. I have addressed three issues and finish by echoing what the noble Lord, Lord Crisp, said.

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My Lords, I, too, thank my noble friend for highlighting one of the most urgent priorities in development assistance. It is not often mentioned in Parliament. I still remember the relief felt by aid agencies when onchocerciasis in Africa was all but conquered. Surgery and medicine have made many advances, and there have been victories along the way; but the combination of disability and poverty described by the Indian novelist Rohinton Mistry is almost unimaginable for us.

I am most grateful to Vision 2020 for its briefing, which helped me to see the facts more clearly. For example, as much 75 per cent of blindness is avoidable. I had not realised that cataracts are by far the most common cause of blindness. I knew that successful operations take place daily to tackle the 15 million or so cases worldwide every year. In the poorest countries, the operations do wonders for the beneficiaries. A survey in Madurai, for example, found that 85 per cent of males and 58 per cent of females who had lost their jobs as a result of blindness got them back again.

The underlying case of blindness is poverty. It is estimated that children born in the world’s poorest regions are four times more likely to suffer from blindness than those born in higher-income countries. Conditions associated with childhood blindness, such as measles, rubella and vitamin A deficiency, are also causes of child mortality, and they are preventable. It is a sad fact that nine out of 10 visually impaired children in the poorerest countries are deprived of education, with the consequent loss to their local economies.

Many charities are combating blindness, and some smaller ones achieve huge results. The Fred Hollows Foundation has reached thousands in Nepal. One agency for which I have great respect is Sightsavers. I will give an example of its work last year in India. Its local partners treated more than 1.9 million people for sight-related problems. They performed 115,000 cataract operations and provided rehabilitation training for more than 3,000 people with irreversible blindness or low vision.

Rehabilitation is an essential part of the agency’s work. One agency related to them, Jana Jagarana in Orissa, tells of a boy called Ravi Nayak who asked his carer, “Aren’t you going to be helping me any more?” She was in difficulty, but replied firmly, “Since you are capable of doing things on your own, I should spend more time with those who need me”. She gradually reduced her visits to him, but the agency has since helped Ravi with capital to start a cycle repair shop, and offered to send him for vocational training. He is apparently now happy and planning his future.

I end with a short song from a Vietnamese girl in Saigon known to Save the Children whose mother was poisoned by Agent Orange. I will never forget her story, which I have no time to recount now. She sang:

“I dream of seeing the colour of the trees

Of seeing the home where I might live

Of seeing the mountain with its waterfall

I dream of seeing my mother’s smile”

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My Lords, the unfortunate reality is that levels of poverty are higher among the blind than among those suffering from any other disability. We are all grateful to the noble Lord, Lord Crisp, for securing a debate in this crucial area. Vision 2020 has been a shining example of how partnerships—and in particular public-private partnerships—can be so effective. There is no better example of this, as noble Lords mentioned, than the Seeing is Believing campaign launched by Standard Chartered Bank in 2003. What a difference it is making.

We are also fortunate that we have with us my noble friend Lord Low, who is such a tremendous inspiration to us all in the amazing work that he has carried out with the RNIB, which he led for so many years. I have personally seen the power of public-private partnerships in founding the UK India Business Council, which is supported by UK Trade and Investment—the Government working together with business in promoting the UK-India relationship.

India, which was mentioned by the noble Earl, Lord Sandwich, has the highest population of visually impaired people in the world by far. One-third of the world's blind people live in India. A study performed by the Prasard Eye Institute in my birthplace of Hyderabad at the turn of the millennium calculated the direct and indirect economic loss due to blindness in India at $4.5 billion per year. To put that figure in perspective, in the year of the study, it would have cost a tiny fraction of that to treat all the cataract cases in India.

I have seen in India institutions such as the Happy Home and School for the Blind in Mumbai, run by the inspirational Meher Banaji, and the amazing, positive impact that they have. Childhood blindness accounts for 28 per cent of the lifetime economic loss. Those children are robbed of a start in life, their disability hindering their primary education and with family members coming to stay at home as caretakers, poverty becomes a real prospect. An investment in developing nations and in their children is an investment in the future, and the future of the children.

The problem of disability, and, more specifically, blindness, not only causes hardship at the level of the individual but has a domino effect. The scope of that knock-on effect is hard to grasp. As the noble Lord, Lord Crisp, said, 90 per cent of those living with blindness live in low-income countries. We can see how real the effects are. It is not only the blind who feel the desperate grip of hardship, but the families of the blind and the communities in which those families live.

Access to healthcare is a human right and there is no question that under that principle, every possible action should be taken to ensure that those living with impaired sight are given the treatment that they need. If that is not incentive enough, the global economic burden of blindness is shocking. The global impact due to low vision and lost productivity was estimated at $42 billion in 2000. In the UK, once you reach the age of 40, an annual glaucoma test is provided free, funded by the Government. Just imagine how many unnecessary cases of impaired sight could be avoided if that were available in developing countries throughout the world.

In our work at the UK India Business Council, we have realised, with British companies working in India, that corporate social responsibility is not a nice thing to do, it is a must. I believe that, through the power of government, and governments working together with the private sector and NGOs, we can eliminate unnecessary blindness forever throughout the world. I urge the Minister and the Government to do everything that they can to make that a reality.

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My Lords, most of what I wanted to say has already been addressed more eloquently by other Peers, especially by the noble Lord, Lord Crisp, whom I congratulate for introducing the debate. I intended to quote something that he stated in another report. At the risk of repetition, he said that there is a huge shortage of health workers globally and what is needed is a powerful and co-ordinated international response to address that shortage, with the developed countries, including the UK, supporting the scaling-up of training, education and employment of health workers.

The UK Government have made an important start with their initiative in Malawi, which provided $99 million over six years to address urgent health and human resource problems. This was a most welcome development and, combined with increased support for health from other donors, has produced some excellent results and is an indication of what can be achieved when such an investment is made. It showed that 40 per cent more doctors were working in Malawi than in the four years previously, and 5 million more people visited a health facility.

As I have said, the relatively small expenditure of $99 million over six years on this initiative has made a huge difference and provided such an excellent return on the investment that I would suggest to the Minister that consideration should be given to reordering the priorities of DfID’s aid budget so as to ensure that a greater proportion is allocated towards eye care services. We should bear in mind that this concerns about 300 million individuals in the developing world and the fact that with the increase in population and life expectancy, this problem could well get worse rather than better, despite all the progress that has been made.

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I join others in congratulating my noble friend Lord Crisp on initiating this debate, and I, too, declare an interest, as chair of the medical aid charity Merlin, which I am glad to say works closely with Sightsavers in some of the poorest countries in the world, including Liberia, which I recently visited. The key point that struck me in my noble friend’s opening remarks was that 80 per cent of the world’s blindness is avoidable and can either be treated or prevented by known, cost-effective means. Some progress has been made, of course, but nothing like enough, and there is a real risk that without major and effective intervention, the number of avoidably blind people worldwide will increase rather than decrease as we approach 2020. That is why the Vision 2020 programme is so important.

I want to stress three or four points which put the issue of blindness into a broader context than just its treatment. First, avoidable blindness is best eliminated when eye health programmes are embedded in health systems and underpinned by effective government policy. Efforts to tackle blindness and visual impairment must be made within an approach that supports and strengthens national health systems. It is particularly important, as my noble friend Lord Crisp said, that that should be done at the primary healthcare level because it provides the best means of reaching the greatest number of people.

My second point was also made by my noble friend Lord Joffe: the importance of adequately trained eye care personnel and the lack of those staff, which is a sub-sector of the broader issue of the chronic lack of effective health workers in developing countries. My noble friend Lord Crisp has done a terrific amount himself on that, on which I congratulate him, but it is a crucial element in treating blindness.

Thirdly, disabled people, including blind people, are among those most affected by natural disasters and conflicts. Refugees with disabilities are among the most isolated, socially excluded and marginalised of all displaced populations, which means that efforts to respond to emergencies both acute and chronic must address the issue of people with disabilities.

Finally, but most important, is the fact that eye disease is no respecter of national boundaries. Initiatives such as onchocerciasis control are dependent on cross-border collaboration in political and health terms among countries. I stress that this is as much a political issue as it is a health issue, which allows me to draw attention to a point that I have made in other contexts in your Lordships’ House. There is a need in our own country for DfID, the Foreign Office and even the Ministry of Defence to work closely together to ensure the right political context in which social measures such as health can be taken and thus the incidence of blindness reduced.

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My Lords, I join in thanking my noble friend Lord Crisp for introducing this very important and topical debate. I would like to devote my allotted few minutes to addressing the problem of river blindness in Africa, where I have spent most of my life. A number of rather chilling statistics exist and one reads that more than 100 million people are at risk in 30 African countries, with almost 18 million already infected with the disease.

In researching for this debate I read the initiatives of Vision 2020 to prevent avoidable blindness. I was encouraged to read that between 75 and 80 per cent of the world’s blindness is avoidable, 60 per cent is treatable and 20 per cent is preventable. I returned last week from a visit to Ghana where the health authorities have been fighting the scourge of river blindness for almost 50 years. West Africa, particularly Nigeria, has been worst affected. Despite treatment with ivermectin, concerns are growing that this crippling disease is endemic and may be developing a resistance to the drug. It is encouraging that its mass administration has been effective in preventing nearly 40,000 cases of river blindness a year, but that figure could be considerably increased with better management. I was pleased to hear that phase three trials have recently been launched in the Democratic Republic of the Congo, Ghana and Liberia to assess the effectiveness of moxidectin in preventing transmission from the worms that cause river blindness. It is also encouraging that scientists in Cameroon and Ghana have identified the first biological agent, a midge, which can be cultivated, that eats the pupae of the blackfly that cause river blindness. Like my noble friend Lord Bilimoria, I also support the work of public-private partnerships in preventing avoidable blindness.

I have always been a firm believer in prevention rather than cure. While it is unlikely that the scourge of river blindness will be eradicated, it is encouraging that there are cost-effective solutions to the problem. In a recent article on combating river blindness in Cameroon, my noble friend’s charity, Sightsavers International, has estimated that for an average cost of just 5p, the drug ivermectin can protect an individual against the devastating effects of the disease for a whole year. However, 15 years of such protection would be needed because that is the period during which the river blindness bug stays in the system. Getting the treatment to remote communities and training people to distribute it is a challenging task. As most speakers have already mentioned, river blindness predominantly affects poor people in remote areas. In many cases, children have missed out on education because they are forced to stay at home to act as full-time carers for relatives who have become blind. In some cases, residents have fled areas where the level of infection has hit hard, leaving “ghost” villages behind. These are often situated in arable areas of Africa, near to fast-flowing rivers.

It is well known that lack of eye care can have a severe economic impact by perpetuating poverty or pushing a family into poverty. Clearly, effective and low-cost solutions exist to eradicate avoidable blindness. To this end, I wholeheartedly support the aims of the Vision 2020 initiative.

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My Lords, we come to the concluding part of this debate. I thank all those whose contributions have highlighted the scale of blindness worldwide. I thank the noble Lord, Lord Crisp, for his excellent contribution, in which he set out the statistics.

I hope the Minister will have noted that we are talking about more than 45 million people with total blindness and a further 269 million with poor vision. A fact that we often seem to forget is that if one breadwinner in a family loses their sight, it is likely on average to affect the development of at least four or five members of that family. Therefore, we are talking about a much wider problem. Those of us who have travelled in many parts of the world, particularly in undeveloped countries, are aware that unless we take drastic action and develop proactive programmes, the number of blind people worldwide will increase substantially. It is estimated that we can add a further 30 million to the present number of 45 million by 2020. We also know that there is a direct link—I am again grateful to the noble Lord, Lord Crisp, and a number of other noble Lords who have spoken about it—between blindness and poverty. This disadvantage often results in families who are unable to afford the often simple treatments that could retain their sight.

Earlier today, the noble Lord, Lord Patel, mentioned the link between premature birth and cerebral palsy. Yesterday, when I spoke to him in the corridor about this debate, he said that a similar link could be established with blindness on the same principle, which is interesting. At this stage, some of the research may ultimately lead to a solution, but we now need to put initiatives in place so that the projected increase in the number of blind people does not happen. The Government’s record in tackling poverty is not bad, but that does not mean that it could not be better. We must remember that poor people will suffer most during the economic depression. Millions of people could build a sustainable life if their sight was restored.

I welcome the initiatives taken by Vision 2020. At the national level, a strong partnership between ministries of health, NGOs, professional organisations and civil society groups, all of which have been brought together by Vision 2020, should facilitate the development and implementation of effective and sustainable national eye care plans worldwide. I hope that the Minister will be able to comment on the role in place for developing and assisting in the strategy that has been developed by Vision 2020. It should not be difficult. Examples have been cited in this Chamber. Pharmaceutical firms and medical providers now operate at the global level. If one of the millennium goals is to eliminate poverty, which is often supplemented by blindness, this is an example of how effective co-operation and co-ordination of effort can assist. A very interesting example was cited by the noble Lord, Lord Bilimoria, about the partnership that could provide this initiative.

The overall objectives of Vision 2020 are entirely commendable; namely, to increase awareness within the key audiences of the causes of avoidable blindness and to look for the solutions. The other aim is to secure the necessary resources to increase prevention and treatment activities. I ask the Minister if he could throw some light on the type of resources that we are making available to tackle this problem.

There can be no excuse. Blindness prevention strategies are among the most cost-effective in healthcare. There are blind people around the world who should not be blind because their condition is treatable. In so many cases, had there been a comprehensive eye care system available, they would have got that treatment and would not be blind. It is imperative that the good work of Vision 2020 is built on and developed further. Support from the Government must be wholehearted and the continuation and furthering of partnerships between the private and public sectors must be actively encouraged. In this way, a future envisaged by Vision 2020 will be realised; that is, a world in which no one is needlessly blind.

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My Lords, I thank the noble Lord, Lord Crisp, for initiating this debate. He rightly emphasised that addressing gender inequality needs to be a key component of future efforts to develop the eye-care industry because this involves childhood access as well. We need to remember that although the number of blind children is far smaller than the number of blind adults, the number of blind years is almost the same. Assigning priority to blindness conditions should be considered, therefore, in terms of blind years rather than just the absolute number of blind people.

The noble Lord, Lord Crisp, asked me to describe the cataract work that we do on a mercy ship in West Africa. This is a hospital ship with six operating theatres, two of which are devoted to eye surgery. We can treat 40 cataracts a day because there are no EU restrictions on the number of hours we work.

The joy of being able to see again after years of blindness is really quite indescribable. I shall never forget my first cataract operation. When the bandages were taken off the man the following day, he shrieked with joy, threw his hands in the air and for the next five minutes praised the Lord—I mean the real Lord, not me. We have witnessed some amazing scenes. Twin boys aged two who had been blind from birth and had never walked were carried onto the ship. It is unusual to see twins in West Africa because they usually die in childbirth. Their eyes were sunken, expressionless and wandering around. The cataracts were removed and on the following day when the bandages were removed, these two little chaps began looking around in total amazement. They had never seen anything before, so they saw each other for the first time and then their mother. It was an emotional scene. They began to walk within an hour. I must tell noble Lords the whole story. The next day, being boys, they started fighting each other, so they were perfectly normal in all respects.

One problem is that in the western world cataracts are removed through a 3 millimetre incision using very expensive ultrasound equipment. Most developing countries cannot afford this kind of machinery, so we do without it and teach the locals a technique that uses a 6 millimetre incision which is almost as good, and in many ways is better because African cataracts tend to be much harder. There is a need to ensure that western countries include this alternative technique in their training programmes so that doctors can visit Africa and teach the local staff how to do it. Perhaps the Minister could encourage this.

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I begin by adding my congratulations to the noble Lord, Lord Crisp, on securing this debate and bringing the important issue of blindness, whether avoidable or unavoidable, to our attention. I know that over many years he has made a great contribution to health, including more recently in developing countries. I also thank all the other contributors to the debate who have brought to it their experience, interest and knowledge. The noble Lord, Lord Crisp, effectively set out three challenges which I hope to answer as I go through the narrative of my speech and respond to questions. On the fourth challenge, his reward is an immediate “Yes” to the question of meeting Ministers. That is a given and can be arranged.

I can certainly confirm the statistics used by the noble Lord and others that, globally, some 340 million people are visually impaired and 45 million are blind. As has been said, the vast majority—almost 90 per cent—live in poor countries with weak health systems and little or no immediate access to health services which could prevent or treat blindness. It was also pointed out that cataracts, which can be removed using a relatively simple surgical procedure, continue to be one of the main causes of blindness. However, they are avoidable if healthcare is available at a reasonably simple level, and I am grateful to the noble Lord, Lord McColl, for his expertise in describing the treatment. The noble Earl, Lord Sandwich, also raised the issue.

Trachoma is the second most common disease. It is linked to extreme poverty and poor sanitation, but even the simple acts of face and hand washing are not easy if there is no access to water. Glaucoma cannot be detected early enough where there are no systems for eye checks. Childhood blindness often arises from poor diet, inadequate sanitation and through diseases like measles, for which a vaccine exists. Onchocerciasis, which henceforth I shall call river blindness—although I got the pronunciation right once, I may not do it a second time—is a parasitic infection that infects the poorest of the poor. They are the people who find it most difficult to access the necessary drug treatment.

There is no need for me to dwell on the huge suffering that blindness brings to individuals because it has been graphically described by other noble Lords. The $64,000 question, or perhaps the rather more expensive question to ask, is what are we doing about it. The important thing has been said already: there are many health challenges across the world, and when it comes to avoidable blindness, it does not have to be this way.

In the vast majority of cases, tried, tested, simple and cost-effective interventions already exist for blindness and other visual impairments. They are preventable and treatable—as indeed they are in developed countries. Let me put that statement into context. We are therefore talking about poor countries—countries where Governments have to contend with manifold health priorities, if not crises, including HIV, TB, malaria, complications in pregnancy and childbirth and other neglected tropical diseases; where there are few doctors and ancillary services; where the system for delivering health care is often dysfunctional; where resources are limited; and where, sadly, health is often not the top priority on the Government's agenda. Here, I am at one with the noble Lord, Lord Bilimoria, in believing that access to health is a public and human right. Therefore, it seems to me that a Government, whether rich or poor, should put that high on their list of priorities.

The question is: what has the UK done and what are we doing to contribute to the elimination of avoidable blindness and to support those who are unavoidably blind? The causes of visual impairment are numerous, so we must address them as part of a global effort on multiple fronts. The noble Lord, Lord, Lord St John of Bletso, raised the important issue of river blindness in Africa. DfID is a long-standing supporter of the African programme of onchocerciasis control. That is a global partnership led by the World Bank and the WHO. In 2008, the programme treated 120,000 communities affected by the disease. The UK also supports research into that and other tropical diseases. The clinical trial of the drug moxidectin, which could dramatically speed up the elimination of river blindness across Africa, was launched last year.

We are addressing vitamin A deficiency and measles vaccinations through core funding to UNICEF—by £21 million in 2008. We support the GAVI Alliance—by £30 million in 2006-08. Through our bilateral programmes in Sudan, 6.5 million children received vitamin A supplements through one such programme and, in 2008, thanks to the work of DfID, more than 3 million children have been vaccinated against measles.

There are clear linkages between malnutrition and the level of blindness, especially among children, so we are now stepping up our efforts against malnutrition with the new nutrition strategy. However, those interventions are not sustainable unless countries have underlying strong and lasting healthcare systems—another point made by the noble Lord, Lord Jay. Those systems must be able to deliver. As noble Lords, including the noble Lord, Lord Crisp, said, that means having a trained workforce, the infrastructure and systems for drugs delivery and healthcare, including eye care, where they are needed. That is why last year the Secretary of State for DfID committed £6 billion until 2015 to improve health systems and services. That is why the UK has led the development of the international health partnership to support developing country Governments who want to improve the health of their people according to their priorities.

In addition to raising additional funding for health systems, we set up the high-level task force chaired by the Prime Minister and the president of the World Bank, Robert Zoellick. The task force reported this year and helped to secure $3.2 billion funding for improved health services across the developing world. However, developing country Governments must lead the way by investing more of their own money in healthcare systems and meeting the Abuja target of 50 per cent of government spending towards healthcare.

I echo the point made by the noble Lord, Lord Crisp, that this is a partnership that is both public and private, national and international, and the task that we have can be achieved only if we work together. The noble Lord, Lord Crisp, made three points. One concerned making sure that primary care included eye healthcare. We agree that it is important that eye care is integrated into primary healthcare. DfID funds health sector plans of developing countries, with a focus on primary healthcare and the diseases of poverty. We also agree that it is important to improve the number and quality of healthcare workers, and healthcare workers at community and health centres will be trained across a range of priority issues, including eye health.

The third point related to the desire for disability to have greater prominence in DfID. DfID recognises that disabled children are excluded in many instances from access to education and that disabled adults are excluded from other services. This is clearly damaging not only to the individual but to families and the local economy. That is why disability is clearly on the DfID agenda.

The noble Lord, Lord Low of Dalston, talked about dismantling copyright barriers, which, as he rightly says, is being discussed in Whitehall. I would welcome any more information that he has on that so that I can take the matter further and discover precisely where matters are and how we can assist. He also asked about DfID’s support for education. DfID has provided £8.5 billion over a 10-year period—from 2005 to 2015—for education. That includes funding to support disabled children, a large number of whom are blind.

The noble Lord, Lord Patel, made a number of important points, including one about diabetic retinopathy. Important though they were, however, they relate to the United Kingdom and its health service, so I am happy to pass them on to my colleagues in the Department of Health. DfID has an interest in their impact in the developing world, but I am glad to say that other ministerial colleagues have the responsibility for them here in the UK.

The noble Earl, Lord Sandwich, talked about avoidable blindness. We support action to prevent blindness by funding international organisations and partnerships and by giving countries bilateral support for research. This support will have a direct and indirect impact on avoidable blindness. We also support the strengthening of healthcare systems. The kind of money that I am talking about is £6 billion to improve healthcare systems between 2008 and 2015; £13.14 million to the World Health Organisation for 2009-10; and £30 million, which I have already mentioned, to the Global Alliance for Vaccines and Immunisation. I also mentioned the African programme to eliminate river blindness. This is dealt with through the World Bank, which manages donor-pooled funds—currently £500,000 per year—and we as a country have supported it continuously since 1974. UNICEF has £21 million of core funding to provide food and other humanitarian aid.

I see from the clock that I have spoken for 10 minutes. I shall have to speed up, which will be of great sadness to the Hansard writers. I am already too fast for most people to understand, which is not always accidental.

India was mentioned. We are supporting the health sector in four states with a total population of 260 million. We are giving West Bengal £100 million from 2004 to 2010, Andhra Pradesh £40 million from 2007 to 2010, Orissa £50 million from 2007 to 2012, and Madhya Pradesh £60 million from 2007 to 2012. That includes support for work on tropical diseases, blindness, and child health and nutrition, the focus of which is on poor and excluded groups, including the disabled and the blind.

I will have to respond in writing to a number of points that noble Lords have raised or I will fall foul of the Deputy Speaker, which I would hate to do. The noble Lord, Lord Jay, made the important point that we need a political context and cross-border collaboration between government departments. I agree. In recent months, we have seen closer co-operation between DfID, the MoD and the FCO on health issues, including a cross-departmental Whitehall group that always includes the Department of Health.

Finally, the noble Lord, Lord Dholakia, pointed out that the recession will clearly have a damaging impact on the world’s poor. We agree, which is why we have made a commitment to continue to support health. Eye care is central to this. We do that best by supporting the kind of programmes that we are supporting and by remaining on track to achieve the UN target of giving 0.7 per cent of our national income by 2013.

I will write to noble Lords on any points that I have missed. I will also ensure that my ministerial colleagues in the Department for International Development have a copy of this debate, so that they can see noble Lords’ awareness of this issue and their desire to raise it. This has been a matter of importance to your Lordships, and the quality of the debate has been excellent.