HC Deb 07 July 1958 vol 591 cc157-68

Motion made, and Question proposed, That this House do now adjourn.—[Colonel J. H. Harrison.]

10.1 p.m.

Mr. John Stonehouse (Wednesbury)

The House today has been debating the tenth anniversary of one aspect of our great Welfare State. It is an interesting coincidence that another aspect of our Welfare State was reported on this morning with the Report of the Food Standards Committee, which showed that our standards of food consumption in this country are very high indeed. They were referred to in the News Chronicle editorial this morning, which said that the miserable days of mass malnutrition are now fading in our memory and that Britain has perhaps one of the best standards of food consumption in the world.

That is certainly true of Britain, but it is not true of many of the Colonies for which we are responsible. That is why I want to refer to the problem of malnutrition in Uganda, because in Uganda it is extremely serious. There is, in fact, in Uganda mass malnutrition which is absolutely deplorable and the most vigorous attention should be applied to deal with it.

The malnutrition in Uganda is not only making adult workers listless. It is also helping to kill thousands of children before their time. Malaria is the principal cause of death in Uganda, but malnutrition is the second most serious cause of death. The figures for child mortality in Uganda are incredibly bad. In January, I asked the Secretary of State for the Colonies the figures for child mortality, but he was unable or unwilling to give the facts. There are, however, other sources, including one which the Secretary of State himself sent to me last year, the report of the Advisory Committee on Nutrition, which was published in 1956.

That report showed that the average child mortality in Uganda is about 400 per thousand up to the age of 14. That is to say that 40 per cent. of the children under the age of 14 die, which is an incredible figure in comparison with our experience in this country, where only three children per thousand die up to the age of 14. That is .3 per cent. in this country compared with 40 per cent. in Uganda. Malnutrition in Uganda is therefore having a serious effect on the child population.

The child population in Uganda is about one-third of the total population of 5½ million. There are some 1¾ million children under the age of 10 and almost 1 million children under the age of 6. Therefore, the problem of malnutrition is vital for children in Uganda. Not only do many of them die, but because of their bad food consumption during their early years they become weak and less resistant to infection and disease later in life. This problem is not only a problem of life and death. It is also a problem of economics, because we cannot expect a country to have a buoyant economy when its people are underfed, and that is the case with millions of people in Uganda today. It is estimated that some two-thirds of the child population have protein deficiency and that no fewer than 30,000 children every year are shown at clinics to be suffering from protein deficiency.

I have purposely given the Under-Secretary of State details of the questions I want to discuss so that he can refute them, for I am not trying to make a party political attack on him. I hope that by ventilating this subject we shall help to deal with this terrible problem. The question I ask him is, which Government Department in Uganda is responsible for tackling this problem of malnutrition? Is it the Medical Department? Or does the Medical Department say that it is not its responsibility, that the Medical Department is responsible merely for treating patients and not for dealing with the wider problem of malnutrition? Is it the province of the Agricultural Department? Is it the problem of the Education Committee?

I should like to have an answer to this question, because so far in answer to Parliamentary Questions my hon. Friends and I have not yet got a satisfactory reply. My hon. Friend the Member for Wood Green (Mrs. Butler), for instance, on 17th June, asked what measures were taken in East Africa to co-ordinate the attack on this problem of malnutrition. I admire the Under-Secretary's technique in replying to Parliamentary Questions, but I thought that on 17th June, in answering my hon. Friend the Member for Wood Green, he really excelled himself. The Question was about measures taken against malnutrition. The Under-Secretary of State in reply gave details of the research work being undertaken, and we had an impressive list of research organisations investigating this problem.

I say to the Under-Secretary of State that this is not good enough. We have had research on this problem for years. I believe that there is an hon. Member in this House who was a member of a committee which investigated this problem before the war. We have had research. What we want now is a bit of action, and as far as one can tell there has not been enough action on the part of the departments in Uganda to deal with this problem.

The main problem as it relates to children is that of providing enough protein to make up for the deficiency in their diet. It is, of course, a question of education, but it is also a question of making available protein foods which are not normally available in their diets.

In many countries there have been very useful experiments conducted with the supply of milk powder. For instance, in British Guiana for the last four years there has been a very useful experiment in providing various milk foods as well as other protein foods in the schools. I believe that in St. Kitts there has also been a supply of milk powder for quite a long period and that it has shown itself of value in improving the protein intake of the children. I believe that in Nyasaland milk powder has been provided for a long period.

Why has this milk powder not been provided in Uganda? I believe that they are beginning to import it, but on such a paltry scale that only a few thousand children can enjoy the benefit of it.

When the Church World Service, which has been undertaking a very energetic campaign to import U.N.I.C.E.F. milk powder, tried to develop its import, it received in the early stages a great deal of official obstruction. I am glad to note that that obstruction is beginning to die down. One understands that voluntary organisations which have agreed to receive this Church World Service milk powder have been told that if they do so the official milk powder, which is also being imported, will not be made available to them, and vice versa.

I hope that that is not so and that official departments will welcome all voluntary provisions of milk power as well as make large imports of the powder from U.N.I.C.E.F. I want the Under-Secretary of State also to consider having a large-scale programme for the importation of milk powder from New Zealand so that we may help that country to deal with her excess of dairy products and at the same time deal with malnutrition in Uganda.

Again, in the school-feeding programme there has been a lack of initiative on the part of the department responsible. There is a school-feeding official, but I understand that she has been handicapped in her very excellent work and that no official arrangements have been made for the supply of protein foods to the schools. The school-feeding programmes are haphazard. Headmasters make their own arrangements and very often only the most primitive kind of foods can be provided. One hears of attempts to cook the food under a tree in bad conditions, and of a headmaster having to keep the sugar under his own bed. The Education Department should make itself responsible for these things and should see that there is an adequate school-feeding programme and that protein supplementary foods are provided in the school diet. This has been done in British Guiana with extremely good results.

Malnutrition affects not only the children but adult workers. In some years 100,000 immigrants come over the frontiers into Uganda. They take jobs and earn low rates of pay in and around Kampala and in the plantations and they are unable to buy the whole range of foods which is necessary to give them the protein intake that they should have in their diets. Certain ration scales are laid down on the plantations but in some cases exemption is allowed to employers. I should like the Under-Secretary of State to give details of these exemptions and say why they are allowed.

In and around the towns, particularly Kampala and Jinja, the feeding arrangements are inadequate. Even in the town planning of the new industrial estate at Kampala, which was built a few years ago, no provision was made for African feeding establishments. All these details illustrate a certain lack of initiative in dealing with this problem of malnutrition. I hope that it will be possible for the responsibility to be allocated in Uganda and that a really energetic effort will be made to deal with the problem.

10.15 p.m.

Mr. Beresford Craddock (Spelthorne)

Everyone will agree with the hon. Member for Wednesbury (Mr. Stonehouse) that the subject which he has raised is very important. The purpose of my brief intervention is simply to make this comment.

I say with great respect that in my view the hon. Gentleman gave what appeared to me, and will indeed appear to many others, to be a rather misleading account of the situation, indicating that very little has been done in this important matter in Uganda. That, as I can say from my own experience, is not the case. The hon. Gentleman kindly referred to me in connection with a Committee which was set up in 1934 by the then Governor to investigate and make recommendations concerning this very important problem of malnutrition and diet. That Committee was composed of Europeans and Africans, under the chairmanship of the then Director of Medical Services. We had very many meetings. We had before us managers and owners of many plantations and shambas, and took a very great deal of evidence and gave a great deal of thought and anxious consideration to this problem. Ultimately, we made what I hope was a very interesting report, suggesting certain lines of research, and, indeed, from that very moment the practical application began in a tentative way.

During my six and a half years working in Uganda, my activities were many and varied. Among other things, I was in charge of two very large shambas, one growing coffee and rubber and the other growing tea, and we had a large African labour force. I got my managers who were in charge of these plantations very interested in the problem of nutrition and proper diet for the workers. As the hon. Gentleman opposite rightly said, in many cases—in fact, I should say in the majority of cases in those days—rations were distributed free by the employer to the African labour and we tried all sorts of experiments.

The real trouble was to get the Africans to try out, so to speak, the various diets that were recommended by the medical authorities. Week after week, the head boy in charge of the labour used to come with great trepidation saying that he could not get the men and their wives and families to try out these various diets which were recommended. In my view, the crux of this problem is to persuade the Africans to try out these various diets. When they have been persuaded to try them, I am sure that we shall have gone a very long way towards solving what is undoubtedly a very important problem indeed.

Finally, it is hardly fair to say that the very high infant mortality in Uganda is entirely due to malnutrition. I am sure that the hon. Gentleman and everyone who knows these territories will agree that there is a great deal of hereditary disease amongst the people of Uganda in all provinces, and that again is another factor which has been and is being tackled, as the hon. Gentleman knows. I therefore hope that my hon. Friend the Under-Secretary will agree with me that a great deal of work has been done over a very long period; that excellent work continues to be done, and that there are very fine programmes of research, and, indeed applied work, in the field now being planned to be carried out in the years to come.

10.18 p.m.

The Under-Secretary of State for the Colonies (Mr. John Profumo)

As the House knows, the hon. Member for Wednesbury (Mr. Stonehouse), who has raised this important subject tonight, has himself been closely associated with the people of the territory, and this has been reflected in the knowledgeable manner in which he has dealt with the subject this evening. I am glad that my hon. Friend the Member for Spelthorne (Mr. Beresford Craddock), from the wide knowledge which he has gained there, has also been able to say something on this subject.

The hon. Gentleman has asked several questions and has made a lot of suggestions, and I wish to say to him that I will study these suggestions. I am grateful to him for them, and will deal with as many as time allows, but first I want to say something about the relationship of child mortality and malnutrition.

Although malnutrition is certainly a major cause of mortality among children, as my hon. Friend has said, nevertheless, it is closely associated with other factors, not the least of which is personal hygiene. I want to make it clear that, while the problem of malnutrition is important, it cannot be considered in isolation from other conditions which contribute to this problem in the Protectorate.

The hon. Gentleman suggested that the reply given by my right hon. Friend on 28th January about statistics of child mortality was misleading, in that such statistics are given in the Report of the East African Royal Commission and in the Interim Report of the Standing Advisory Committee on Nutrition. I assume that the hon. Gentleman was referring to the memorandum submitted to the Royal Commission and published as Appendix 7 of its Report, in which figures are given for fertility and child mortality. In earlier passages of this Appendix, however, a clear indication is given of the very doubtful validity of the figures on which these conclusions were based, although they were the best approximation then available from the census of 1948. I have not time to quote from the Report, but if the hon. Gentleman looks at page 462, towards the end, under "General Considerations", he will see what I mean.

As for the Interim Report of the Standing Advisory Committee on Nutrition, that was a report on a survey conducted in six isolated villages in five districts in the Protectorate and it cannot be regarded as representing accurately the position in the Protectorate as a whole.

Turning to deaths among children under one year, the 1948 census indicated an infant mortality rate of approximately 160 per thousand for the whole of Uganda. No other specific rates are available relative to age groups, and therefore one cannot quote any figures about child mortality with confidence in their accuracy. It is true that birth and death rates are recorded in all districts in Uganda, but data are too unreliable for use in calculating the rate of child mortality. An Advisory Committee on vital statistics has been set up, and it is to make recommendations to the Government for improving the realiability of returns. The next population census, as the hon. Gentleman probably knows, is to be held in 1959.

Mr. Stonehouse

Before the hon. Gentleman leaves this important question of mortality rates, would he confirm that Mr. Goldthorpe, in his paper to the Royal Commission, drew a conclusion that in fact went further than mine, namely, that half the children die before reaching the age of 13?

Mr. Profumo

Of course I have read that paper but I thought I ought to place on record the fact that the Report to which the hon. Gentleman was referring when my right hon. Friend replied explains that the figures are unreliable. I am not denying the general tendency, but it ought to be put in its right relationship.

Now I should like to say a few words about child welfare clinics. At the present dine it is only in the more sophisticated areas of the Protectorate that parents are willing to use child welfare clinics as distinct from sick children's clinics, so the Government are paying greater attention to welfare work in sick clinics which are held in most hospitals and dispensaries and now total 253 throughout the Protectorate. Eight clinics are devoted exclusively to child welfare work, and these are in operation in Kampala, Jinja and Mbale. In addition, selected rural dispensaries throughout the Protectorate are being converted into health centres, which will include general clinics. Eight of these dispensaries are being converted this year.

Now about school meals. Funds are not available to establish a free school meal service in day schools but parents are encouraged to pay a small sum every term towards the cost of a mid-day meal. I am told that on a rough estimate—and I emphasise that this is only a rough estimate—one-fifth of the 2,000 grant-aided primary schools and all rural day secondary schools supply an organised mid-day meal.

No dried milk powder, groundnuts or fish flour are provided by Government as diet supplements for schools. Schools which provide meals purchase food that is available locally and—this is an important point—that is acceptable to tribal prejudices. These, as the hon. Gentleman knows, are very strong on matters of diet. Such meals as are provided normally include beans, peas or groundnuts in the diet. Fish flour, suitable for human consumption, is not at present available in Uganda, but experiments in its manufacture are going on.

The hon. Gentleman referred to the quantities of dried milk available in Uganda. Some 15 tons of dried milk has been received from U.N.I.C.E.F. for distribution in the Protectorate in 1958. U.N.I.C.E.F. also intends to import 45 tons of dried milk into Uganda next year. A small quantity of this milk is used for demonstration purposes at district training centres and at Red Cross clinics; the remainder is issued through the Government and mission medical units to mothers and young children suffering from malnutrition. A further 15 tons of dried milk given by the Church World Service of the U.S.A. is distributed to under-nourished children in Buganda. Some local governments subsidise the sale of dried milk at their district clinics, and considerable success has been achieved in encouraging African shop-owners throughout the Protectorate to stock non-fatty dried milk for sale to the public.

Turning now to nutrition among adults specifically, the Uganda Employment Ordinance does not place a statutory obligation on employers to provide their employees with food. The employment rule empowers the Labour Commissioner to require employers to provide rations according to a specified minimum scale. These rules have been applied to all employers whose labour is recruited under contract and from a distance. They are not applied to employers whose employees are locally engaged and who return to their homes daily.

The Public Works Department and other official departments feed employees only in certain remote areas of the Protectorate where food is not readily available in sufficient quantity and at reasonable prices in markets and shops. However, experiments are taking place now to assess the value and popularity of mid-day meals provided by the Public Works Department for major working units in urban areas.

The hon. Gentleman asked who was responsible for dealing with problems of nutrition. The Health Education Section and Nutrition Unit of the Medical Department, in conjunction with the Education and Community Development Departments, try to educate the local people in simple elements of a sound diet by means of talks, books, pamphlets, posters, radio talks, health weeks, country shows, and so on. Balanced diets are now being given in all hospitals, and this also has an educative effect. In addition, the Community Development Department is co-operating with U.N.I.C.E.F., the Red Cross and the Medical Department in training mothers in child care.

A discussion of the steps which are being taken to counteract malnutrition would be incomplete, however, without mention of the valuable contribution of research. I should like, therefore, to congratulate the staff of the East African Medical Survey and Research Institute on the progress which they are undoubtedly making in this important field.

There is a nutritionist post in the Medical Department of Uganda which was filled until recently when the lady holding the post left on getting married. With the assistance of the Applied Nutrition Unit we are trying to recruit a successor, but nutritionists are in short supply in this country. The Director of Medical Services is considering a proposal to send a local officer for training in the United Kingdom, which would have its advantage in the long term.

I have tried in a very short space of time—and I would emphasise to hon. Members that this is an incomplete picture because of the lack of time—to show what measures the Government are already taking in the fight against malnutrition. I should like hon. Members to be sure that they do not interpret this as evidence of complacency either on my part or on the part of the authorities in Uganda. It is certainly not.

A considerable amount of work is being undertaken in the Protectorate to find the best ways of dealing with the problem. Committees on general and applied nutrition have been set up, and the Nutrition Unit is being further developed. I am sure that the advice drawn from these bodies is, and will be, of the greatest value to Uganda, but, without diminishing their value in any way at all, we should be wrong if we did not clearly recognise that hand in hand with basic dietary problems goes the even greater problem of educating the people to make the best use of the proteins available in the Protectorate, which is equally important. Uganda is not short of animal or vegetable proteins. Malnutrition so often stems from the failure to utilise nutritional foodstuffs in good supply and from ignorance regarding the preparation of suitable diets for children in the post-weaning period.

Mr. A. Fenner Brockway (Eton and Slough)

And from poverty.

Mr. Profnmo

And from poverty; but from these things often. It may also be due to superstition, lack of hygiene, and, in some areas, a backward economy.

In these respects the Government encourage, as far as financial resources will allow, the educative work of the Community Development Department, improved agricultural and veterinary methods and a planned programme of economic development.

All these things when taken together mean that progress is being made in a matter which I do not think we could relegate to anything but first importance. It is for that reason that I am grateful to the hon. Member for having raised this matter tonight and to my hon. Friend for having made a valuable contribution. I emphasise that what I have said represents only part of the picture and that this is something which my right hon. Friend continues to study with the very greatest interest.

The Question having been proposed after Ten o'clock and the debate having continued for half an hour, Mr. SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-nine minutes to Eleven o'clock.