HC Deb 17 March 1981 vol 1 cc229-45

5 33 pm

Mr. Robert Rhodes James (Cambridge)

May I say at the outset how much I welcome the presence here tonight of the hon. Member for Crewe (Mrs. Dunwoody) as a result of her new responsibilities? Because we have had other responsibilities, on which we were opposed to each other, I am delighted to see her in her new post. I am also delighted to be introducing a very brief debate on a subject which I know to be very close to the hon. Lady's heart—that of preventive medicine, with particular relevance to the problems of developing countries.

My interest in this subject began intellectually—I hope that my hon. Friends will not be too disturbed about this—when I read the accounts of Engels of the situation in Leeds in the 1840s and the cholera outbreaks there. In my own lifetime—in which I have seen the death of a younger brother and the crippling of a sister through poliomyelitis— there has been a revolution as a result of the use of antibiotics, which would have saved my brother's life. But, more important than that, I have seen a revolution in preventive medicine, and the understanding of preventive medicine.

In talking of the problem of cholera in Leeds in the 1840s we are not talking simply about a medical problem. We are talking about a whole constellation of problems in which housing, hygiene and understanding of living were as important as purely medical responses.

Particularly in this, the International Year of Disabled People, I should like to draw the attention of the House for a few minutes to a simple point. When we talk about disabled people we tend to talk about people who are already disabled, or, indeed, to believe that we are talking about people who are disabled for their entire lives. Most people become disabled for one reason or another, and in many cases that disablement could have been prevented.

In dealing with this subject, one should not speak locally, or even nationally, because the problems are much wider than that. The most glittering achievement of the United Nations was the elimination of smallpox. That elimination, achieved in seven years at a very small cost, could have taken place only because the countries of the world had the political will to destroy that bestial disease.

I suggest to the House that what has been done with smallpox can and should be done with other diseases. Bilharzia, diphtheria, malaria, measles and poliomyelitis are among the great killers. They are all preventable if the political will exists among the Governments of the world.

Poliomyelitis was a terrible killer in this country until the 1950s. It is still a killer elsewhere in the world. It is important to recognise what could be achieved in positive terms in development and in health prevention for literally millions of children if this immunisation programme could succeed. Instead of giving grants to disabled people, perhaps it would make better sense to try to prevent certain kinds of disablement occuring in the first place. Therefore, although these diseases are national problems, and although they afflict our children or our grandchildren—or can do—they are also international and can be properly dealt with only by an international response.

It is said in this country that we do not have to worry any more about poliomyelitis—three doses of vaccine on a sugar lump and a child will be protected for life. That is absolutely true. The trouble is that, through complacency, people are forgetting to make use of this basic and readily available protection for their children. But for millions of families in developing countries poliomyelitis is a dreaded disease that strikes at everyone, but principally at children and young people. For those who survive an acute attack, their disabilities usually mean that they are unable to work or to be independent in any way, and that they require specialised treatment and facilities. In many countries those are simply not available.

I declare an interest—but not a financial one—as the vice-chairman of the Save the Children Fund "Stop Polio" campaign, in which a very distinguished colleague of mine is the wife of my hon. Friend the Minister for Overseas Development—the Member for Banbury (Mr. Marten). We work very hard to produce vaccine and to deliver It to certain countries in the world on an experimental basis, in order to meet this scourge.

It is not generally recognised that poliomyelitis is a huge and international problem. At least half a million cases occur each year among children. I emphasise the words "at least". Those are the ones that we know about. Alas, the number of cases is increasing. Paradoxically, an increase in the number of cases occurs as living standards improve and as children do not achieve the immunity that they had previously gained through exposure to polio viruses early in their lives. That is a curious and tragic paradox.

It is vital that as living standards improve—even marginally—we should tackle the problem. The Save the Children Fund "Stop Polio" campaign has launched itself in Malawi, Swaziland and Lesotho and is co-operating not only with the Governments concerned but with the World Health Organisation. The purpose of the campaign is to ensure that all children are immunised against this terrible disease.

I am sure that the House is aware that it takes seven months to create the vaccine. It has to be refrigerated from the moment that it is created until the moment that it is put into a child's mouth. The maintenance of the cold chain from the laboratory to the child represents an acute problem, particularly in Africa. In addition, we hope to expand our operations into Asia. However, these problems are being met and resolved.

It is remarkable that a small and not very rich British charity should lead the world in this operation. I have stressed this point because in the International Year of Disabled People I hope that we shall begin to think more about the prevention of disablement—poliomyelitis is only one example of a disabling disease—rather than about the cure. Indeed, this is also the year of the Mexico summit on the Brandt commission.

When I worked for the United Nations for four years and saw this country from abroad I was struck by the fact that the British people and British Governments underestimate the extraordinary qualities that they possess. Britain has a unique knowledge of and expertise in diseases, particularly tropical diseases. That expertise is recognised all over the world, yet British people are often unaware of it. Therefore, in the International Year of Disabled People I hope that the Government—with the support of both sides of the House—will recognise that preventive medicine, both in Britain and abroad, should be one of our dominant themes. I hope that my particular concern—poliomyelitis— will be one of the main items for consideration.

I am comforted by the fact that my hon. Friend the Under-Secretary is to reply, because last time I raised an Adjournment debate with my hon. Friend I was concerned about the maternity hospital in Mill Road, Cambridge. I urged the building of a new hospital. My hon. Friend gave me a most courteous but not very positive reply. However, many things stemmed from that debate. Last week building work began on the new maternity hospital. I hope that that is a good omen and that my hon. Friend will respond positively to the appeal made not only by me, but by many others. I recognise the limitations that are imposed on him, but in this year of all years we should consider the role of preventive medicine with considerable vigour and interest.

5.43 pm
Mr. Peter Bottomley (Woolwich, West)

I congratulate my hon. Friend the Member for Cambridge (Mr. Rhodes James) on bringing this subject to the attention of the House. He has dealt both nationally and internationally with the importance of preventive health measures, which promote health and well-being and prevent ill-health and handicap.

In addition, I welcome my hon. Friend's reference to the Mill Road maternity hospital. For a long time my aunt was a distinguished gynaecologist and obstetrician at that hospital. I always think that I should have represented my hon. Friend's constituency, because my family has brought most of his electors into the world. However, I have managed to recruit one of my aunt's babies—perhaps she is one of my hon. Friend's ex-constituents—as my agent. She is now going into the maternity business herself, and I wish her luck.

I shall concentrate on the importance, both in this country and overseas, of making people aware of the measures that they can take to promote health and wellbeing. My hon. Friend the Minister has distinguished himself by leading campaigns, both inside and outside Government, on smoking. The hon. Member for Crewe (Mrs. Dunwoody) has often joined that campaign and dealt with me when I have strayed from the straight and narrow.

We must not only occasionally demand action from the Government; we must use the Floor of the House to remind members of the public—whether they are professionals in health care, involved in voluntary organisations, such as my hon. Friend the Member for Cambridge, or ordinary families—that they will find that information is available about the action that they should take in their own best interests. As some hon. Members may know, I am associated with a new body called "Family Forum". It is designed to bring people together to consider not only health measures but the other measures that people can take. I refer not only to the suggestions that can be made to Government but to an awareness that the primary determinant of health and wellbeing in a family is the family's own actions.

The Court report on child health services and the parts of the Black report that did not involve the spending of large sums of money show that a family's actions often make a great difference to handicapping accidents, whether in the home or outside. I am sure that hon. Members will remember the campaigns on perinatal mortality and on avoidable handicap at birth and in the early years of life. The French programme is perhaps the most sophisticated project on avoiding birth handicaps. It reached its target levels of achievement within about 18 months and not—as was expected—after seven years of Government programmes. The discussions on ways of avoiding handicaps and on the targets that could be achieved dramatically raised public awareness and consciousness. The people of France have benefited. Obviously, adjustments in Government policy can also make a difference. However, the most significant difference can be achieved by increasing public awareness.

I remind the House and the public that there are two simple ways of avoiding the distress that afflicts so many. We should deal with smoking and with the wearing of seat belts. There is a great deal of public concern about issues such as nuclear power. If people realised that only one-tenth, one-hundredth or one-thousandth of the casualties that arise from smoking or from accidents in which seat belts are not worn might arise as a result of nuclear power, they might accept that we should concentrate more on certain risks.

We do not consider risks realistically. The avoidable risks that we run in our every-day behaviour are far greater than the risk attached to events that have never occurred in Britain. I hope that this debate will make people aware of what can be achieved both overseas and in Britain.

5.48 pm
Mr. Bob Cryer (Keighley)

I congratulate the hon. Member for Cambridge (Mr. Rhodes James) on securing another Adjournment debate. There has been a slightly surprising turn of events and, as a result, we have time for this debate. I support the hon. Gentleman's concern for preventive medicine in developing countries. In addition, I echo the comments made by the hon. Member for Woolwich, West (Mr. Bottomley) about preventive medicine in Britain. However, I shall concentrate on the problems of developing countries rather than on those that we face, which are—at least in part—the problems of an affluent society. The problems in the developing world are clearly much greater. I believe that this is behind the motivation of the hon. Member for Cambridge in seeking to raise this issue.

I should like to quote from the Brandt report. an important document that has twice been debated in the House by concerned hon. Members on both sides. Somehow or other that concern has to be translated into action. We shall see a continuing gap between the affluent nations of Western Europe and the American continent on the one hand and the developing countries on the other, unless we can translate into action some of the ideas in the Brandt report.

I should like to quote from page 14, where the report says: The prospects which might open up if only part of the unproductive arms spending were turned to productive expenditure on development are only slowly dawning on people. The annual military bill is now approaching 450 billion US dollars, while official development aid accounts for less than 5 per cent of this figure. The report goes on to give four examples, one of which is connected with the subject raised by the hon. Member for Cambridge. The report states: The military expenditure of only half a day would suffice to finance the whole malaria eradication programme of the World Health Organisation, and less would be needed to conquer river-blindness, which is still the scourge of millions". That is the military expenditure for half a day. As the third in its list of examples, the report states: For the price of one jet fighter (20 million dollars) one could set up about 40,000 village pharmacies We are currently buying about 380 Tornado jet fighters at roughly the price quoted in the Brandt Commission's report, that is, at around £10 million each. We have to look at our own priorities. The fourth example quoted in the Brandt report is: One-half of one per cent. of one year's world military expenditure would pay for all the farm equipment needed to increase food production and approach self-sufficiency in food-deficit low-income countries by 1990". That alone would help to curb disease. People who are not well fed are open to attack from disease because they do not build up a natural resistance. Disease can attack them much more easily and rapidly—and it does.

I want to emphasise that we have to tackle this issue ourselves. I wish to make the point that the Government have cut back overseas aid by 21 per cent. That is entirely mistaken. Among that 21 per cent. I am sure that there must be an element of assistance for the provision of facilities to prevent disease and to prevent the onset of deprivation of one sort or another.

Putting aside the moral dubiety of cutting overseas aid to the very poorest developing countries, such a policy is not to our commercial advantage. As countries develop they will look to us to provide them with further technical assistance facilities, and the provision of those facilities will help us, commercially and industrially.

I believe that foreign students coming to our universities help to gain knowledge from our facilities and take that knowledge back to their own countries. That is another important aspect of our sharing in the attack against the onset of disease in developing countries. Whether it is straightforward knowledge of better medical facilities, indirect assistance, such as improved agricultural facilities, or simply some sort of engineering knowledge, it is of advantage, both from a moral and commercial view, if the Government are prepared to tackle this issue on the basis of setting an example.

I wish to touch briefly on a suggestion in the Brandt report–

Mr. Rhodes James

I do not wish to become involved with the hon. Gentleman in a debate about overseas aid policy, although it is fair to point out that the present overseas aid budget is considerably higher under this Government than under the previous Government. Not nearly enough of it, however, is devoted to preventive medicine. That is true of the budgets of other Governments. That is the point that I was trying to make. It is implicit in the Brandt report. I regret only that it was not given sufficient emphasis.

Mr. Cryer

The hon. Gentleman makes a fair point about the allocation of the overseas aid budget. That is a matter that the Government must take into consideration.

I wish to conclude my remarks by referring to a suggestion in the Brandt report for a tax on military expenditure. On page 122 the report states: The treaty under which Latin America was declared a zone free of nuclear arms could be an interesting model for consideration by other regions. Measures to curb the global arms race have made only limited progress. They may have prevented some programmes from expanding and certainly the major powers have come closer together in appreciating the dangers and the costs of the escalation of arms production. Bur real disarmament, actual reduction of weapons and expenditure levels, remains elusive. On page 123 the report adds: Nonetheless, military expenditures and arms exports might be one element entering into a new principle of assessment for international taxation, and efforts to generate appropriate information for this purpose deserve encouragement. That is absolutely right. The developing nations must get together in order to stem the arms flow to the developing countries which are poor, and, in some cases getting poorer, but still find financial facilities available for the purchase of arms. On this planet we are now in a position in which if we fail to live together we shall die together.

There is a great moral imperative. It is difficult to defend a decision, for example, to spend over £25 million—an enormous sum for these poorer countries—on the installation of cruise missiles or £5 billion on the installation of Trident submarines. When we talk about the development of preventive medicine in developing countries—an important subject, on which hon. Members on both sides of the House feel deeply—the fact is that the developing countries say "A large proportion of your expenditure goes on means of extermination which, hopefully, will never be used". They also say "You are not setting a very useful or good example in priorities". I would much prefer to see the release of that expenditure in aid to the developing countries of the world—to set, if one likes, a moral example in non-proliferation of nuclear weapons.

Whatever view one takes of nuclear weapons, the fact is that we live in a dangerous age. It is not getting easier. Expenditure on nuclear weapons and conventional weapons becomes greater with each year that passes. Some initiative must be taken to break through the momentum that the arms race is gaining of its own accord. I believe that the Government could and should set an example to the rest of the world by saying that they are not prepared to spend £5 billion on Trident and that they intend to restore the 21 per cent. cut in overseas aid.

The hon. Member for Cambridge said that it was more than the Labour Government would have spent, whatever the cuts. I should like to think that a Labour Government would still preserve that level of progressive expenditure for overseas aid whatever difficult circumstances existed at home, because we like to think of ourselves as international Socialists, who feel concern for people all over the world. I also hope, even at this late stage, that the Government can be pushed away from their militaristic posture and be persuaded against the expenditure of this enormous amount, which will probably be doubled by the time that the missiles are actually stored in the submarines, if that dreadful day ever comes.

This is an important moral imperative that should bring strength. The point of view is universally held, not necessarily by the Labour Party but by people of all political views or of no political views, and by the Churches, that it is a scandal that so much money is spent by the West on nuclear weapons while two-thirds of the world's people are short of food, clothing and shelter. It means, of course, that preventive medicine is all the more important, because basic deprivations leave people more open to the ravages of disease.

The Brandt report, which I know is supported enthusiastically by some Conservative Members but also receives its fair share of sneers from the Conservative Benches, contains some ideas which are worthy of our support. It indicates paths that Governments can follow. I realise that the Minister may not be able easily to answer the argument, having been propelled into an Adjournment debate at very short notice, but I must tell him that the Government are not setting a good example to the rest of the world in the priorities that they are pursuing. It would be welcomed by developing countries if they shifted their priorities so that some of the money that they have allocated to be spent on the means of extermination could go into a programme for survival, including the preventive medicine that was mentioned by the hon. Member for Cambridge.

We have had a short but useful debate. The topic that it concerns will not go away. I cannot marshal all the arguments at this short notice, but they relate to the most important question of all—whether we live together or die together. With the proliferation of nuclear weapons and the greater expenditure by this Government we are set on a course that is beset by grave dangers. Let us pull back and support a programme of survival for humanity. In so doing, I am sure that our influence in the world will be immeasurably enhanced.

I do not believe that people who are deprived of food, clothing, shelter and medical facilities are much impressed by a Trident missile programme. If we were to embark on a programme of hospitals, irrigation facilities and village pharmacists we should be able to win friends and influence people, if that is what the Government's foreign policies seek to do. So if we are to win friends and influence people in the developing nations of the world we need to help them. They will be impressed by help, and not by some of the expenditure that this Government, alas, are carrying out.

6.5 pm

Mr. John Farr (Harborough)

I want to get back to the purpose of the debate. The hon. Member for Keighley (Mr. Cryer) spent 10 minutes or so telling us what a short debate we are having and then concentrated almost entirely on the sins of the British Government in deciding to defend ourselves in a proper way against nuclear attack. I believe that most of us, certainly those on the Conservative Benches, believe that if we are under threat, as we are, from the East, we must be properly defended against any form of conventional or nuclear attack.

I come back to the subject of the debate. I congratulate my hon. Friend the Member for Cambridge (Mr. Rhodes James) on his initiative and alertness in securing this important debate on the use of medicines in the developing world. I join him in welcoming the hon. Member for Crewe (Mrs. Dunwoody) to her new position. We look forward to seeing her there for a number of years. I am sure that the whole House recognises that she has a fund of knowledge of these matters, and we look forward to hearing her contributions.

I intervene in the debate to say something about the use of preventive medicine in developing countries, and in particular in India and Bangladesh. My hon. Friend the Member for Cambridge, as chairman of the appropriate committee, is an expert on the subject. I was in India a week or two ago, and I discovered that some of the preventive medicines that are used there against malaria are no longer effective because the malaria mosquito is continually developing a different strain. It is therefore essential that there should be continuous and permanent research into the type of preventive medicine that is used—the injection—in combating malaria in India and Bangladesh and some of the other diseases to which my hon. Friend referred. While preventive medicine has performed remarkable achievements in India and Bangladesh, at the same time it is helping to swell a growing and obvious menace on the horizon, namely, the growing population of those countries, with their continuously growing demand for more food and more money to be spent on them. The more effective that preventive medicine is in developing countries such as Bangladesh and India, the more infant mortality rates drop, as is happening in India, and the more maternal mortality rates drop, and the longer people live.

Perhaps my hon. Friend the Minister can assure the House that he recognises that, hand in hand with the progress of preventive medicine in developing countries, there is a proper programme of family planning. The Family Planning Association in India is an example to the rest of the world. It is run almost entirely by volunteers, headed by its president, Mrs. Wadia. It has worked for about 37 years in Bombay and has had remarkable success in reducing the population growth in India. But, despite that success, and despite the work of countless thousands of volunteers throughout the country, it is likely that the population of India will approach 1,000 million by the turn of the century.

The Family Planning Association in India, and to some extent in Bangladesh, almost entirely through volunteers encourages mothers and wives to learn the benefits of a limited family. "Two will do" is a phrase that is gaining publicity. Mothers join clubs to perform plays and sketches showing the benefit of having only two children, compared with five or six, and the relatively poorer conditions in which larger families live.

We visited some of the villages in the countryside around Bangalore and saw some of their projects. Whole villages are taken over by a team of skilfully led volunteers. All the married couples in some of the villages are volunteers in limiting family numbers. Guided by the Family Planning Association, some villages have for a number of years been reproducing at only replacement rate. It is essential to have a full and effective family planning link with any schemes to improve medicines in developing countries.

We saw almost the same situation in Bangladesh, although the history of family planning in Bangladesh is not as old as it is in India. We took a car trip to a town called Mymemsingh. After a long and dusty journey we were welcomed by a large number of ladies who were wearing lapel badges proclaiming that they were members of Mymemsingh Childless Ladies Club. They were all part of the family planning scheme in Bangladesh.

I was encouraged to discover that the family planning scheme, particularly in Bombay, is not designed only to bring population numbers down. A counselling service to childless couples operates in Bombay and in other towns. The Family Planning Association has made it clear that it wishes all families to have two children. The counselling service is a great help to many childless couples. Some of the counsellors who offer family planning advice to childless couples have remarkable records of success. Unless the Governments of the world co-operate and recognise and assist family planning in a proper way, it is likely, as the hon. Member for Keighley said, that some of the dangers of excessively large populations, of which we were warned in the Brandt report, will arise.

I was lucky to attend the world food conference in Rome, where a number of Ministers from developing and developed countries spoke on this subject. After listening for only a day or two one could detect the general pattern of opinion. Unless the number of extra mouths represented by the number of children born every day is reduced the agriculturists will not be able to cope by growing increased amounts of food.

The key to the problem is not disarmament, as the hon. Member for Keighley claims. The key to helping the Third world is education. With a better education the people of the Third world could understand and apply the techniques of modern food production and help themselves to grow more food. If we could improve the appalling literacy rate in India—it is only 27 per cent.;we would have a chance of getting over the benefits of family planning and bringing home to people how a smaller family would help towards a better family life. Education, which is the key, cannot be had without money. I believe that the Government must provide that money to the limit of their ability.

6.15 pm
Mrs. Gwyneth Dunwoody (Crewe)

The hon. Member for Cambridge (Mr. Rhodes James) is well known for his genuine commitment to the interests of the Third world. He introduced our first debate on the Brandt report. He feels strongly that we do not do enough in Britain. I agree with him. I find it dispiriting that the Government take the attitude that they do, not only to the provision of overseas aid but in particular to the provision of services.

The hon. Member for Cambridge said that we could be doing many other things to assist the prevention of disease in the Third world. He was reminding us that we have money, expertise and ability. Even if it were necessary to cut the amount of money available to the Third world—and I do not think that Britain has ever achieved the targets that a civilised nation should achieve—we should look hard at the effect of some internal policies on other countries.

Only last week students from the London School of Hygiene and Tropical Medicine lobbied hon. Members. They are worried about the effect of Government policy on fees for overseas students. They fear that their remarkable unit, which is known throughout the world for its suberb level of provision, will have to close or so curtail its activities that it might find it difficult to continue. That is shameful.

If a nation with the standard of health care enjoyed by Britain does not offer assistance in training doctors from overseas, does not provide information about new techniques and the development of new drugs and vaccines, it is behaving dis astrously. We are not even behaving in a normal, civilised Christian manner.

As the hon. Member for Harbrough (Mr. Farr) said, both education and services are essential. There are many reasons why we should examine our consciences. Some multinational companies have argued strongly with the Government about the health warning on cigarette packets. They have sought to avoid doing anything to restrict advertising that noxious product, tobacco. They do not apply stringent standards when selling tobacco in the Third world.

There is clear evidence that the multinationals, which are responding to pressure in the so-called civilised Western countries, are using techniques to sell tobacco in Third world countries when it has been proved to be capable of causing hundreds of thousands of deaths a year. Television in Britain has been prepared to put forward arguments that the House has not had time to develop. Recently there was a moving and frightening programme about the sale of tobacco products by multinationals in South America. It proved conclusively that there is astonishingly little evidence that Western countries, who make the largest profit from the sale of those products, are prepared to consider the interests of those to whom they are selling.

Mr. Cryer

Will my hon. Friend remind the House that multinationals are going along exactly that same path in the sale of baby milk products? They are usurping the natural breast-feeding process to improve sales of their products. That is having a retrogressive effect because it produces more disease due to the lack of washing facilities for babies' bottles, and so on.

Mrs. Dunwoody

My hon. Friend, as is his wont, has stolen one of my best points. I was about to come to the whole question of the sale of powdered milk in Third world countries. We sell not only tobacco elsewhere in the world, but many other products. I do not necessarily agree that multinationals are deliberately seeking to dissuade mothers from breast-feeding. The difficulty is simple. An undernourished mother, extremely tired, doing a hard physical job in high temperatures, inevitably finds it difficult to feed her baby. She will therefore look for means to supplement the food. Anyone who has dealt with even a well-fed British baby will know that mothers have a habit of looking for means to keep the baby quiet from time to time.

There is also the simple problem of hygiene education. I want to see ritain actively training many more village pharmacists. A simple amount of training could produce a fantastic result. In Africa we can see the work being done by individuals able to control a number of straightforward drugs, do simple first aid and teach people in the langauages and attitudes of the area in which they work to look after themselves in a better way. It is time that we imposed a code on the sale of products such as powdered milk from Western countries to Third world countries.

Inevitably, the education level of many of the communities is such that they do not always take care to use only absolutely clean water. The damage that can result from that is quite frightening. A few years ago the European Community found itself facing an intolerable problem. As part of its food aid it was handing large sums of money and large amounts of powdered milk to African, Caribbean and Pacific countries—only to find that because there was not sufficient tuition in the way that the powdered milk should be served it was doing positive harm. The Community took fairly active stops to ensure that the recipients of powdered milk understood how the products had to be used, and also that it could never be a substitute for human milk but should be used to boost the intake of food for babies.

Mr. Rhodes James

The villain of the piece is not the multinational companies, or the powdered milk; it is polluted water. That takes us back to one of the most fundamental problems of all. With great respect to the hon. Member for Keighley (Mr. Cryer) and the hon. Lady, it is easy to attack companies for manufacturing a product. The real issue lies in the basic poverty, pollution and corruption of the environment in which people live, of which polluted and corrupted water is the most serious problem of all.

Mrs. Dunwoody

I do not think that we are in disagreement. I was not suggesting that the multinational companies deliberately set out to poison those buying their products. Obviously, that is nonsense. Nevertheless, they have a responsibility to ensure that simple education is provided, and that simple and straightforward instructions are supplied with their goods. With the example of tobacco, I am not sure that I want to be as generous to the multinationals as is the hon. Member for Cambridge. It is a different question. In the case of the supply of milk products, the expenditure of quite a small amount by the multinationals—a tiny percentage of their budget for advertising—should be used to ensure that those who buy and use their products are aware of the dangers. It would be a simple thing to do. It would not cost a great deal of money but it would save a great many lives.

There are good arguments for extending preventive medicine to the supply of vaccines and medicines. Britain has always endeavoured to export the very best standards of the National Health Service. There is a department dealing specifically with the provision of high quality information and services to Third world countries, to encourage them to ask for the right facilities, but it cannot provide sufficient health care if it does not have the money to do so. It is part of our problem, and certainly part of our responsibility, not only to lecture people on the health care that they should be providing, but to enable them to have access to bank loans and other money to give that help to those who most desperately need it. That is where the Government are falling down on the job in a specific way.

When the Government think about their expenditure on overseas students, when they examine the rates that they are now charging for education in Britain—which includes medical education, one of the most expensive courses—will they consider whether they cannot now admit that they were wrong, admit that they should not have put such a high cost on the provision of education, but should have been prepared to accept that it was one way to help the Third world constructively? When the Government look at the workings of the multinationals, especially those based in Britain, will they ask for the same safeguards for the marketing of their products in Third world countries as they are trying to achieve for Britain?

Above all, when, as a country, we offer help and advice to Third world countries, can we be sure that we do only those things, and provide only those services, for which we are asked? I find it sad that the Governments in Africa, Asia and many other countries are always happy to come to Britain to discuss the sale of arms and the provision of equipment for causing death. Can we not offer the same encouragement to those Governments to come here to seek to benefit from our expertise and to take back with them a very much better life for their people? That is the message that should go out from the House today. The families that we are happy to acknowledge as friends and dependants of Britain should be healthy as well as happy.

6.29 pm
The Under-Secretary of State for Health and Social Security (Sir George Young)

I join other hon. Members in paying a tribute to my hon. Friend the Member for Cambridge (Mr. Rhodes James) for his moving and knowledgeable speech when he introduced the debate. He is an expert on the Third world, and he displayed that expertise very well during his opening remarks. He was kind enough to say that the last time he had an Adjournment debate on the provision of a new hospital in his constituency, within 12 months a new hospital was being built. Building new hospitals in England is difficult, but possible. The extermination of preventable disease in the Third world could take me a little longer.

My hon. Friend asked what initiatives had been planned for the International Year of Disabled People. On the specific subject to which he referred, we have plans for an international initiative this autumn on the prevention of disability. I think that my hon. Friend will wholeheartedly endorse that initiative. I shall return in a moment to some of the specific subjects that he mentioned in his speech.

My hon. Friend the Member for Woolwich, West (Mr. Bottomley) made some kind remarks about my attitude to smoking. He is right to emphasise the role of the individual in making sensible decisions about life-style. It is no good bullying and lecturing people into doing things that they do not want to do. Such decisions do not stick. We should give people the information on which they voluntarily come to sensible decisions about life-style. Decisions of that sort will stick.

My hon. Friend mentioned seat belts. I have always voted for the compulsory wearing of seat belts, and shall do so whenever the opportunity arises. However, we must be selective about the freedom that we seek to defend. The freedom to kill oneself in a motor car is not one that I should spend much energy defending.

My hon. Friend also talked about relative risks. I never cease to be amazed by the way in which the public become hysterical about threats to life that are so slight as to be almost fanciful, yet regularly ignore the real killers. Nuclear power is an example. In a typical year in Britain, the chances of dying from radiation are about 1:16 million. Of the actual risks from radiation, over 98 per cent. arise from natural causes or medical X-rays, while less than 2 per cent. arise from all other causes, including nuclear power stations. All over the world campaigns are mounted against the generation of nuclear power, but where are the mass demonstrations against smoking?

When I saw the hon. Member for Keighley rising to his feet I wondered how he would introduce cruise missiles in a debate on preventive medicine in the Third world. I should never have doubted his ingenuity, because, quite rightly, he found a clause in the Brandt report which linked the two subjects. Most of the hon. Member's speech was not directed at my Department, but was about defence spending. Last November the Government, when making some difficult decisions about public expenditure, cut defence expenditure and left health expenditure alone. Therefore, I am not sure that the hon. Member is right to grumble about the Government's priorities.

Having suggested that we should cut defence expenditure, the hon. Gentleman recommended a measure that would increase that expenditure by adding a tax to what we already spend on it. If one were to maintain the volume of defence spending, that would increase the amount of resources devoted to it. However, the hon. Member was right to say that we have a moral, economic and political interest in tackling the problems of the Third world.

I shall draw the hon. Member's remarks to the attention of my hon. Friend the Minister for Overseas Development and my right hon. Friend the Secretary of State for Defence to see whether there is any new gem of information in the hon. Member's speech that might cause them to rethink or to write to the hon. Member in response to his arguments.

My hon. Friend the Member for Harborough (Mr. Farr) had an interesting trip in India and Bangladesh. I endorse what he said about the need for more research into malaria. The School of Hygiene and Tropical Medicine is playing a large part in monitoring the spread of chloroquine-resistant malarial parasites and is offering advice on the use of drugs that have been developed to combat the resistant parasites that he mentioned. Discussions are taking place about the impact of policy on overseas students. This year and last year a special fund was made available to provide transitional relief. Discussions are now taking place on what should follow.

My hon. Friend the Member for Harborough was right to say that there were implications for the population if we were successful in introducing preventive medicine, extending longevity and reducing infant mortality. If the rate of infant mortality fell, family size would also fall because parents would not need to produce so many children to ensure that a given number survived into adulthood. I am happy to say that I shall shortly meet the all-party group for population and development which is concerned with those problems. I shall speak to it, and I shall then listen to the remarks of its members to see in what further way the Government can help the initiatives that are taking place in India. I shall write to my hon. Friend at greater length about the Government's help in this matter.

The hon. Member for Crewe (Mrs. Dunwoody) urged us to take initiatives in areas which I believe are the responsibility of other Health Ministers. It is difficult enough to keep the show on the road in this country. If we were to assume the responsibility for health in other countries, as the hon. Lady implied we should, by, for example, insisting on various health warnings for cigarettes sold in South America or other countries, that would be an abuse of our power. However, we can make available to health departments and Ministers overseas the sort of information that we have here. We can explain the measures that we are implementing to tackle smoking, for example, and encourage them to adopt them in their own countries. As we do not have the power, we cannot insist that those who package or prepare their export products here do so in a way that we think is right. That is the responsibility of the receiving country. I see problems in adopting a slightly higher profile on the lines suggested by the hon. Lady.

With regard to baby milk, about three weeks ago I made an perceptive speech on the Adjournment in response to a debate initiated by the right hon. Member for Stoke-on-Trent, South (Mr. Ashley). The hon. Lady will be pleased to know that we are supporting a code of conduct that will be discussed at the forthcoming meeting of the WHO. If other countries support us in recommending that code of conduct, the abuses to which she referred will be curtailed. This country has played an important role in drawing up that code of conduct. The abuses that undoubtedly exist are not the responsibility of manufacturers based in this country. There is a role for us to play in the forum of the WHO, in encouraging that code of conduct to be adopted to avoid the senseless deaths caused by the indiscriminate and often illiterate use of baby milk powder.

The quality of life today owes much not to acute medicine but to preventive medicine. It is easy to forget that during the last century only six out of every 10 children grew to adulthood. If they survived childbirth, which was a hazard for mother and child, they then had to face diseases such as scarlet fever, measles, whooping cough and diphtheria. Other diseases struck at any age—diseases such as typhoid, cholera, tuberculosis and smallpox. Water supplies were frequently tainted with sewage and uncontrolled industrial waste. Our cities were dark with soot and smoke. Overcrowding and poor nutrition contributed more misery.

Public health achievements have contributed many improvements since that time. We took action to protect the public against the hazards of their environment. The sanitary reform movement ensured reasonably pure water supplies and the efficient removal of sewage by the late 1880s, and the virtual disappearance of enteric fever. There were Acts to control air and water pollution in the 1860s and 1870s.

Preventive measures such as vaccination and immunisation reduced the toll previously exacted by common infectious diseases such as TB, polio and diphtheria. About 99 per cent. of those diseases have now been eliminated. More recently there was the widespread acceptance of family planning, and there were improvements in antenatal care. Those initiatives have done more to improve the quality of life than does the more dramatic and expensive acute medicine that often hits the headlines.

We must pass on that basic information to the Third world. We must not forget that many of those measures were not achieved without controversy. For example, in the nineteenth century The Times was concerned at measures that were being taken to prevent further outbreak of cholera. It said: We prefer to take our chance of cholera and the rest than be bullied into health. There is nothing a man hates so much as being cleaned against his will or having his floors swept, his walls whitewashed, his foul dung heaps cleared away". There were battles to be fought even in those days on the familiar grounds of personal freedom and State intervention. The quality of life today owes much to measures designed to preserve public health.

In his opening remarks my hon. Friend the Member for Cambridge referred to polio. Many hon. Members will recall the 1940s and 1950s, when poliomyelitis was common in this country. There were over 3,000 paralysis cases in 1957. Immunisation was first introduced in 1956, and the disease was brought under control. In 1979—the last year for which figures are available—there were only six paralysis cases in England and Wales. Of those cases, four acquired their infection abroad.

The uptake of vaccination against poliomyelitis is high. About 79 per cent. of children born in 1977 had been vaccinated by the end of 1979. There is no doubt that it is the high vaccination rate that is protecting our children from the disease. It is true that there is a certain, slight danger from vaccination to unimmunised parents when their child is vaccinated. That is why the Department advises unimmunised parents to be vaccinated at the same time as their children. However, very few cases of polio now occur in this country.

I believe that my hon. Friend has a particular interest in the activities of the Save the Children Fund in the fight against polio abroad. I should like to take the opportunity to make particular mention of the work that the fund is doing and to congratulate it both on its original campaign and on its expansion to a wider immunisation programme covering measles, diphtheria and other killer diseases. We are well aware of the valuable work being done by the Save the Children Fund in assisting Governments in certain Southern African countries to established programmes of immunisation.

In addition, the World Health Organisation has set the ambitious goal of Health for all by the year 2000", now endorsed by the United National General Assembly. The organisation has identified immunisation against the major infectious diseases as one of the keys to the attainment of that goal. To that end the WHO has an expanded programme on immunisation. Its objectives are to provide immunisation for every child by 1990 against certain selected diseases—initially, polio, together with diphtheria, whooping cough, tetanus, measles and tuberculosis—and to promote national self-reliance in the delivery of immunisation services and regional self-reliance in vaccine production and quality control. I believe that it was through the officers working with the expanded programme that the Save the Children Fund was able to identify as in prime need of assistance the countries in which it is now working in Southern Africa.

On the technical side, the WHO's work includes developing effective vaccines and the "cold-chain" for the transport of refrigerated vaccines from manufacture to the field and their storage there, particularly in extreme tropical conditions. Our expertise has been very prominent in the whole of this work. For example, the WHO cold-chain support unit, which is about 65 per cent. funded by the ODA, has been remarkable in its success, from the development of cheap, locally manufactured, hand-carried cold boxes to the commissioning of an icemaker that can be used on dung or wood fires in the bush. There is also an organisational side since, as with other health measures, the basic work must be in the hands of local people. The intention of the expanded programme to promote national and regional self-reliance is an expression of that.

Finally, the WHO is making considerable efforts to mobilise resources in cash and kind outside its own budgetary financing on a United Nations-type basis. Thus, in addition to the £1.7 million that it has devoted to the expanded programme from its own resources, it has raised to date the equivalent of a further £1.7 million as voluntary contributions, with a further £2.2 million firmly pledged, but not yet fed into the programme. I believe that we all recognise that this is where bodies like the Save the Children Fund come in. We have received numerous indications from the WHO and from contacts abroad of the way in which its campaign has been so well received.

I hope that the organisations will continue to work closely with the United Kingdom departmental elements—which include officers of both the DHSS and the ODA—involved with the WHO in the expanded programme of immunisation, which is now being given such high priority. The WHO has demonstrated by its successful campaign to eradicate smallpox that it has the skills necessary to organise and manage a global campaign, although I recognise that the expanded programme of immunisation is a much more complicated business, which the WHO seems to be putting together fairly well now. I assure the House that Ministers and officials in my Department play a full part at international conferences in doing all that they can to spread the gospel about preventive medicine overseas.

In congratulating those who have worked so tirelessly to achieve success, I must emphasise that prevention remains the responsibility of us all—Governments, health authorities, health workers throughout the world, voluntary bodies and, last, but not least, ourselves as individuals. The Government are pledged to play their part.

Mr. Rhodes James

I thank the Minister and all who took part in the debate for their contributions.