§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Douglas Hogg.]12.32 am
§ Mr. Jonathan Aitken (Thanet, South)
With this debate the House moves away from the episcopal saving of souls towards the medical saving of lives, for the prevention of heart disease is a most important health issue which, until recently, has been tragically neglected by public opinion, by large parts of the food industry and by the Government Departments which should be most interested in it. The results of that neglect show in a series of deeply disturbing statistics, which prove that not only is heart disease the biggest killer in Britain but that, with the possible exception of Finland, Britain leads the world as the country with the highest incidence of heart disease, deaths from heart attacks and strokes.
To enlarge on those statistics, each year approximately 250,000 British people die of cardio-vascular disease, of whom 175,000 die specifically of coronary heart disease. In plain language, that means that heart attacks and strokes cause 40 per cent. of all male deaths and 38 per cent. of all female deaths. The nearest rival as a cause of death is cancer, representing 24 per cent. of male and 21 per cent. of female deaths. Among men who have the misfortune to die under the age of 65, 30,000 a year, or one man in every 11, are killed by heart attacks—again, by far the biggest cause of death in that age group.
That loss of life and the disability which often precedes it become even more unacceptable as the realisation grows that many deaths from heart disease are preventable. One need only consider some international comparisons to understand that there seems to be a peculiar, if not downright sinister, local dimension to the heart disease problem, which makes Britain the heart attack capital of the world.
For example, why should the British heart disease figures be six times higher than Japan's or two and a half times higher than Italy's, and significantly higher than those of any other European country? Why should the British total of heart attack deaths have remained at their present high levels for the past 20 years, while during the same period in such countries as the United States of America and Australia there has been a steep decline, showing an overall fall in heart attack deaths of more than 25 per cent. per annum? If we in Britain had seen anything like the Australian or American decline in heart disease we should have approximately 45,000 fewer heart attack fatalities a year. So why has not it happened?
The answers to some of those questions can be found in the growing consensus of expert medical opinion, whose reports confirm a clear link between our national pattern of diet and our record of heart disease. Over the past 10 years or so there have been studies from more than 20 expert medical committees, the most notable being the Royal College of Physicians' report in 1976, the NACNE report in 1983 and the Canterbury conference report in 1984. All confirm the thesis that heart disease can be prevented on a substantial scale by following some simple basic rules of diet and lifestyle. The Canterbury report, for example, estimated that 40,000 heart attack deaths a year can he prevented. Other experts have put the preventable deaths figure at estimates ranging from 25,000 to 75,000 a year.
146 All this evidence about the preventability of heart disease has been mounting for some considerable time. In some quarters the Government have been criticised for the apparent inertia of their response. For example, the recent best-selling book "The food scandal" by Geoffrey Canon and Caroline Walker is, as the title suggests, an attack on what the authors consider to be officialdom's scandalous reluctance to implement the recommendations of NACNE and other reports.
The Government's policy so far could be described as waiting for COMA, a report of the DHSS committee on medical aspects of food policy. Although waiting for COMA has seemed to some observers almost as interminable a process as "Waiting for Godot", by a piece of fortuitous timing the COMA report was finally published some four days after I was lucky enough to secure this Adjournment debate in Mr. Speaker's ballot. So tonight is the first parliamentary opportunity to debate COMA and to hear the Government's response to it.
The COMA report is a cautious but authoritative document. In broad terms it confirms the statistical evidence outlined earlier in my speech. It supports the thesis that heart disease and diet are linked. Although it avoids estimating the figure of heart disease deaths that could be prevented each year, COMA believes that several important policy changes are necessary towards Britain's food and dietary patterns. It asserts that these changes would be likely to reduce our present high levels of heart disease if they encouraged people to eat less fat, less salt and no more sugars than at present.
Perhaps the most important recommendations of COMA are those which tackle the much neglected subject of food labelling. Having identified the excessive intake of fat and fatty acids as the principal villain in heart disease, COMA argues strongly in section 2.4 that all manufactured foods should be clearly marked with a simple labelling code warning the public when the fat content is high. In addition, COMA insists that the contents of manufactured foods must be clearly labelled with percentage by weight figures of their various ingredients, including fat, salts and sugars.
I take the view that it is a serious criticism of both the food industry and the Government that manufactured foods are not already labelled with the sort of minimum nutritional information that gives the public the opportunity to know which foods may increase the risk of heart disease and which foods are best for healthy eating. We need a policy of full disclosure on food labelling.
To illustrate my point, I ask my hon. Friend the Parliamentary Under-Secretary to reflect for a moment on the differences in contents labelling between a pair of socks and a packet of sausages. I have here a pair of socks. They are well labelled, as the law requires. They say clearly how much of the socks are made of fibre, where they were made, how to wash them, and what their exact contents are. They are 80 per cent. cotton, 20 per cent. nylon, they were made in Hong Kong, they should be washed in warm water and given a minimum spin—all information which is very helpful and informative.
I also have with me a packet of sausages, and the labelling might be described as a highly edited version of the contents. There is a long list of such contents as colour, spices, salt, sodium and so on, but there is no mention of the quantities involved. Rather puzzlingly, there is also no 147 mention of fat, though even an O-level chemist such as myself could easily discern a large quantity of killer fat in these sausages.
I hope that my hon. Friend the Under-Secretary of State for Health and Social Security, who is to reply, will note the sharp contrast between the labelling required by law for an ordinary pair of socks and the misleading labelling of a packet of sausages and many other foodstuffs. I press my hon. Friend to tell us when and how he expects to bring in regulations that will impose adequate food labelling on the food industry.
My hon. Friend will not have an easy task, because he is sure to encounter resistance from vested interests such as some sections of the food industry, its lobbyists and its marketing organisations. We have only to look at the advertising activities of the Milk Marketing Board, whose motto might as well be, "Fat is good for you", and then look at section 5:4 of the COMA report which says the exact opposite, to realise what an uphill struggle a labelling change, warning of the dangers of excessive fat intake, will be.
I hope that my hon. Friend will not fall back on the old clichés about voluntary discussion and self-regulation. He must take power under section 7 of the Food and Drugs Act 1955. He has the opportunity to do so, and I hope that the Government will impose mandatory regulations as soon as possible.
When my hon. Friend brings in the reform of food labelling, he will need to seek the full co-operation of the Ministry of Agriculture. That should be easily forthcoming, because the British fanner has nothing to fear and much to gain if our national dietary habits change in the direction signposted by COMA. On the other hand, the milk lakes and butter mountains produced by the EC are likely to perpetuate high rates of heart disease if they are consumed. I hope that COMA' s support for reforming that aspect of the common agricultural policy will be noted by the Government.
If reforming the CAP seems a distant target, let me come closer to home. I hope that my hon. Friend the Under-Secretary will take on board the enormous savings that could be made in the National Health Service and other departmental budgets if some of the ideas set out in COMA were implemented. The costs of heart disease are astronomical, not only in human terms, such as bereavements, disability and anxiety, but in pure economic terms. No one has begun to measure the costs of premature deaths and retirements or absences from work because of heart disease-induced sickness. However, we can estimate that the rising cost to the NHS of treating heart disease is now running at about £350 million a year.
For example, in my constituency, the Canterbury-Thanet health district fills about 22 per cent. of its acute beds in local hospitals with heart patients. In Thanet and every other health district, substantial savings could be made if we could only achieve the levels of heart disease prevention that prevail in many other countries.
My only purpose tonight is to argue for a shift in emphasis by the Government towards a campaign for heart disease prevention. I believe that a revolution in food labelling is the most important step in that campaign, but it must be accompanied by a major educational effort, in schools, in the media, among doctors and in Government and Parliament. I hope that my hon. Friend will not neglect 148 the leaders in the campaign so far — the Coronary Prevention Group, which currently receives a derisory grant of only £3,000 a year from the Government, compared with the £750,000 given to other worthy organisations, such as the Royal Society for the Prevention of Accidents, for their worthy work in preventing important, but numerically less significant causes of death.
Much should be done to convince the public that far too many British people are digging their graves with their teeth and needlessly increasing their risk of heart disease and heart attacks. I recognise that no Government can prevent people from eating foolishly if they choose to do so, but Governments can ensure that those who wish to eat wisely are not made fools of either by nutritional ignorance or by misleading food labelling. The medical experts have given their judgment, COMA has reported and I hope that my hon. Friend will rise to the challenge by starting the campaign for heart disease prevention.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
I rise to welcome this important debate which has been initiated by my hon. Friend the Member for Thanet, South (Mr. Aitken), who has shown a characteristic interest in heart disease prevention. My hon. Friend the Member for Swindon (Mr. Coombs), who is also greatly interested in these issues, is decorating the somewhat sparsely inhabited Benches when comparison is made to the previous debate on the appointment of bishops when 40 to 50 right hon. and hon. Members were present.
My hon. Friend the Member for Thanet, South has given us some of the facts on coronary heart disease and it is worth while recapitulating one or two of them. In 1982, the most recent year for which we have figures, coronary heart disease claimed over 155,000 lives in England and Wales, a quarter of all deaths. An increasing proportion of victims are under 65 years and many are in their 40s and 50s. Coronary heart disease is the commonest cause of death among middle-aged men. That means, as my hon. Friend said, an enormous toll of human suffering from disabling illness and bereavement. It means also the loss of about 30 million working days a year in England alone. There are at any one time about 7,000 National Health Service beds in use by patients with heart disease and my hon. Friend can speculate on the considerable cost of those beds and the cost to the NHS.
It is important for us all to realise that we do not know, in the House or in the scientific community, all the causes of coronary heart disease; it would be foolish to pretend otherwise. However, we know that in many instances its onset can be delayed or prevented, or the prognosis can be improved, by changes towards a generally healthier lifestyle. I shall refer to three ways in which a healthier lifestyle can help to prevent the onset of coronary heart disease, two of which my hon. Friend did not deal with at any great length. I hope that he will forgive me for mentioning them. One cause of coronary heart disease is smoking and another is hypertension. I appreciate that diet was the main theme of my hon. Friend's speech.
Cigarette smoking is known to be a major cause of coronary heart disease. The Royal College of Physicians, in its latest report entitled "Health or Smoking", estimates that smoking is responsible for 20 per cent. of all deaths 149 from heart disease. That is over 30,000 deaths a year in England and Wales alone. Many of those deaths will be among people in early middle years of life.
An important part of our strategy for the prevention of the onset of early heart disease must be to discourage smoking and to present the necessary information in a non-nannying way so that we draw attention to the risks that attach to smoking. The Health Education Council, which the Government fund, is active in alerting the public to the dangers of smoking. Earlier in the year I announced to the House that we are giving the HEC an additional £500,000 to spend on anti-smoking campaigns, bringing its total spending on smoking education and information in 1983–84 to about £2.5 million. That is money that is well spent. The Government are maintaining their own efforts to discourage smoking, especially among young people.
As far as we can see at the moment, hypertension, or high blood pressure, is perhaps second in importance to smoking as a risk factor for coronary heart disease. People with blood pressure in the top 20 per cent. of the range are about twice as likely to develop coronary disease as those whose blood pressure is in the bottom 20 per cent. Hypertension could well reduce the life expectancy of a 35-year-old by 40 per cent. or more. In turn a number of factors may lead to hypertension, including obesity and, in particular, diet and its salt content.
That leads me neatly on to trying to answer the points raised by my hon. Friend the Member for Thanet, South about diet, the COMA report and the Government's initial reactions to it. One of its key recommendations was that individuals should try to lessen their salt intake, either directly or indirectly, from manufactured products. That may make a considerable contribution towards lessening hypertension or high blood pressure. We greatly welcome the report of the expert panel of the committee on medical aspects of food policy, which was published last week. It considers the significance of the relationship between nutrition and cardio-vascular disease.
As my hon. Friend has said, the report contains several important recommendations for Government, food producers, for the food processing, retailing and wholesaling industries, for medical practitioners and, in particular, for the public. As he said, the report is based on the best possible scientific evidence available. It is significant that among the membership of the panel that produced that report are such distinguished medical experts as Professor James, who chaired the NACNE working party, and Professor Rose, who chaired the important World Health Organisation working party that produced another report on diet. All the medical experts, under the excellent chairmanship of Professor Philip Randle — who is distinguished not only for being a Fellow of the Royal Society but also for being, at 6 ft 9½ in, the tallest practising professor in any British university—have produced a report to which the Government must respond.
My hon. Friend asked me how we would respond. The report came into our hands on 15 June, and by any standards in Government, we produced and published it quite quickly. I was personally committed to its rapid publication, and my right hon. Friend the Secretary of State and I made sure that it was published as quickly as possible. However, we are now faced with a twofold task. First, we must consult all interested bodies about its contents, and secondly, we must translate its contents into 150 a form that the public can readily understand. I have no scientific training, and I found some parts of it, with its formulae and scientific terms, hard to understand.
However, my right hon. Friend the Secretary of State has asked the British Nutrition Foundation and the Health Education Council to ask their joint advisory committee on nutrition education—now to be called JACNE—to turn the advice from the report into practical guidance which the average consumer who is interested in the relationship between diet arid a more healthy lifestyle, and in the prevention, among other things, of coronary heart disease, can readily understand.
We have already sent copies of the report to several interested bodies, including, very importantly, the Royal College of Physicians and the British Cardiac Society. We must consult all the bodies involved as quickly as possible about the implications of the report before we can take any further decisions about the report's interesting suggestion that we should have a regular series of reviews about the relationships between diet and cardio-vascular disease.
I am sure that it is a mistake to publish such reports only once every 10 years. The pace of knowledge is changing so much that we need more up-to-date evidence provided in a more up-to-date way.
I have been asked to give the Government's view on one of the issues which stems from the report—the right of the consumer to know as much about the fat content of a packet of sausages as is already known about the contents of a pair of stockings. His point is well made and the Government recognise it. That is why some weeks ago, in advance of the receipt of the report, the DHSS and the Ministry of Agriculture, Fisheries and Food began consultations with the food industry about the prospects for the realistic fat content labelling of foodstuffs so that the package of sausages that my hon. Friend showed to the House can have an adequate label that people can understand.
When I look at lists of food contents I find it hard to relate them to anything that I understand. We must ensure, when and if—I hope that it is when rather than if—fat labelling is introduced that the consumer can readily understand the information on the label.
My hon. Friend is doubtful about the willingness of some food manufacturers to introduce such labelling, but I was reassured at the weekend to see that one or two large dairy products firms had inserted large advertisements in newspapers pushing low-fat cheese and other products, relating their advertising campaign to the report. That shows that the food industry realises how consumers, Government and medical opinion will mould demand, but that it is able to appreciate marketing opportunities.
The British farming industry and the food processing industry have nothing to fear from the report's recommendations. It simply means change, not decline. In that context I am pleased to see the warm welcome given to the report by my right hon. Friend the Minister of Agriculture, Fisheries and Food and other Ministers. That should not be overlooked.
The family doctor has an important role when tackling diet, hypertension and smoking. The GP and the practice nurse are in the front line when helping to prevent coronary heart disease. All the advice in the world from Ministers, books and articles will be no substitute for the individual advice by doctors or nurses to an individual. No one national diet or menu is right for every individual. The structure and tradition of general medicine in Britain is 151 well suited to anticipatory care. The GP will see at least once in five years about 90 per cent. of all the patients registered with him.
Increasingly, GPs — certainly those in my constituency—when they see their patients, especially the middle-aged, are taking the trouble to record blood pressure and to identify those most at risk from heart disease. They can then advise them on how to reduce risk, and to provide treatment. Part of that will be concerned not only with smoking but with important issues of diet and the need to reduce the intake of saturated fats, salt and too 152 much sugar. I acknowledge the valuable part played by the Royal College of General Practitioners in encouraging GPs to take a more practical approach to the prevention of heart disease.
I thank my hon. Friend for raising this important point. We cannot escape the fact that, unless we can convince the public to change their lifestyles and to think more about the way in which they live, we shall not be successful in reducing the appalling rate of heart disease. That is why I am so grateful to my hon. Friend for raising the subject tonight.
§ Question put and agreed to.
§ Adjourned accordingly at one minute past One o'clock.