§ THE LORD BISHOP OF WINCHESTER rose to ask His Majesty's Government if, in view of widespread malnutrition and the existence of a large milk surplus, they will take steps to extend still further the provision already made to supply liquid milk to school children and to initiate a scheme on similar lines for expectant and nursing mothers and for children under five; and to move for Papers.
§ The right reverend Prelate said: My Lords, it may seem a little incongruous to have a debate on the subject of milk wedged in between two debates on national defence, and to be followed by a militant Motion from the noble Lord opposite (Lord Mottistone). But in a rural county there is a far more vigorous controversy on the subject of the price and distribution of milk than upon national defence. If I remember rightly, some two years ago there was a most vigorous controversy in the Press over the subject of malnutrition. I hope as far as I can to avoid these controversial matters. I shall say nothing about the Milk Marketing Board nor shall I enter into the perpetual dispute which goes on in many places betwen the producers, distributors, and consumers of milk. As for the problem of malnutrition I propose to use the term not in a strictly scientific way, but to give it the interpretation which is given by the Concise Oxford Dictionary, where it simply says 60 that malnutrition means underfeeding. I shall hope to show to the House that there is at the present time a great deal of underfeeding or malnutrition in this country and that this can best of all be met by a larger supply of free or cheaper milk. In speaking of the extent of malnutrition in the country I am most anxious to make it plain that I do recognise most fully all that has been done, and all that is being done, by our public services and by the Ministry of Health for the health of the people of the country.
§ Great advances have been made in recent years, but notwithstanding these advances there is undoubtedly a very large amount of malnutrition. I notice that the Minister of Agriculture, speaking on this subject only a short time ago in another place, said that there was a great deal of malnutrition in the country. Your Lordships may have noticed that last week there was issued a very important and valuable report by Sir John Orr, a great authority on this matter, called "Food, Health, and Income." I imagine this report will, for a long time, be the standard work on this subject. He takes a new standard by which to judge nutrition. Instead of taking an average standard of what is sufficient to stop people from suffering ill health or insufficient diet, he takes what he calls an optimum standard—that is, "a state of well being such that no improvement can be effected by a change of diet." He explains very shortly what a standard diet should consist of. Then he divides population into six groups according to their income and he tests by this standard the nutrition or malnutrition of these various groups. The lowest and the highest groups are the smallest in number, containing some 10 per cent. of the population; the intermediate groups contain 20 per cent. He shows that the lowest group spends only 4s. per head on food, while the highest group spends 14s.—a very great difference in the amount spent between these two groups—while the average amount which is spent on food per head is 9s.
§ He then analyses the food which is consumed by these groups and he comes to these conclusions. The average diet of the poorest group, comprising 4,500,000 people, is by the standard adopted deficient in every constituent 61 examined. The second group, containing 9,000,000, has some of the constituents, but is deficient in all the vitamins and minerals required. The third group consists of 9,000,000 people and is deficient in several of the important vitamins and minerals. He concludes that a diet "completely adequate for health according to modern standards "is only attained by 50 per cent. of the population. The other 50 per cent. is below this. He does not for a, moment say that the 50 per cent. are all suffering ill health or, still less, that they are near starvation, but he does say that if they had a more sufficient diet they would be better in health and in vitality and well being. To prove this he illustrates by showing how closely diet is associated with ill health. First of all, in a very interesting investigation, he points out that in the lower classes of income the height of boys at the ages of 13 and 17 is between two and three inches less than the height of those who belong to the classes where there is better food. He then shows that three diseases, bad teeth, anaemia and rickets, are very prevalent among the children of the country, and that these diseases are very closely associated with malnutrition. He argues that if there was better food, if a higher standard of food was reached, a great deal of these diseases would be removed.
§ Investigations elsewhere show the same results. In the Newcastle area 47 per cent. of the children of the poor are below normal weight and 23 per cent. anaemic. In Manchester 20 per cent. of the children, according to another certificate, had rickets with deformities, while the medical officer of health for Leeds points out that there are a number of children suffering from rickets who attend welfare centres. Adults as well as the young suffer from malnutrition. In Aberdeen, out of 1,000 working class women whose health was inquired into, 50 per cent. were found to be suffering from anaemia, 15 per cent. of them from what is described as severe anaemia. Of course it is not true to say that all malnutrition arises from lack of food. There was a very interesting letter the other day in a newspaper by a well-known London doctor who has had great experience with children. He pointed out that malnutrition is sometimes due to anxiety and worry, and this can even be the case 62 with quite young children. He gives an actual instance of it. But when all allowance has been made for this, it does remain true that the chief cause of malnutrition is underfeeding, and underfeeding does lead to a great deal of ill-health and preventable suffering.
§ I will now pass to my next point—namely, that milk is a food which helps to supply these deficiencies. If we look at any hoarding we see all sorts of claims made for various foods. We are told that if we eat more fruit or more brown bread, take more Oxo, drink more beer, we shall have perfect health. It may very easily be asked: "Why is it that milk is specially chosen as the food which is of such value in cases of malnutrition? "Well, the answer is that milk is the one food which has practically all the vitamins and the mineral salts which are lacking in a defective diet. This is now generally recognised. Only last week, I think it was, the Medical Research Council reported that milk should be the chief diet of children, and added that where a pint of milk was added to what was regarded as an adequate diet there followed surprising benefits in height, weight, mental activity and general health.
§ Sir John Orr gives two very remarkable illustrations of this. In seven Scottish towns fifteen hundred children were given for seven months some additional milk. At the end of that time the rate of their growth was 20 per cent. greater than that of others who did not get this milk, and this was accompanied by a notable improvement both in health and vigour. Even more remarkable is the other instance. Some time ago in Tokyo children in the elementary schools were given additional milk daily for a period of six months. At the end of that time it was found that they had gained in weight 86 per cent. and in height 16 per cent. more than those who were not given this additional diet. I do not think I need spend more time in arguing the point that where milk has been given to those who are poor they have been improved greatly in health and in general well-being.
§ Now I come to my last point, that the provision which is already made, and has been made with very great success, in providing either free or cheap milk for the children in our elementary schools, should be extended. I think it was 63 nothing less than a stroke of genius when it was arranged that both the producer of milk and the children in the schools should be benefited by this cheap milk scheme for our elementary schools, and there is no doubt that this scheme has been very successful. While before it was introduced there were some 900,000 children receiving milk in the schools, the numbers have gone up enormously and something like 2,750,000 children are now receiving this cheap milk. But there are limitations to this. There are a very large number of children, something like 50 per cent. of those in the elementary schools, who are not receiving this milk and who are not benefiting under this scheme. The children who do receive it only receive a small amount, one-third of a pint of milk, and they receive that only five days in the week as a rule. There are, I know, exceptions made in some cases. There are a large number of others, women who are expecting children, women who are anaemic and poor, who do not come under the special provisions or do not avail themselves of the special provision of being able to receive milk at some of the welfare centres, and there is, I think, a general opinion on the part of all those who have studied this subject that it would be a very great advantage both to the children and to a number of working-class women of the country if such cheap milk was made available for them.
§ There is a very significant fact which I want to bring to the notice of the House. There is plenty of milk available. One-quarter of the milk which is produced goes to the factories, and goes to the factories at about one-third of the price which is paid for the milk which goes to the children. That is an undoubted fact. I do not say that this milk which goes to the factories is wasted; no doubt it produces commodities which are very valuable foods; but the fact remains that the children need this milk and that the milk goes to the factories at a much less price than is spent on milk for children in the schools. That being the case I would ask the Government the question which was asked in The Times when The Times was referring to this subject: "Why should not some of the milk now poured into factories be poured down human throats?" I think there is one answer which may be given in objection 64 to this proposal. It may be said that this will cost a great deal of money and that we cannot afford the additional cost. To that objection I would make a twofold answer. In the first place, I would say that against the additional expenditure you must set the saving there would be in hospitals and in medical services which have now to be rendered in removing illnesses which might well have been prevented by a better and more adequate diet. In the long run I believe the nation would save rather than lose. My second answer is that even if it does cost more money, if the State exists, as we believe it exists in this country, for the welfare and well-being of its citizens, surely there can be no better way in which money can be spent than in preserving health which is so necessary for the happiness of its citizens. I beg to move.
My Lords, my noble friends have asked me to thank the right reverend Prelate for bringing forward this Motion, and I am sure your Lordships will wish to thank him for the very temperate and brief speech which he has made. We want to support the terms of the right reverend Prelate's Motion. I do not think he need apologise for bringing it forward as a kind of sandwich between the debate last night and the debate we shall have to-morrow. I suggest that it is peculiarly appropriate, and if the right reverend Prelate had heard the speech made by the noble and gallant Earl, Lord Cavan, in the debate last night he would have heard a military man's reason for taking better care of the youth and children of the country. I was delighted, and my noble friends were delighted, to hear excellent reason found at last by a great figure in the public life of the country for taking care of the young people, even though it was primarily for the purpose of producing healthy soldiers.
I am glad to see the noble Viscount the Leader of the House in his place, and I may interpolate that I hope that the fact that he is able to be here heralds good results for his recent activities. He is an ex-Secretary of State for War and so is the noble and learned Viscount on the Woolsack. They both know the extraordinary figures of the rejection of recruits in this country on medical grounds. We have been discussing the question of 65 defence, and I have seen the figure of £500,000,000 stated as the total cost of the Government's defence programme. I do not know whether that is correct or not, but I should like to ask what is the use of building up a great structure of national defence on a foundation of sand. Out of 68,000 recruits who applied for enlistment in His Majesty's Army last year only 28,000 were accepted. Of three men who came forward to enlist, one was rejected on sight, another was rejected as physically unsuitable or educationally unfit, and the third was accepted. One in three only was fit to be taken into the Forces.
The right reverend Prelate referred to the very remarkable publication just published by Sir John Orr. He has dealt with it so faithfully that I will not trouble your Lordships with more than one quotation. Your Lordships have heard from the right reverend Prelate that 4,500,000 people in this country are not getting enough to eat. That is a terrible indictment of this, the greatest, richest and most powerful country in the world. Sir John Orr said in his summary of the position: "To make the diet of the poorer groups the same as that of the first group whose diet is adequate for full health, i.e. group IV, would involve increases in consumption of a number of the more expensive foodstuffs "—
I underline those words "more expensive "—viz., milk, eggs, butter, fruit, vegetables and meat, varying from 12 to 25 per cent.A great many of your Lordships are exercised about the state of agriculture in this country. I would like to add an argument to those put forward by the right reverend Prelate. Increased consumption of these articles of food enumerated by Sir John Orr would immediately help the whole of our farming industry.
I have here a very remarkable letter which, with your Lordships' leave, I will read. I did not solicit the letter. It came to me because of something I had written in the Press, but I have the permission of the writer to read it this afternoon. She says:
"…while you have a lot to say about giving free milk to school children, you do not say much about free or even cheap milk for toddlers and nothing at all about the present exorbitant price of milk. Every mother knows that thousands of children 66 under school age are going short of milk because it is too dear to buy Yet the Milk Board has money to squander in advertising milk! It is adding insult to injury. Every woman I know is incensed about it, and every time I see a milk poster I long for a Mills bomb, or the strength to scream until the Government wakes up!
My husband is a ' blackcoated worker, ' an ex-Service man (he was under fire at nineteen). We are the best type of young parent and have two bonny baby girls, one ten months and the other two years two months. They must have at least three pints of milk per day between them. I need another pint for cooking and a pint for husband and self (husband ought to have much more as he was gassed and is subject to chronic catarrh in the winter), so that my milk bill is about 10s. per week, which means that nearly one third of my money goes on one item of food, and I have got to go on paying this until my babies are old enough to go to school. If I have to cut down milk any damage suffered by them will be irreparable in four years time.
Yet the only child of well-to-do parents can have cheap milk every day simply because ho or she is old enough to attend school. I know several cases, one where the wife has more than double my allowance and one schoolboy to keep…and that one child can get cheap milk at school! What of those poor souls with even less money than I and perhaps several toddlers to keep? A local dealer openly admits that he could sell milk at 2½d. per pint but the Board won't let him. I am amazed that this ' milk muddle ' has been allowed to go on so long and more than surprised that our women M. Ps. have not done something about it…. Milk should be reduced one penny per pint, and available to all children at the same rate as school milk."
When I got that letter I wrote to the good lady and said that there would be a debate on the Motion of the right reverend Prelate and asked whether she would mind if I read her letter in your Lordships' House. She replied that she would be very glad if I quoted it, and she added:
" It seems rather queer that all foodstuff inflicted with a ' Marketing Board ' or ' quotas ' have immediately become scarce and dear, while the producers seem no better off…Mr. Walter Elliot's smugly complacent statement about the Government's ' achievement ' in increasing milk consumption should be challenged. The increase, if any, shown by statistics (often misleading) can only be by the amount supplied to school children who would otherwise go without. When the children get milk at school at a cheap rate, the housewife seizes the chance to cut down the household supply and use the money for other things, equally necessary."
67 She writes a good deal more but that is the most important part of the lady's letter.
The right reverend Prelate referred to this terrible report of Sir John Orr. Last week I saw in the newspapers a report of a farmer in Yorkshire being fined £50 for growing too many potatoes. Now according to the On report we have 4,500,000 people underfed, and we prevent the farmers from producing the fruits of the earth. I hesitate in the presence of the most reverend Primate to use the word, but I think that the Government's policy in regard to foodstuffs is blasphemous. I hope that the right reverend Prelate's Motion will be accepted and will produce results.
THE EARL OF RADNOR
My Lords, I am not going to follow the noble Lord, Lord Strabolgi, into his indictment of the Government's policy through Marketing Boards, nor am I going to pursue the subject of malnutrition from the point of view which he took at the beginning of his speech. I was very surprised to find that he looked on the necessity for proper nutrition of the people of this country solely from the point of view of providing for the forces which are necessary either to defend this country or to attack other countries. It is a surprising point of view, coming from that side of the House, and I think it is rather a point of view which is to be deprecated.
Would the noble Earl please excuse me. I am sure he does not want to misrepresent me. I was quoting the words of the noble Earl, Lord Cavan. I agree that it is a perfectly good argument, but it was not my argument. We have other reasons besides the need of healthy soldiers.
THE EARL OF RADNOR
The noble Lord must have adopted the noble Earl's point of view; otherwise he would not have quoted it. But the question of the nutrition of the people of this country is of great importance in itself, quite apart from any question of recruits for the Army or anything else, because it means the happiness of the people of this country and their general well-being. The right reverend Prelate has confined his Motion entirely to the question of milk, and he suggests that the Government should still further extend the very successful scheme for providing milk in 68 schools, and extend it, I think quite logically, to children under school age and to nursing and expectant mothers. One must, however, consider it from various points of view, and, before we even consider the principles underlying it, it is necessary to realise the aim and object of the existing milk-in-schools movement. It is not a form of charity to the general public nor to the undernourished. It is, in effect, a very big experiment to try to find out how far the consumption of milk can be increased by a reduction in price, an experiment in which the Government, the producer, and the distributor are all joined and all take their parts financially in reducing the price and thus encouraging the consumption of milk.
The right reverend Prelate referred extensively to that book by Sir John Orr on the question of nutrition, an extremely valuable investigation and a book which everybody who is interested in this subject should read. That book, amongst other things, has certain graph? showing consumption of various foods in relation to income. I would draw your Lordships' attention to two of those graphs—namely, the graph showing the consumption of fresh milk and the graph showing the consumption of tinned milk. The consumption of fresh milk rises steadily with rising income, and the consumption of tinned milk falls as steadily with rising income. That is to say, one might infer that there is a definite desire on the part of the consumers of milk, if they can afford it, to purchase the fresh milk in preference to the tinned variety; consequently there is a fall in the consumption of tinned milk. I have been advised that a small reduction in the price of milk will have no effect on the consumption. I am informed that the reduction in price of a penny a quart which occurs between the winter price and the summer price has little or no visible effect on the total consumption, and that a reduction of not less than twopence a quart will be necessary before one will see any increase in the consumption.
A reduction of twopence a quart in the price of milk means a reduction of eightpence a gallon, and if you divide that reduction equally between the producer and the distributor it means that each has to reduce his margin by fourpence a gallon. Again I am advised that a reduction in price can probably 69 be only compensated for by an increase in consumption of not less than 20 per cent. of liquid milk. If that reduction produced a 20 per cent. increase, then you would see an adequate return. Now that is rather a difficult problem for both producer and distributor to face. It is a gamble on whether a reduced price would produce the necessary increase in consumption to compensate either party. I am thinking, of course, more particularly of the producer, whose experiences I know, and who to-day is getting very little more than his bare cost of production and in many cases even less than that. So we have this experiment of milk in schools, designed primarily to find out whether a real reduction in the price of milk will produce that increase in consumption, or produce some evidence that there will be an increase in consumption sufficient to allow of a general reduction in price.
I agree with the noble Lord, Lord Strabolgi, that there is nothing more likely to increase consumption than a reduction in the price, but I hope that whoever is going to reply for His Majesty's Government will tell us that the experiment of milk in schools, which is in progress, is in their view designed for this object, and that they are not looking on it as the final policy of the Government so far as milk is concerned. If they are looking on this veiled subsidy of wages as a means to assist not only the nutrition of those people who are under-nourished but also to assist agriculture, they may go on increasing subsidies to wages and through wages to agriculture until the taxpayer finds that he has no money left at all.
So far as milk in schools is concerned, the right reverend Prelate has, quite rightly, coupled in his Resolution the question of nutrition with help to agriculture, and, as I have tried to indicate, there is that difficulty in front of us in the very fine idea that what agriculture wants is a higher price for its produce, and what the purchaser requires is a lower price. So far as milk in schools is concerned, I have figures here which are of considerable interest. The increased sales of milk through the Milk Marketing Board in 1935 over those in 1934 were 136,000,000 gallons. That is not the increased production of milk in this 70 country. That is the increased sales through the Milk Marketing Board.
THE EARL OF RADNOR
Liquid and manufactured. It is the increased quantity which has gone through the Milk Marketing Board, taken to a very large extent from farm-house cheese and farmhouse butter-making, and sold for preference through the Milk Marketing Board, but it indicates to some extent the amount of liquid milk there is available for consumption by the public. The right reverend Prelate said that one-fourth of that milk was manufactured. As a matter of fact my figures show that nearly one-third of that is manufactured. Against that you have increased sales owing to the milk-in-schools movement. In 1935 the total consumption owing to the milk-in-schools movement was 23,000,000 gallons, as against 136,000,000 gallons increased total sales through the Milk Board. So far as taking up the surplus production is concerned, milk in schools is not going a long way to do it, and even if you extend it to children under five and expectant mothers you are not going to use up the available surplus of liquid milk which could be so usefully put into the mouths of the people of this country as liquid milk rather than as cheap cheese and butter.
Those figures are interesting, and I think they need considering very carefully. There is, however, a much wider question really embodied in this Motion of the right reverend Prelate. He has, I think, perhaps wisely, confined his Motion to the question of milk as being the most important and probably the easiest product to deal with, but, as was indicated in Sir John Orr's very useful book, milk is not the only fresh food product in this country, and not the only product which can provide the necessary addition to the diet of the people in his country, to bring it up to a reasonable standard. You can, however, take milk perhaps first and as showing the way to other products. What I feel that I would like to ask the Government is whether they are proposing to take any steps to bring the needs of agriculture and the needs of the nation, so far as nutrition is concerned, more into line. We know for certain that, it is fresh food that the people need to bring their nutrition up to standard, and it is in this country only 71 that the fresh food can be produced satisfactorily. Any food imported into this country has to be preserved in some form or other.
If I may, I would make a few suggestions as to the ways in which the Government might begin to try to bridge that gap between the needs of our agriculturists and the needs of the nation. There is a very wide gap, to-day, between the price the producer gets and the price the consumer pays. I do not know whether any Government will ever have the courage to have a searching inquiry into the costs of distribution. There are modern factors which have made the cost of production considerably cheaper, especially so far as perishable products are concerned. There is, for instance, the widespread use of cold storage, whereby, without in any way destroying the food product—that is to say, by merely keeping it in a cool place and a much more efficient cool place than the old-fashioned ice box—a man, instead of having to destroy perishable foodstuffs over the week-end, can keep them fresh and then sell them in the following week. There are other directions also in which, owing to modern invention, the cost of distribution must have been reduced, but so far as I know the margin which the producer expects to get out of his food sales is very much the same as it was years ago. I think a searching inquiry into that particular gap might produce some suggestive result.
So far as other questions are concerned, the Government might consider also giving us a standard, or inducing the Marketing Boards to give us a standard, at which the producer in this country can produce profitably. I can say from my own experience of the farmers of this country that some of them are extremely efficient, and others are not so efficient, and the tendency, and the natural tendency, of the Marketing Boards is to favour the inefficient producer. The inefficient producer has a loud voice and will complain of the price he is getting for his products. The efficient producer is naturally, in those circumstances, not going to say anything, because if he gets a better price he only makes a little bit more money. I think by some means or other we want, at the same time as we have an investigation into the cost of distribution, to have some standard by which we can measure the price that the 72 producer in this country ought to get if he is reasonably efficient. Those are two points on which the Government might go into this question, and at least achieve some degree of bringing the prices to the consumer down, thereby increasing the consumption of the various fresh food products in this country.
I have only one other point. Sir John Orr, right at the end of his book, notes the fact that this question of health and food and agriculture is not the function of any one particular Department. I can imagine that it concerns very closely the Minister of Health, the Minister of Agriculture, possibly the Board of Education, certainly the Commissioners for the Special Areas, and perhaps other Departments. But it is to my mind clearly a case in which one wants some overriding Minister not concerned in departmental duties, who could sit down and draw together all the possibly conflicting or divergent interests into one coherent whole. We have already the precedent of a Defence Minister for that purpose for the various Defence Services. I feel rather strongly that it is just as important to have a coherent whole and a coherent policy for the health of the nation. If we have a nation which has no health it is hardly worth defending: equally if we have a healthy nation we must defend it. But I think that the precedent of the Defence Minister might be very usefully followed in the question of health, nutrition and agriculture.
§ VISCOUNT ASTOR
My Lords, the right reverend Prelate in his Motion raises two points, the question of malnutrition and the desirability of increasing, by subsidy or otherwise, the amount of milk which is made available for certain sections of the population. We were discussing the question of milk quite recently and I shall endeavour to avoid the ground which I covered then. There have only been two speakers since the Resolution was moved, but those two speakers, together with the right reverend Prelate in his speech, indicate the wide range that can be covered by this subject. I could give quite an interesting talk about the experiment which is being conducted on 8,000 children to test the relative value of raw milk and pasteurised milk in different quantities, but I would rather deal with some other aspects of this problem. There was the 73 report recently published, the Orr-Lloyd report. I shall not repeat what has been said in connection with that, but there have also recently been two other reports, one the annual report of the Medical Research Council, which mentions the fact that there is a problem of malnutrition and that the health of a considerable section of the people is not what it should be because they are not getting an adequate and proper diet.
In addition to that, there is the report, probably the most important of all, of an International Commission of experts which met here in London; but, being a report of experts, it has been ignored by most people. As these international experts were unanimous, and as I believe the nutrition policy of all the countries must ultimately be based upon what they say, I would like to refer to that very briefly. More particularly I want to quote what they say in connection with the Motion of the right reverend Prelate. First of all, this Commission states that it is agreed
that deficiencies in important nutrients are a common feature of modern diets and that these deficiencies usually occur in the protective foods.They define these protective foods. They state that "the first and most important is milk." They then say that:The pregnant and nursing woman…should be regarded as the member of the population needing the greatest protection…. For growing children, however, the maintenance of a high proportion of protective foods "—the main one is milk—should be the aim.And further:Milk should form a conspicuous element of the diet at all ages.So that there you have it on the authority of this very important Commission of experts that there is a real problem of malnutrition, and that milk is one of the most important diets that should be dealt with.
Your Lordships may be aware of the fact that at the Assembly of the League of Nations last September three days were devoted to the discussion of this subject. The matter was raised by Mr. Bruce, the High Commissioner for Australia, and the noble Earl, Lord De La Warr, took a prominent part in the discussion. After a three days debate the Assembly passed unanimously a resolution 74 indicating that there ought to be a comprehensive inquiry into (1) nutrition and public health, (2) the repercussions upon agriculture and economics of an improved nutrition policy. As a result of that, a Committee, of which I have the honour to be Chairman, was set up—a large Committee on which sit medical experts, agriculturists, economists and others. It would obviously be improper for me to indicate to-day the contents of the report on which we are engaged. We shall present a report to the Assembly next September. But I could without any indiscretion indicate one or two things which are being dealt with. In September, 1936, we shall present an interim report. The subject is so vast that we should be failing in our duty if we attempted to submit a final report then. The standard which was laid down by the experts who met in London last autumn is a standard which is set out in scientific terms. That is being sent to scientific bodies in every country, and they are being asked whether or not they accept it as being a right definition of nutrition, or whether, because of climate or anything else, there should be any national modifications. When those replies are received, we shall in fact have-in every country a correct scientific standard of nutrition. It is essential that you should have that if you are to set out to have a nutrition policy.
Then a questionnaire has been sent to all the Governments asking what steps they are taking to improve the nutrition and feeding of their people. When we get the replies we shall know what the facts are. We shall have in every country an agreed optimum standard, and every country will know what is being done there, and will be able to compare that with what is being done in other countries. We are also informally urging Governments to deal with the problem straight away. In this country I think there has already been set up an Advisory Food Council. I shall not say anything about it, because there is a noble Lord present who knows a great deal more about it than I do. In the interim report we shall deal only with the Western world. At some future time—and that is one of the reasons why we are only presenting an interim report this year—we shall have to deal with the Far East, where the problem of malnutrition is far more serious than it is in Europe. Then 75 there is the whole problem of the Tropics. We have decided—and I think it very desirable—that it should be made clear that we are not going to ask the League to impose any agricultural or economic policy upon any country, but we are going to ask all agriculturists in every country to agree that if people eat more food there will be a greater demand for agricultural products; and I hope that things will so work out that the international trade upon which modern civilisation has been built up will also improve. We hope very much that as nutrition improves so cheap foods will be allowed to go from countries where they can be produced most cheaply into other countries where, from causes of climate or for other reasons, they cannot be produced so cheaply. All who are interested in this problem owe a deep debt of gratitude to the noble Earl, Lord De La Warr, for raising this question internationally.
May I just turn now to the other aspect referred to by the right reverend Prelate—namely, milk? Again I agree entirely with what he has said. I do not believe it is possible to exaggerate the value of milk as a food. As I understand it, he wants to increase the amount of milk which is provided for children who attend elementary schools, for the pre-school children, and for pregnant women. It is quite evident that he is right that if those people are to get the amount of milk they ought to have, some amount of public money will have to be paid by way of subsidy. I believe that if all the children got the milk they ought to have according to the London experts, the average expenditure on milk alone per child would range between 2s. and 3s. per week. As the Orr-Lloyd report points out that 4,500,000 people spend 4s. per head per week on food, it is quite evident that it is impossible to spend 2s. or 3s. on milk alone. It is obvious that some subsidy has got to be provided.
I am very sorry that the right reverend Prelate avoided what he called the controversial subject of price, because it is the crux of the whole problem. I was very glad indeed that the noble Earl who has just spoken, Lord Radnor, indicated that, because unless you can get the price of milk as low as possible—and I shall go into that in a moment—the burden upon 76 the taxpayer is going to be so heavy, particularly at a time like this when he is called upon to find so much money in connection with defence, that he will feel less inclined to do what he ought to do in order to help the people to have adequate nutrition.
Two other sections of milk drinkers who, I think, will not get the amount of milk they ought to have unless something is done to reduce the price, were not referred to by the right reverend Prelate. First of all, there are what I would call the middle classes. The noble Lord who spoke from the Opposition Benches quoted a letter from a lady who, I understand, belongs to what is called the black-coat class of the community. There are many of them who will not be helped through the elementary schools and yet who cannot afford to buy milk for their family at present prices. There is another section of big consumers of milk—namely, our hospitals and infirmaries, who find it very difficult to buy milk in adequate quantities at present prices. Are we going to subsidise the women, the preschool children, the elementary school children, the children who do not attend elementary schools, and the hospitals and other institutions? If we are going to subsidise them out of the taxpayers' money then the burden will be enormous. It may be necessary to foot that bill, but before we embark on that policy we must be satisfied that the milk is being produced at as cheap a price as possible; and that brings me to the point to which the noble Earl, Lord Radnor, referred.
I am convinced myself that the price of milk to-day is too high, and is higher than it need be. The price of milk is too high to-day because of the machinery for fixing the price of milk and also because of the policy we have adopted in connection with the dairy industry. Take, first of all, the machinery. The noble Earl, Lord Radnor, indicated the fact that the members of the Milk Board, when fixing the price, are apt to fix it at such a level as will allow certain inefficient farmers or the less efficient farmers—nobody likes to admit any farmer is not really efficient—some of the farmers who produce in a more costly manner to make a profit. That is quite natural, because members of 77 the Milk Board have to come up for re-election, and if they put the price of milk too low they will not be re-elected. Therefore their temptation is not to fix the price of milk at such a figure as will knock out the inefficient farmer or will compel those who are inefficient to become more efficient.
I am convinced that a great deal can be done to reduce the cost of production. I am not going to repeat what I said the other day, but there are two ways in which we can fix the price of milk—either on the cost of production, which is apt to be very fallacious, or you can do it to meet the demand. Unfortunately, the Milk Board have not adopted the second policy. If they had adopted the policy of fixing the price at such a figure as will produce the quantity of milk required to meet the demand of the consumer of liquid milk, they would not be faced now with the glut which is creating a very difficult problem. The fact that the price of milk is fixed so high is tempting a large number of farmers to give up other branches of food production and turn to milk production. They are not only being tempted, they are almost being compelled. The marginal producer, the man who never in the old days thought of turning to milk, is tempted by the too high price, the statutory price, fixed by the Milk Board. The result is that more farmers are turning to milk production and we have got an artifically created glut. It is not a natural glut. It is a glut which has been created by the machinery which has been set up under the Milk Board.
Then we come to the second factor, the second cause, which is keeping up the price, and that is the policy which has been adopted by the Milk Board, supported in this case by the Government. The Government are making the glut profitable. When this artificial glut arose there were two policies that might have been adopted—one, to let the effect of the glut react on the producers, and the other to make it profitable. Every time the Government make a glut profitable, they are inducing more farmers to turn to milk. The result is at the present time we are building up by subsidies, and by having too high a price for liquid milk, entirely new industries—the industries of processed milk, manufactured milk, butter, cheese, dried milk. I do not want to say that there ought not to be any 78 dried milk or butter or cheese produced in this country, but it should be a normal industry, not an industry built up partly at the expense of the taxpayer and partly at the expense of the consumer of liquid milk. The drinker of liquid milk should have very much cheaper milk to-day. He could have milk 3d. a gallon cheaper if we were not trying to build up these industries of dried milk, butter, and cheese. In addition to that we are by building up these industries, acting in a manner which is contrary to the best interests of the British Empire as a whole. Do we want people to settle in the Dominions? Do we want the Dominions to buy our manufactured goods? Do we want our shipping to continue? If so, we have got to import from the Dominions some of their dairy produce. The policy which has been adopted at the present time of artificially creating butter, cheese, and dried milk industries in this country is prejudicing the development of the Dominions as well as hitting our shipping.
The noble Earl, Lord Radnor, referred just now to the policy of reducing the cost of distribution. I am not going to say a word about that. I think it is possible; but I want to deal with the other point—namely, that it is possible to reduce the cost of production. I indicated just now that if we were not adopting the policy of building up butter, cheese, and dried milk industries we could reduce the price to the consumer by 3d. a gallon. At the present moment 3d. a gallon is being taken off the price which the farmer gets because of the volume of milk which is going into these industries. It would be possible also by increased efficiency to reduce the cost of production—I am not going to be as dogmatic there—it might be by a 1d., it might be 2d., I think over a period of years it might be 3d.—that is to say, that you could reduce the cost of milk up to about 6d. a gallon without touching distribution. You could reduce the cost of producing milk over a period of years by from 3d. to 6d. per gallon. If to that you add the economy which you can make on distribution you will see that a great deal may be done to reduce the price of milk to the consumer. I was sorry the right reverend Prelate did not tackle this thorny problem, because I am convinced that unless you can get the cost of milk down you will not be able to 79 get enough public money by way of subsidy to bring about consumption of milk on an adequate scale. This question of price is vital. A reduction of 1d. a gallon means a saving of something like £1,000,000. Think of the amount of money which could be saved and the consequential increased consumption which I am convinced is awaiting! But we cannot have cheap milk for the milk drinkers if at the same time we are trying to build up artificially and by Government subsidies a huge butter, cheese and dried milk industry.
I will only say just one word on the question of butter. We are not dealing with the question of nutrition as a whole, but your Lordships know that the question of fats is a very vital and important one in nutrition. It is very important to have cheap fats available. There are different sorts of fats which are available. A sufficiency of fats contributes more than anything else to a sense of well-being and of mental stability, whereas a deficiency of fats promotes discontent and restlessness. Those are proved statements and I wonder, when I compare the price of butter in England with the price of butter in France, where it is 50 per cent. higher, and the price of butter in Germany, where it is 100 per cent. higher, whether the price of butter in the different countries might be taken among other things as a fair index of the present political temperature. Let us do all that we can not only to make milk cheap but also fat foods cheap. I am sure that if we can do that we shall get not only more nutrition but greater contentment.
I am as interested as any of your Lordships in the welfare and the development of agriculture. I have ventured to criticise the policy of expanding the cheese and the butter and the dried milk industries. If you adopt the policy which I am venturing to suggest, and which I believe the right reverend Prelate is also advocating—namely, a largely increased consumption of liquid milk—I believe you will benefit agriculture quite as much if not more. If we get people drinking enough milk we shall certainly have to increase our national dairy herd by a quarter of a million, perhaps by half a million cows. Let us do that, let us get that increase in our national herds for the production of liquid milk for consumption as liquid milk and not for 80 heavily subsidised processed milk as butter or as cheese.
I wish, like other noble Lords who have spoken, to express my gratitude to the right reverend Prelate for raising this most important subject to-day. I would urge the Government to do all that they can directly or indirectly to cheapen the price of liquid milk and to face the fact—it will not be admitted at first by some farmers—that liquid milk can be reduced in price both by reducing the cost of distribution and also by reducing the cost of production. I would urge the Government to accept the proposal of the right reverend Prelate. The milk which is to be provided for certain sections of the community will have to be cheapened, whatever the natural price may be, by way of subsidy. I would urge the Government very seriously to consider the policy, to which I have referred, of trying to build up artificially at the expense of the drinker of milk and of the taxpayer these artificial industries of butter, cheese and dried milk. I believe that policy may have very serious repercussions upon our trade and upon the Dominions of this Empire. Lastly, I hope very much that the Government will give a lead in developing a wise nutrition policy, because if they do that I am sure that they will find that in this country we shall have a healthier population, and a more vigorous agriculture, and that our world trade will continue to expand.
§ LORD ELTISLEY
My Lords, I do not wish to follow the noble Viscount, Lord Astor, along the road of high national policy. I find myself in disagreement with him upon several points and particularly on his suggestion that there is no case for us here at home to employ our own people in manufacturing milk products. I believe that they are entitled to the same measure of protection and to the same standard of wages as are those engaged in other industries in this country, and I hope that the Government will bend their utmost activities to devising a levy subsidy policy which will enable us not only to manufacture and deal effectively with our surplus milk but to do it in an economic way to the great benefit of our own people. There will be general agreement with the aims and objects of the Motion which has been moved by the right reverend Prelate in an endeavour to secure milk at reduced rates for 81 certain sections of our people. It cannot fail to be in the best interests of the nation that every child under five and every expectant and nursing mother should be afforded adequate supplies of pure, fresh, good milk, but in so far as this is a national matter it must be dealt with by national funds and on a national basis.
The right reverend Prelate, in the course of his eloquent speech, stated that he was not prepared to deal with the difficulties which there are as between producer and distributor and consumer. I venture to suggest that is practically the kernel of the difficulty; that is really the problem with which we are concerned. We are all in sympathy with the object he has in view, but the point is, how to hit the target and meet that difficulty. I would venture with respect to crave the indulgence of the House while I mention one or two of the practical difficulties with which we are faced. In the first place the milk to be supplied, if the supply is to be on a large scale and on a lasting and permanent basis, must be produced and dealt with in an economic way, certainly so far as the consumer is concerned. If not, whatever scheme you build up will inevitably in a short time fall to the ground. It was for the very reason that the milk situation was in real danger of collapsing altogether that a national attempt was made to deal with it by setting up a Milk Board, establishing control (which every farmer hates and most other people hate) and bringing all this machinery into being. This was done to prevent the farmer losing all his capital. It was brought into being to prevent the workers—there are 350,000 associated directly or indirectly with milk production—losing their jobs; and it was brought into being also in order that the public might not lose their milk, which would have been the effect of continuing on the way we were going.
The price level of milk as of other things must be maintained at an economic level in the general national interest. It is therefore necessary that any scheme, however admirable it may appear to be, however great the appeal it may make to our hearts, should be on a sound basis. The liquid milk market must not be allowed to break down. May I refer for a moment to the schemes which have been got out to deal with the Special 82 Areas? The Milk Board has already indicated its willingness to play its full part in any scheme which may be promoted for providing milk in the Special Areas. A scheme has been formulated which provides for the co-operation of the three parties interested—the producer, the distributor and the Commissioner for the Special Areas, or the Treasury, as the case may be. Under the scheme the farmer has indicated his willingness to do his share by providing milk under the standard liquid milk price of 1s. 3d. per gallon. The farmer is willing to provide it, not at 2½d. as the noble Lord, Lord Strabolgi suggested, but at 2d. a quart or 8d. a gallon. The farmer in fact is making a sacrifice of 7d. on every gallon which he is selling in the standard liquid milk market. This loss of 7d. will be made up partly by grants and partly by the Milk Board. I would ask your Lordships to note that the Commissioner for the Special Areas has set aside no less a sum than £50,000 to try out this experiment on a great scale,
I desire to reinforce the plea made by my noble friend Lord Radnor that the Government should investigate the attitude taken up by the distributors. They have refused to accept the sum of 8d. per gallon as their distributive margin. I think they are refusing to play the game and to do their part, because the 8d. per gallon now suggested as their margin is 2d. more than the 6d. they now get under the milk-in-schools scheme. I hope some steps will be taken to throw a little more light on the attitude of the distributor and to see what is really his case. It is for him to justify the demand he is making before he will take part in the scheme. One other point in the speech of the noble Earl, Lord Radnor to which I would like to refer is his suggestion that a Food Commission should be set up and that there should be a health and nutrition representative in the Houses of Parliament. Personally I would deprecate any appointment of a nature which would impinge on the work of the Ministry of Health. The Ministry is a very efficient Department, which deals ably with its problems, and I hope we shall not send out a suggestion from this House that we want another Minister to do work already being very efficiently done by the Ministry of Health. I do, however, plead with the Government to exercise their influence, and perhaps 83 even to exercise pressure, to overcome the difficulties with respect to a cheap and plentiful milk supply in so far as they may arise from the attitude of the distributors.
§ LORD LUKE
My Lords, you will have listened with profound sympathy to the speech of the right reverend Prelate. There are few subjects which have a stronger appeal than the welfare of mothers and children and the importance of this subject is by no means diminished when the interests of agriculture run side by side with those of health. The wedding of agriculture with health is a phrase that has caught the imagination since it was first used by Mr. Bruce at the Assembly of the League of Nations last September. It is a union which we all want to bring about and one which we hope will be blessed with sturdy and flourishing offspring. But we want it to be a marriage of love and not of convenience so that neither party can be reproached for entering into it for the sake of the money bags of the other.
My reason for intervening in the debate to-day is that I have for the last few months had the privilege of serving the Government in their campaign for improving the nutrition of the nation. There has for several years been a Standing Advisory Committee to the Ministry of Health on Nutrition, its function being to advise the Minister on the practical application of modern advances in the knowledge of nutrition. In 1935 the Government decided to reconstitute the Committee with wider terms of reference and the noble Lord, Lord Kennet, who was then Minister of Health, did me the honour to invite me to become its Chairman. I know that, prior to 1935, much useful work was done by the Committee and technical reports of great value were published. I propose, however, to confine my observations to-day to the period in which I have been associated with the new Committee and to the task, entrusted to the Committee at the time of its re-constitution, which my colleagues and I are now endeavouring to perform. I make no apology for referring to the work we are doing because I believe it to be of considerable public importance that the fact that this work is being done should be made known and its nature understood.
This is, I think, particularly desirable at the present time when the subject of 84 nutrition is receiving much attention and comment, not always of a well-informed kind, on the public platform and in the Press. It is a misfortune that a subject which is of such immense importance to public health and which should be investigated with scientific accuracy and impartiality, lends itself so readily to the exaggeration of controversialists and the misrepresentation of political catch-cries. The task which the Committee have been set is—to quote the terms of reference—to inquire into the facts, quantitative and qualitative, in relation to the diet of the people, and to report as to any changes therein which appear desirable in the light of modern advances in the knowledge of nutrition. We have been asked, in short, to find out what food the people of this country are eating and to advise whether it is satisfactory from the health point of view. The task is an immense one. To complete it adequately must take much time, and at present we are only at the very beginning of our labours. I earnestly trust that we shall not be asked to issue reports in haste upon matters which cannot be properly considered in a hurry, though I can assure your Lordships that there will be no unnecessary delays. Your Lordships will, I think, agree that a careful and comprehensive inquiry of this kind is an essential preliminary to any reshaping in the interests of public health of our national food policy.
Accurate knowledge is the indispensable basis of sound policy and of no subject is that more true than the subject of nutrition. Of one thing at least your Lordships can be fully satisfied and that is that my colleagues on the Committee are fully qualified for the difficult task entrusted to them. They include, in addition to representatives of the Government Departments concerned, Mrs. Eleanor Barton, Dr. G. F. Buchan, Professor E. P. Cathcart, Dr. A. Bradford Hill, Sir Frederick Gowland Hopkins, Dr. Donald Hunter, Professor E. Mellanby, Sir John Boyd Orr and Mrs. Chalmers Watson. Your Lordships will agree after hearing this list of names that I am fortunate in my colleagues and that the Government have in them very expert advisers on this difficult subject. The Committee have already put in a great deal of work. We have set up a number of Sub-Committees, 85 the chief of them being the Physiological, the Statistical and the Economic and Social Sub-Committees, in order to cover the very wide field referred to us. These Sub-Committees are actively engaged in collecting and testing information and forming opinions on a number of subjects for consideration by the Committee as a whole.
Your Lordships will appreciate that, before a report on a given subject can be presented to the Minister as the considered advice of the Committee, the fullest consideration must be given to what is nearly always very copious and not infrequently conflicting information, and that such a, report must be established on a more general basis than the contributions to the problem of experts working independently. One most interesting independent contribution has indeed been published by a distinguished member of the Committee within the last few days: Sir John Orr's book on "Food, Health and Income." Much of the information used in this book was considered by the Committee some months ago, but they were of the opinion that much of the data marshalled, although of interest and importance, was insufficient to justify far-reaching conclusions. Nevertheless, the publication of the book at the present time is no doubt of value, as it will enable the interesting hypothesis put forward by Sir John Orr to be more fully examined. In the examination of the book which the Committee have now been asked by the Minister of Health to undertake we shall, of course, be assured of the cordial co-operation of the author. Sir John Orr himself has been careful in the book to mention the inadequacy of the data available to him and the tentative nature of his conclusions. The view of the Committee on the statistical data they had before them was that, in order to reach satisfactory conclusions, further investigations should be made as to family budgets and as to the frequency distribution of weekly earnings. Accordingly we made a recommendation to the Minister that investigations of this kind should be undertaken.
In the meantime there are one or two observations which I should like to make upon Sir John Orr's book in view of the public interest which it has naturally aroused. In the first place, Sir John has 86 set up a standard of diet which he regards as an optimum. On the basis of an examination of family budgets derived from 1,152 families, more than a third of which are from the most industrially-distressed areas of the country, he has come to the conclusion that about half the population of this country receive less than the optimum diet. Whether the standard chosen is satisfactory and the statistical method used to reach the estimate of 50 per cent. falling below it adequate, are questions for technical discussions which, with Sir John's assistance, will, I hope, be fully considered by the Committee. In the second place, what your Lordships might look for in this book and, I am glad to say, will fail to find, is any reason to doubt that the nutritional state of our people is improving. On the contrary, evidence is presented that even in the last ten years there has been substantial improvement; in times of widespread unemployment, things are better than when recorded unemployment was almost negligible. Mortality from tuberculosis, the disease which beyond all others—as the war-time experience of Central Europe testified—is associated with malnutrition, continues to decrease. The Registrar-General's returns show that between 1924 and 1934 the standardised rate of mortality per million fell from 1,156 to 832 in males and from 934 to 657 in females. I think that careful study of this document should strengthen, not over-confidence, but a reasonable optimism.
Lastly, an interesting fact brought out by Sir John Orr is that, as a family's income increases, the increase is not wholly expended on food. Food is only one of the gratifications that appeal to people, and if that is made too expensive the available money will be spent on something else. I hope, therefore, that whatever special measures may be possible to increase the consumption of milk by mothers and children, both the Government and those concerned with the sale of milk will bear in mind the paramount importance of bringing down its price so that the quantities which we desire to see consumed may be within the purchasing power of all those who need it.
This, my Lords, brings me to the last observation which I desire to make. I am glad to say that my Committee are able fully to endorse the views now 87 generally held in regard to the consumption of milk. The large problems referred to the Committee must, for the reasons I have sought to indicate, take a considerable time to examine. But the Committee has been able already to produce a report on the nutritive value of milk which has been presented to the Minister of Health and will, I understand, be published very shortly. This report sets out in popular form the nutritive value of milk and its importance for the promotion of growth and health in children and for the needs of expectant and nursing mothers, and the beneficial effects which would result to the population generally from an increase in its consumption. I hope very much that the Government, even if they cannot accept the precise terms of this Motion, will be able to indicate that they will consider favourably proposals for the increased supply of milk to nursing mothers and children.
§ VISCOUNT BLEDISLOE
My Lords, after non-participation for nearly five years in the debates in your Lordships' House, I am a little reluctant to inflict myself on your patience at this stage of the debate, and should not do so but for the fact that, after a very interesting experience in the most distant Dominion of the British Empire, I have come to regard this problem as perhaps the most serious social problem which can be attacked by the statesmen in any country of the Empire. For my part I most fervently welcome the right reverend Prelate's Motion before this House, if only because it will tend to reinforce the very valuable campaign which Sir John Orr and other scientists are so ably and courageously bringing to the attention of the public throughout this country.
If there are two countries in the whole world that may be said to be flowing—indeed, overflowing—with milk, if not with honey, they are Great Britain and New Zealand. Curiously enough, they are the two civilised countries of the world which have the unfortunate distinction of consuming the smallest quantity of milk per head of population. In each of them there is happily to-day, recognising the prevalence of malnutrition, particularly among the poorer classes of the country, an earnest effort on the part of public men to remedy 88 this social evil. But when the right reverend Prelate emphasises the widespread malnutrition existing throughout this country, I want quite seriously to ask him and others, and particularly the noble Earl, Lord Radnor, who indirectly referred to the matter, whether there is not a danger of putting too much emphasis on the insufficiency of essential foods and not enough emphasis upon the impropriety or unsuitability of foods as consumed by a very large section of the population in this country.
It is something like forty-five years or more since I received an agricultural education in one of the leading agricultural colleges, and I learned there, as every agricultural student learns under similar conditions, a considerable amount about food values and about what a properly-balanced ration should consist of as fed to farm animals. I venture to suggest that the average efficient British farmer knows far better how to feed his farm animals than the average British mother knows how to feed either herself or her children. This leads me to express the hope that this problem will be tackled not merely by remedial measures such as the right reverend Prelate and others have described, but tackled in our schools, so as to bring to the notice of the people of all classes some knowledge of what their food should consist in, and how they should most economically spend the money available for feeding themselves and their children, so as to obtain the best value for it in the form of a well-balanced ration. I venture to wonder whether even among the so-called well-educated classes there is any widespread knowledge of food values, or as to how the children of the household should be fed.
But what I should like to ask, when I hear so much said about the expenditure of public money in this direction, is: Where does true economy actually lie? Some years ago I remember that I found myself a member of the Gloucestershire County Council, and quite prepared, as a tyro in county public administration, to take the line that any public money expended upon the feeding of school children was an injustice to the ratepayers, and likely to prove a great waste of public money. Within a year I had frankly to confess that I was mistaken, because I discovered that whenever the 89 coal industry in the Forest of Dean was depressed, and there was insufficiency of food for the children in the homes of the coal-miners, the educability standard of the children fell very considerably. And I am tempted to ask whether the large sums of money expended in this country upon education are proving good value to those who have to pay the cost, if the value of education in our schools is materially reduced as a result of a lessened degree of educability consequent upon lack of food.
In asking where does true economy lie, I should like to say, apropos of what Lord Luke has said, when he drew attention to figures based upon the budgets of certain selected families in working class areas, would it not be almost a truer index of the degree of gravity of this problem if there were some sort of analysis made of the human contents of our hospitals and infirmaries, in order to determine to what extent the inmates of these institutions, upon which such enormous sums of public and private money are being expended, are there as a result of malnutrition, resulting from an inadequacy of milk and other essential foods during childhood? Carrying on, as I did, an unofficial inquiry in New Zealand—and no one sees more of the inside of hospitals in the Dominions than the Governor-General does—I came to the conclusion, from conversations with the medical staffs of the hospitals, that 35 per cent. of the inmates of those hospitals, supported as they were by Government money, were there as a result of malnutrition in childhood.
Lord Radnor drew attention to the desirability of considering in this connection other foods besides milk. That may be right, but do let us start with milk which, after all, is not only a complete food but the most all-round essential food that human beings consume. I want to emphasise the value of milk not only from a nutrition point of view but because milk is admitted by expert authorities to be to children the best buttress against, and the best help in resistance to, disease. I remember that twenty-five years ago, when an inquiry was pursued with regard to tuberculosis, which was exceptionally prevalent in the Borough of Hammersmith, it was said that this widespread condition was due to bovine tuberculous germs in the milk. It was demonstrated in that inquiry that, even 90 allowing for the fact that milk was sometimes tainted with bovine tuberculous germs, in that Borough tuberculosis among poor people was more largely due to lack of milk than to the existence of a few bovine tuberculous germs which the milk might contain. I am afraid nothing has proved such a deterrent to this campaign in favour of drinking more milk than the idea that there is this poison in the milk pail. I am certain from my own unscientific inquiries that a far larger amount of disease is prevalent amongst children, and a far larger amount of weakness, which may last throughout their lives, is initiated in children, as a result of insufficient milk, rather than as a result of tuberculous germs in the milk itself.
One more word. Lord Astor referred to our overseas Dominions, and I want, in all seriouness, to ask the Government whether the time has not come when they ought seriously, if agriculture in this country is to be protected, to make up their minds on a well-considered all-round scheme of protection, instead of what I may call a lop-sided scheme, putting for the time being a premium, as a result of Government subsidy or some measure of Government guarantee or protection, upon one product of agriculture to the relative exclusion of others. That brings into our British husbandry a certain number of people who normally would not participate in it, or that particular branch of it, and tends to flood the market with a commodity which enjoys the greatest measure of protection. There is no doubt far more milk produced in this country than was the case three or four years ago. New Zealand and the Dominions are quite unfairly blamed for the glut. The increase of milk products coming from New Zealand during the last three years is out of all proportion to the increment in the milk supply owing to Government protection and so-called milk producers in this country.
That leads me to endorse the hope that, in these measures for the protection of the agricultural community, some premium will be put upon agricultural efficiency, so that we shall not have the really inefficient farmer enjoying the greater benefit out of Parliamentary money, and relatively inefficient people coming into the business who have no right to participate in it at all. After all, the Dominions have to live, and unless 91 you make it economically possible for a country like New Zealand, which is to-day predominantly a dairy country, to meet the service of the loans provided from this country, it is going to be very difficult to blame them hereafter if they find it impossible to meet the obligations which the old land naturally expects them to do. I for my part most warmly thank the right reverend Prelate for his Motion.
§ LORD ELTON
My Lords, I only venture to stand between your Lordships and the reply on behalf of His Majesty's Government for five minutes, and I do so very largely because this most interesting debate has turned itself, to a considerable degree at any rate, into a discussion of agriculture and I would like to reinforce some of the things said by the right reverend Prelate about nutrition in order to some extent to redress the balance. I would like to say how exceedingly opportune is the moment which the right reverend Prelate has chosen for introducing this Motion, for the question of nutrition is at that extraordinarily interesting stage at which it is visibly passing from being the mere current coin of cheap Party controversy into the domain of the exact scientific problem. It is really difficult to think of a more stimulating and a more exacting test than this, not only of the flexibility of our political machine but of the enterprise of our Government; for, if the results set out by Sir John Orr are to be regarded as securely established, they must lead within four or five years to a profound change in our economic policy.
I say if they can be regarded as securely established, because I feel very strongly that some caveat should be entered as to the permanence of the results at which scientists arrive. For one thing I think we have to remember, with regard to what Sir John Orr says about the relative heights in various age groups, that we have also to consider environment and we have also to consider heredity: the problem must not be isolated. And science is an inconstant mistress, ever apt to deny to-morrow what she has affirmed to-day. In that connection I am never myself able to forget the perhaps somewhat banal instance of cod liver oil, which may be an unpleasant landmark in some 92 of your Lordships' earliest memories, as it is in mine. How many hundred thousand nurseries have rebelliously submitted to that unwelcome regimen before science made another discovery and announced that the manufacturers of that unpleasant substance were excluding from it precisely those elements which would have given the vital properties to it—and indeed which would have made it more palatable to consume. However, I understand that we can assume that Sir John Orr's results are likely to stand, in their broad effects at any rate, and that in this sphere science may extend its discoveries, but is not likely to recant them.
I think it very necessary to disentangle the political from the scientific aspect of nutrition. That has not been forced upon us in any sense by the course of the debate to-day. The noble Lord who spoke from the opposite Benches, and who is not present at the moment, very properly and very judiciously abstained from using the question as a stick with which to beat His Majesty's Government. The fact remains, however, that less judicious speakers, in less august surroundings, are in the habit of using loose language about widespread starvation in connection with this problem of nutrition. I should therefore like to point out that, as far as the political aspect of nutrition goes, the only standard by which you can criticise a Government—this Government or any other—is in relation, firstly, to the relative purchasing power of the people in comparison with what it has been in past years, and, secondly, to the actual standard of their health. Your Lordships will remember that in his report for 1933 Sir George Newman actually went so far as to say that the nutrition of the English people "is better to-day than at any past period of which we have record." That, of course, is no reason for satisfaction. That is the pre-Orr view, you might in a sense say the pre-scientific view. To-day we know from a number of controlled experiments that, by giving certain groups of children selected food, and pre-eminently milk, you can, as in the case of an institution a few miles from London, increase their weight and their height, one of them by approximately 40 per cent. and the other by approximately 80 per cent. over the normal growth for those years. The scientific problem of nutrition therefore, 93 as distinct from the political problem, is to extend an advantage of that kind to the whole mass of our population.
The first consideration is I think that we should remember that an advance in the required direction is already taking place. Mr. Feaveryear published conclusions last year which showed that the consumption of those desirable articles of food, fruit, eggs and butter, had actually gone up between the average of the years 1924–27 and the year 1932 by considerable amounts—in the case of butter actually by 40 per cent. There is an advance in the required direction. The question is, how can we accelerate and extend it? I suggest that the present position, from the point of view of the agricultural industry, is something in the nature of a paradox. As they view their business to-day, we have actually a surplus of milk of some 250,000,000 gallons a year. We are paying a subsidy of something like £1,000,000 a year precisely in order to make milk dear, to keep milk up to 5d. in summer and 6d. in winter—precisely in order, it would seem to a dispassionate observer from Mars, to prevent the children making those advances of 40 to 80 per cent. over the normal growth, from adding those inches to their stature and those pounds to their weight. And what is more, I believe a certain percentage of this subsidised surplus is actually going in the form of condensed milk to foreign countries. We are actually sending the milk which these children need away in tins, with a small present of our public money in each tin, to those foreign countries because we have no better use for it at home.
That is the industry organised primarily from the point of view of the producer. The problem of to-day is how to organise it in such a way as to meet the clamant needs of the consumer, without damaging the interests of the producer. May I make this suggestion? Would it not be possible to attempt a controlled experiment for milk of the type which was undertaken with regard to potatoes in Bishop Auckland? Would it be possible to take a Special Area, to make a cut of 25 per cent. in the price, and to test the effect of that cut on demand? Would it be possible to combine with a reduction in the price, as was attempted at Bishop Auckland, a reduction of the services carried out by the 94 distributor? The people might fetch the milk without the intervention of the distributor in return for a cheap price. I throw that out as a suggestion for some sort of immediate action.
For the longer term policy I admit that I was very much impressed by what the noble Viscount, Lord Astor, said about the difficulty of selecting the social group to which, if you are going to give free or subsidised milk to any social group, you should give it. There are many applicants. There are the expectant mothers, there are the children already receiving it on about 220 days in the year. There are the elementary school children as a whole. There are the black-coated workers whom I was very glad to hear the noble Viscount mention. All I can say with regard to this is that while obviously we cannot give milk to all of them, from my point of view I should welcome giving it to any of them. Finally, would it be too much to appeal to the agricultural experts who naturally have thought so long over this problem in term of agriculture, to co-operate, as I am sure they will co-operate, actively with His Majesty's Government in handling this problem in such a way that we may in the course of the next five years begin to add these inches to the stature and these pounds to the weight of our children?
My Lords, I think we must be grateful to the right reverend Prelate for initiating this very interesting debate. It has, as one might have imagined, ranged over a wide field. Indeed I was alarmed at the width of the responsibility which the Government spokesman on this occasion was expected to face. I therefore hope your Lordships will forgive me if confine what I have to say to the question more of nutrition and health, though indeed that question in itself has a very wide scope if we are to believe my noble friend Lord Astor that the bellicosity of the various nations of the world has been in inverse ratio to the amount of butter they consume.
First of all, may I confirm what was said by the noble Lord, Lord Elton? This is a timely Motion because nutrition is a matter which has been the object of much scientific study in recent years, and many-new discoveries and advances have been made as a result of that study. I think we can claim justly that we have been 95 pioneers in these advances. The last Annual Report of the Medical Research Council contained an interesting account of the work on nutrition for which the Council has been responsible, and many valuable contributions have been made by other workers in the same field. The noble Lord, Lord Luke, mentioned several of his colleagues—I need not repeat their names—who have won international reputation for their work on nutrition and, as has been said, the subject has received much attention at Geneva, where more than one tribute has been paid to the leading part taken by this country. It is fitting that I should acknowledge the lead given by my noble friend Lord De La Warr in these discussions and also the prominent part taken by Empire representatives such as Mr. Stanley Bruce. It is also noted that my noble friend Lord Astor has been invited to preside over the League of Nations Committee on this problem of nutrition. In this country the Government have been actively associated in the work, and the Advisory Committee on Nutrition was appointed in 1931 and reconstituted in 1935 under the Chairmanship of my noble friend Lord Luke. As your Lordships have heard, a number of valuable reports have already been published, and more may be expected.
The Motion which we are considering this evening speaks of "widespread malnutrition." This is a phrase which, as has already been suggested, should be treated with some reserve. Malnutrition is a physical condition which cannot be easily defined, and its diagnosis is often largely a matter of personal opinion. It is always a somewhat invidious matter to those of us who have plenty to eat to draw nice distinctions between those who have not, but I think it would be very foolish to make no recognition of the vast efforts made by successive Parliaments to remove the menace of starvation from the poor, and indeed such a course would give very little encouragement to those very numerous people who spend so much of their time, quite gratuitously, in administering the Poor Law to the best of their ability. The problem we have to consider is not whether our people are receiving sufficient food to maintain life, but how far the dietaries of the various classes of the community are adequate to promote and maintain full health. 96 That is a question on which, in our present state of knowledge, various opinions are no doubt possible. Certainly no one, and especially the Government, would suggest that there is no room for improvement. But I think we should be viewing this matter in a wholly false light if we do not take into account, not merely the high standard of living in this country as compared with most other countries, but also the steady improvement which has taken place both in the standards of nutrition and in public health.
I hesitate to inflict figures on your Lordships but the ones I have are somewhat striking. First of all, may I take some which have already been mentioned from Sir John Orr's recent book? These show the increases in the estimated annual consumption per head of certain foodstuffs, and indicate the percentage of consumption in 1934 as compared with the period immediately before the War:—Fruit, 188 per cent.; potatoes, 101 per cent.; other vegetables, 164 per cent.; butter, 157 per cent.; eggs, 146 per cent.; cheese, 143 per cent.; meat, 106 per cent.; wheat, 93 per cent. I can best indicate the significance of these increases by quoting two sentences from Sir John Orr's book itself:
" It will be seen that, with the exception of wheat, flour and potatoes, there has been a substantial increase in the consumption of most of the principal foods since before the War. The largest increases have been in fruit, fresh vegetables, butter and eggs. In each case the rate of increase has been greater since 1924–28 than in the previous fifteen years."
" These increases in consumption of animal fat, and of fruit and fresh vegetables, are increases in foods of high biological value."
Reference has already been made to some of the conclusions reached in Sir John Orr's book, and I was very glad to hear my noble friend Lord Elton refer to some of the misrepresentations that have been made of these conclusions. It has been stated in at least one paper that Sir John Orr concluded that 50 per cent. of our people are starving. It is of course ridiculous to attribute any such statement to Sir John Orr, and I am sure he would be the first to deny it. What he said is quite different—namely, that 50 per cent. of the population have a standard of nutrition below that which is explicitly stated in the book to have been selected as an ideal or optimum standard. 97 The right reverend Prelate, I am glad to say, at the very outset of his speech acknowledged that fact.
May I turn now to the public health figures? The annual death rate per 1,000 of the population in 1871–1880 was 21.4; in 1901–1910 it was 15.4; in 1921–1930 12.1; and in 1934 it was 11.8. Therefore, since 1871, the figure has been almost halved. The average infant mortality rate per 1,000 births in 1871–1880 was 146; in 1901–1910 it was 128; in 1921–1930, 72; and in 1934,59. Again, a very remarkable decrease. The tuberculosis mortality rate, which has considerable relation to nutrition, was 1, 349 per million in 1912, and 799 in 1933. Finally, the death rate of children under five from rickets—another test of nutrition—was 109 in 1921 and 41 in 1933. Without any complacency, it will be seen from these figures that we are making steady and considerable progress. Notwithstanding the industrial depression there has been no halt in the improvement of public health, and for this I think the health services can claim their share of credit. Of course the figures I am quoting are figures for the country as a whole, and it cannot be assumed that in all parts of the country and in regard to every class of the community these average figures will apply equally. Nevertheless, it can hardly be disputed that the recent social history of this country reveals rising standards of living, improving standards of nutrition, and better health accompanied by a remarkable increase in the length of life. I think we must keep these facts clearly in mind if we are to form just conclusions upon current problems of nutrition.
The problem to which much attention has been given, and it has been referred to in very considerable detail this afternoon, is that of discovering means to make better use of surplus foodstuffs of high nutritional value in the interests both of public health and the agricultural industry. As your Lordships have heard, the problem has been termed one of the marriage of health and agriculture. I think there will be general sympathy for the ideal enshrined in that phrase, but the proposals must certainly involve serious economic and political problems. No doubt the increase which we all desire to see in the consumption of these health-giving substances could readily be attained by drastic reductions in price, but a marriage arranged on these terms 98 might well be a marriage of convenience to health but it would not be particularly welcome to agriculture, and if the desired increase is to be attained by other means—as for example by the payment of State subsidies—then indeed formidable problems have to be faced, not only concerned with the mere handing over of money from the Treasury. For instance there might well be a risk, if any ill-considered scheme were adopted, of the general public being deprived of the benefit of reductions in price consequent on more efficient methods of production and distribution. We have heard that emphasised this afternoon. I think a large-scale subsidisation of the supply of foodstuffs would clearly give rise to serious difficulties as regards the conditions on which the benefits of the scheme could be granted and the selection of those who were to be benefited.
I am not suggesting that the view of the Government is that no advance is possible. On the contrary, much useful work has already been clone, and I can certainly assure your Lordships that the Government are fully alive to the supreme importance of nutrition to health and have been giving, with the assistance of the Advisory Committee, very close attention to the newly acquired knowledge on the subject. Fortunately, as the Medical Research Council pointed out in their last Annual Report, the essential teachings of modern science can be reduced to a few simple statements. I will quote from the Report:
" On the dietary side, the broad requirements can be simply stated to the public by saying that much more milk (' safe ' milk), cheese, butter, eggs (especially egg-yolk), and vegetables (especially green vegetables) ought to be consumed. In particular, milk ought to be the chief drink for children, and especially in the first years, while bread and other cereals should in these early years he greatly reduced."
It is clear from this statement that, of all foodstuffs, milk is from the nutritional point of view by far the most important. Milk is almost a perfect food. Yet the consumption of liquid milk in this country is abnormally low. I do not know if any of your Lordships gave the figure, but my information is that it averages about 3 pints per head per week as compared with 5½ pints per week in the United States. There is no doubt that to increase the consumption of milk is the most fruitful of all ways of improving 99 the nutrition of the people. That view is, I know, fully shared by the right reverend Prelate and by others of your Lordships.
I think, therefore, we may be assured of the value of the schemes already in existence. These have been referred to, but I ought perhaps to remind your Lordships how extensive the schemes are. In the first place, the milk-in-schools scheme, which was instituted on October 1, 1934, under the Milk Act of that year, enables a daily ration of a third of a pint of milk to be supplied for a halfpenny. It is operated by the Milk Marketing Board, with the voluntary co-operation of teachers, and the Government contribute half the expenditure incurred by the Board. The scheme covers all children in grant-earning schools, and also adolescents attending junior instruction centres aided by the Ministry of Labour. During the first year 22,750,000 gallons were consumed on which grant amounting to £401,000 was paid. The number of children participating in the scheme has varied monthly between? 2,250,000 and nearly 2,900,000. In recent months the number has averaged about 2,600,000. The Milk (Extension of Temporary Provisions) Bill, which recently passed through your Lordships' House, will enable the milk-in-schools scheme to be continued for a further twelve months until the end of September, 1937.
In the second place, Section 84 of the Education Act, 1921, enables local education authorities to provide free meals, including milk, for children who need this help to enable them to take full advantage of the education provided for them. Children obtaining milk in this manner often receive two-thirds of a pint or one pint per day. All such milk ranks for grant under the milk-in-schools scheme and since that scheme began the number of children in public elementary schools in England and Wales receiving free milk has risen from 100,000 to 275,000. Finally, under Section 1 of the Maternity and Child Welfare Act, 1918, local authorities in England and Wales are empowered to provide free or cheap milk for expectant and nursing mothers and children under five years of age. The provision of free milk under these arrangements depends on the recommendation of the medical officer and the inability of the 100 recipient to pay for the milk. Practically all the 422 maternity and child welfare authorities provide some free milk or at less than cost. About half the milk supplied is in the form of dried milk. Full information as to the annual consumption of milk under maternity and child welfare schemes is not available, but it has been roughly estimated to be equivalent to 7,000,000 gallons—3,500,000 gallons of liquid milk and 5,000,000 lbs. of dried milk.
The noble Earl, Lord Radnor, asked several questions, some of which I am unable to answer, but I can say this. The Government believe that there would be great value in any extension of the policy of encouraging the consumption of milk which may be found practicable and the Ministers of Health and Agriculture have for some time been examining the possibility of a further extension and encouragement of these milk schemes. But, as your Lordships are aware, the whole question of the working of organised milk marketing in Great Britain under milk marketing schemes and its incidence on production, distribution—I would remind the noble Earl, Lord Radnor, that the original terms of reference did include distribution—and consumption is at present under the examination of the Milk Reorganisation Commission. It would clearly be premature for my right honourable friends to introduce any new scheme for the provision of milk until the Commission's report has been received and decisions have been taken on their recommendations. I can assure your Lordships that, in the meantime, the possibilities will continue to be fully explored and that full emphasis will be given in the comprehensive review of milk policy which is about to be undertaken, to the undoubted advantage to public health which would result from an increased consumption of liquid milk by mothers and children. Perhaps the right reverend Prelate, after receiving this assurance, would be good enough to withdraw his Motion.
THE LORD BISHOP OF WINCHESTER
My Lords, I am very grateful to the noble Viscount for his reply, but I am bound to say he has spoken more of what has been done in the past, and is being done in the present, than of what ought to be done in the future, to meet the needs which have been put before 101 your Lordships. I must say I am somewhat disappointed that he has not been able to put before us a more hopeful and constructive statement of what the Government will do to expand the scheme which already has proved so successful. I beg leave to withdraw my Motion.
§ Motion for Papers, by leave, withdrawn.