HL Deb 25 July 1989 vol 510 cc1403-20

9.17 p.m.

Lord Rea rose to ask Her Majesty's Government whether, in view of the large sums raised through excise duty on tobacco, they will establish a health promotion foundation to fund sporting and cultural activities and medical research.

The noble Lord said: My Lords, before asking my Question, it is my pleasure to thank the noble Lord, Lord Henley, who has answered on health matters from the Government Front Bench for the past few months. He has always been very courteous and helpful. I wish him good luck but also some sympathy in his position in the Department of Social Security. That is a much more boggy area than health and much more complicated. I cannot say that I envy him but I wish him luck.

I should also like to congratulate the noble Lord, Lord Trafford, on his new post. I have looked back as far as I can through lists of Government Front Bench Ministers in your Lordships' House and I cannot find a previous doctor, especially as a health Minister. I think that he set an important precedent. The Government are fortunate to secure the services of someone with political skills and experience as well as professional eminence to guide their forthcoming, very controversial legislation through your Lordships' House. I look forward to some well informed debates.

This evening we are concerned with health and not health services. I am firmly convinced that action against smoking along the lines which I shall suggest will save more lives than could be achieved by any possible changes in the National Health Service. The great advantage is that it would cost the Government not one penny.

I have asked this Unstarred Question to put the idea of a health promotion foundation funded through tobacco tax on to the political agenda in the United Kingdom. I regret that the concept was not my original idea but forms the central part of the Tobacco Act 1987 which was passed in the state of Victoria, Australia, with all-party backing.

In the wording that I first used in my Unstarred Question I also referred to the large sums of money raised through tax on alcohol. However, as I intend to concentrate on tobacco, yesterday I removed the world "alcohol" from the Question without realising that the noble Baroness, Lady Masham, was going to contribute. She is to talk about alcohol and many of the arguments I shall use about tobacco are relevant also to that substance.

Before describing the proposals I will, with your Lordships' permission, give a brief review of the present situation regarding smoking and tobacco advertising in the United Kingdom. The past decade of steady decline in cigarette smoking by adults has stopped. While the rate is still going down in adult men and is now stable in women as a whole, it is still unacceptably high. More than one adult in three is a cigarette smoker and far too many teenagers smoke—17 per cent. of boys and 22 per cent. of girls aged 15 smoked cigarettes in 1988, according to OPCS figures. In fact, virtually as quickly as an older person gives up smoking a young person is drawn in, often to start adult life as a confirmed, addicted smoker. By the time they give up, if they can—and it is difficult as any smoker, ex-smoker or person who has lived with a smoker can confirm—after, say, 30 years the damage done will be mainly irreversible. Their latter years, if they survive, may be of poorer quality than they should be due to the effects of smoking; for example, through strokes, emphysema, angina, heart failure, other arterial disease and peptic ulcer; let alone the effects on the unborn children of women smokers.

Quite a few who are more susceptible, however, will meet their end before giving up smoking and before reaching retirement age. It is sad to see lung cancer, which was formerly mainly the prerogative of male smokers, increasing steadily in women. It is about to overtake breast cancer as the most common cancer in women. Illnesses due to smoking have been calculated at a conservative estimate to cost the National Health Service about £500 million per annum.

However, against that figure we have to balance the £5.7 billion collected in tobacco tax and VAT which amounts to 4 per cent. of total tax revenue. The Chancellor of the Exchequer also saves money through the pensions he does not have to pay to people who die prematurely. An amateur calculation by myself puts this at about £2 billion per annum. That is calculated on 100,000 deaths, each saving £20,000. The average smoker dies 10 years younger than a non-smoker. With a pension of £2,000 per annum and 100,000 deaths from smoking, a total of around £2 billion may be saved by the Government through not paying pensions.

I very much hope that the Minister will be able to assure us that this useful saving, which, added to tobacco revenue, gives a total of £7.5 billion, is not in any way connected with the Government's timid and ineffective action in discouraging the consumption of cigarettes. Although we may not like to admit it, cigarettes are a slow acting, highly addictive lethal poison, despite the fact that they do have some pleasurable effects and I do not deny that. It has been pointed out in the past that if a product with the currently known effects of tobacco were to be put on the market it would not receive a product licence. No advertiser would touch it with a barge pole. As it is, the tobacco industry makes much of the fact that it is a legal product and therefore can be promoted. In fact, the tobacco industry spends £130 million per annum doing just that.

The Government rely mainly on voluntary agreements with the tobacco industry, though they have banned sales to children under the age of 16 and have also banned advertising on television. Under the voluntary agreements, no outdoor advertisements are allowed near schools, but there is no restriction on advertisements on the way to school, which rather undermines the effect of that restriction. Health warnings are printed in rather small letters on packets of cigarettes and on hoardings. It seems extraordinary that our Government should have been the only member of the European Community whose Health Minister objected to the recent European Commission suggestion that health warnings should be made more effective, particularly as we have the worst rate of heart disease in the world.

The tobacco industry contributes approximately £11 million voluntarily to the Health Promotion Research Trust which funds medical research but has a specific clause restricting research into the ill effects of tobacco on health. That is rather ironic when smoking is our number one preventable health problem. Under the voluntary agreement no advertisements are supposed to link smoking with active pursuits or success in sports. However, the spirit of the agreement is blatantly breached by sports' sponsorship. Approximately £6 million is spent by the tobacco industry on this form of advertising. The sports include cricket, rugby league, tennis, golf, motorcycling and motor racing—four different brands of cigarette back racing cars—and also bowls, darts and snooker, which are backed by three different brands. A number of cultural events also have tobacco industry sponsorship, giving prestige to the tobacco industry and smoking.

This form of investment has a vastly greater impact when the event, sports or cultural, is televised, which it often is. The brand name or logo is often mentioned or is clearly visible on the small screen in millions of homes. It has been shown in one study that 55 per cent. of 15 year-olds watched Embassy snooker at some point in 1985. Overall, 10 to 15 year-olds could have seen references to cigarette sponsors nearly 3,000 times while watching snooker on television in 1987. If the tobacco industry itself had had to pay for the television time devoted to sponsored events, the bill would have been nearer to £6 billion than £6 million. In fact, other advertisers (on ITV) and the public (on BBC) pay for what in fact is virtually free time on television for the tobacco industry.

Sports organisations are clearly unwilling to forgo their current tobacco sponsorship. If the events were to stop there would naturally be popular dismay, which would be politically undesirable for the government of the day. The most important aim of the proposed health promotion foundation, to be mainly funded by tobacco tax, would be to provide an alternative source of sponsorship for the events which now have to turn to the tobacco industry.

The foundation would be independent of existing health promotion bodies but should liaise closely with them and draw its membership from them and other appropriate organisations. It would complement the work of existing bodies but would have the following aims: to provide information and advice relating to the promotion of health or the prevention and early detection of disease; to promote healthy life styles and disease prevention through the sponsorship of sports, the arts and popular culture; and to provide alternative sponsorship opportunities to those sports and arts events which are currently sponsored by unhealthy products, especially tobacco.

It would also have as its remit the sponsorship of new areas which would help to promote information and advice relating to the promotion of health or the prevention and early detection of disease. It would fund health promotion and medical research into the prevention of disease. The result would be a source of funding for health promotion and prevention purposes specifically aimed at buying out existing unhealthy sponsorship, especially as regards tobacco. It would encourage sponsorship of new areas, associating them with health promotion and prevention measures from the beginning, and it could also help in researching the effectiveness of such health promotion and prevention measures.

In Victoria, Australia, the foundation now established by law is funded by an extra 10 Australian cents being added to the price of each packet of cigarettes. That raises 23 million Australian dollars each year—the equivalent of £11 million.

As regards the United Kingdom, if, for example, one penny of extra tax were to be put on each packet of cigarettes, the sum of £40 million would be raised. If used to fund the health promotion foundation as suggested, that would be sufficient to sponsor all the sports and cultural events which are now funded by the tobacco industry. It could augment the health education's miserly £5 million which tries to compete with the £130 million spent by the tobacco industry promoting the consumption of tobacco, and also provide useful extra funding for medical research, as I have already mentioned.

I am aware that taxes raised in the United Kingdom mainly contribute to the Consolidated Fund and that the instrument of earmarking or hypothecation is unpopular and does not often form part of legislation. However, I do not think that that would in fact be necessary since the foundation could be funded out of general taxation at no extra cost to the Exchequer if an equivalent sum were collected by raising the tobacco tax as I suggested. That would have the added benefit of increasing the price of cigarettes and adding a small additional deterrent. Price increases have been shown to be especially effective in reducing smoking by younger people. This would back the main aim of the whole exercise, which is to reduce the number of people taking up smoking in the first place.

9.32 p.m.

Baroness Masham of Ilton

My Lords, on my copy of the Whip which I received last Friday, the Unstarred Question included the subject of alcohol. However, when I telephoned the Whip's Office on Monday to put my name down to speak, I was not informed otherwise. Therefore most of my remarks will be linked to alcohol because this is as important as tobacco, and because I know more about the problems arising from alcohol. I consider them to be similar in regard to taxation and health, and I have been a strong campaigner against smoking for as long as I can remember.

I thank the noble Lord, Lord Rea, for asking this Question. I wonder how sincere the Government are in their wish to promote good health. While congratulating new Government Ministers on their appointments, I hasten to say that it is very depressing to find Ministers at the Department of Health who should be setting the younger generation a good example but who cannot do so because they themselves smoke. Perhaps they will be able to kick the habit and show their strength.

I am most attracted to the suggestion of the noble Lord, Lord Rea, of a health promotion foundation. We need health promotion more now than ever before. At a conference yesterday Mr. Douglas Hurd, the Home Secretary, spoke of the serious threat from the growing use of "crack", the highly addictive form of pure cocaine which can cause paranoid psychosis, hallucinations and many other problems leading to violent crimes. Once addicted, it is almost impossible to get the people weaned from their addiction and terrible consequences may result. The Home Secretary said: We are determined to do everything we can to make sure that the United States tragic experience is not repeated here". These people who smoke cigarettes are the ones most likely to move on to the dangerous drug habits. The results of medical research need to be promoted and a health promotion foundation would help to achieve that aim. Above all, it would give a boost to the many excellent people working in this field who at present do not know where their funding will be coming from or if their posts will be in existence after a year.

In 1987 I chaired a committee which looked into and reported upon young people and alcohol. Many of the recommendations are as relevant to smoking as to drinking.

The Home Office report is still being debated, and some of our 50 recommendations have been implemented. The recommendations which do not seem to have been adhered to are some of those which are relevant to the debate. We heard evidence from taped interviews of young people. They said that the pub was often the only acceptable meeting place. We found that many young people who drink in groups in public places do so in response to the boredom which develops during long periods without constructive activities, such as during holidays and unemployment, and when there is a lack of sporting and cultural activities.

The problem can be just as great in rural areas as it is in inner cities. In rural areas, such as the one in which I live in North Yorkshire, there is hardly any public transport. Any comprehensive programme designed to reduce illicit and irresponsible drinking must ask why people drink or smoke, and what alternative venues and activities do, or should, exist to compete with the obvious attractiveness to young people of drinking in pubs and public places.

The youth service seems to be short of funds. Its facilities are often shoddy and inadequate. Drinking has become a problem among some of the youth leaders as well as the youngsters. In one of our recommendations we call upon the alcoholic drinks industry to build upon its existing work against alcohol abuse by promoting resources to set up a wide range of alcohol-free facilities, in co-operation with local agencies and the community, and to evaluate their effectiveness. That could also be said to the tobacco industry. As the drinks industry seems slow to do that, the suggestion before us from the noble Lord, Lord Rea, may be the better method.

Last week I was sent a paper and a video about an initiative taken by a major British drinks company. It is all about the training of its staff and about dealing with problem drinkers. It is useful so far as it goes; but I saw nothing in it to do with providing alternatives or the promotion of low or non-alcohol drinks.

This morning, before leaving Yorkshire, I spoke to my local grocer. He was exasperated and calling for action. He had been out to dinner with his family to a Porterhouse restaurant. He had been charged £1.40 for a pint of Whitbread white label low alcohol bitter. He said that it would have been bought by the restaurateur for about 35p. In his grocers the grocer can make a profit on a 440ml can of low-alcohol beer when he sells it at 45p. One of our recommendations in the report is that the alcoholic and soft drinks industry should make a concerted effort to promote low and non-alcohol drinks as an attractive alternative to alcohol, but not just for drivers, and to ensure that the profit margin on those and other soft drinks is not greater than that for alcoholic drinks.

To charge £1.40 for a pint of low-alcohol bitter makes a mockery of everything that responsible people are trying to do. I hope that the Government will not just sit like Pontius Pilate and wash their hands of all responsibility. I hope that they will try, and succeed, in stopping law-abiding people being ripped off by others who are not interested in helping to provide a safe and happy society. With 1992 approaching, many people are concerned that the prices of strong alcoholic drinks will go down. Our committee was concerned at the continuing belief that cider is a safe drink for young people. Many parents who would not dream of giving their children beer offer cider, which is frequently very much stronger. Parents seem ignorant of the fact, of which many young people are well aware, that cider is a quick and cheap means of intoxication. We recommended that the taxation of cider should be changed to increase the duty on high strength ciders so that the price per unit of alcohol to the consumer is brought roughly into line with that for beer.

We also recommended that the Government should consider increasing the tax on stronger beers. This extra tax could well go to help to provide healthy sporting and cultural activities. Many people drink and take drugs because they have low esteem; they are often, but by no means always, low achievers. They see little future. They need to be encouraged into healthy alternatives, both sporting and cultural. At home I run a trekking centre so that people coming into or living in the district can enjoy a country activity. I consider it a service to the community. Because I employ people, it is impossible to cover expenses, but it gives an interest to many young helpers and a needed activity.

There are some good initiatives in the community. On Friday at the opening of 'a scanner at a cancer hospital in Leeds I met a group of young children who come up to the hospital from their school to give Scottish dancing performances to the patients. These delightful young girls were like bright, twinkling little stars of goodness on a cloudy horizon. We need our young people to be healthy and kind. We should invest in their future. Tonight we have a useful proposal. I hope that the Government will go away and seriously consider it in a constructive manner.

This year among other categories for the Winston Churchill travelling fellowships we have trainers of children's choirs, recreation for disabled people, managers and trainers of healthy leisure activities, alcohol abuse and smoking. These are all to do with the subject of this evening's debate. Many people realise that a healthy lifestyle needs promoting. I end with a quotation: If you think education is expensive, try ignorance".

9.42 p.m.

Lord Addington

My Lords, the advantage of tax on tobacco and alcohol has two very good prongs to it. One is that we generate more revenue and if it is used correctly it could certainly enhance the lot of those people who might in some way be damaged by the two substances. There is a second prong—that we restrict the consumption of those two substances. The idea of a fund and the examples given were very enlightening.

I think that the noble Lord, Lord Rea, has put his finger on a good solution to the problem. We would at one stroke effectively cut down consumption, especially among the young who would presumably have more limited incomes. We could also provide other activities, especially for the young and other groups in society by using the finances that are raised.

Initially what attracted me to the subject was the fact that we have a chronic lack of resources, for instance for sport in our society. The situation is currently improving but we still have a long way to go. I think that we should remember that every year when we complain that no Briton gets beyond the third round at Wimbledon—and even then he has to play at least two British opponents to get there—the situation might be helped somewhat if we had a few more courts and, far more important, proper coaching to help achieve the standards of excellence for which the country seems to pay all the time.

In sport as a whole, we should consider that we need more coaching and guidance for people as these activities can be seen as a type of preventive medicine in themselves. I suggest that anyone who is keenly involved in sports will at least cut down considerably on their smoking or drinking if they do not stop completely. Much more benefit and enjoyment is gained from a sport if one knows what one is doing. That can also make a sport safer in many cases. As a Rugby player I can confirm that there is a great deal of bad coaching in Rugby football for the simple reason that it is a highly technical and complicated game. Any one player cannot be expected to coach a team of his juniors for the simple reason that if one has played on the wing in Rugby football one does not know how the scrum works.

There could be other examples in other sports, but in a team sport the matter becomes more complicated as more resources and more back-up is required. The growth of such areas as sports medicine shows how the whole thing can snowball. I suggest that the Government should be putting more funds into this area. If we are to get the best out of our young people, we should give them a sense of achievement, as has already been mentioned. Sport is probably one of the best ways of doing that.

To turn to cultural activities, I cast my mind back to probably one of the most rewarding and satisfying activities that I took part in as a teenager outside the sporting field, which was drama. Acting and certain aspects of the performing arts are available in our schools; but unfortunately under the new national curriculum and the GCSE exams—I think those exams are an improvement on their predecessors—teachers increasingly have their time pinned down. Timetables are now dictated to them. As their hours now have to be accounted for, there seems unfortunately to be rather less willingness to donate time to extra-curricular activities. To supplement this, we should be looking to instruction outside schools and to facilities which fall outside the age group for schools. Pupils should be encouraged to take part in any of the performing arts from dance to acting. The same could be said of any form of artistic creation; for example, drawing or pottery. Once again, I think more emphasis should be placed on following these activities outside school. Very often when we leave school there is a cut-off period concerning these activities.

Much of what I was going to say has already been mentioned and has been expressed far more clearly than I could have done. I wholly endorse the view that alcohol abuse is a very serious problem, not only because of the financial costs of the medical attention required and the costs incurred through time taken off work, but also because of the terrible damage that is caused to our society. There is an undeniable link between alcohol and violent crimes, especially spontaneous violent crimes. I was therefore a little surprised when alcohol was removed from the subject to be debated this evening. However, I agree that the example of tobacco has been very solidly covered.

I wish to close on the thought that if we are not going to fund these forms of social and sporting activities, and indeed research, of which we can surely never have too much, especially if it is well channelled research, and they are not to be promoted in that way, we shall not slow down the growth of the problem. I should like to hear from where the Government suggest we generate funds.

9.49 p.m.

Lord Ennals

My Lords, like my noble friend Lord Rea I, too, wish to expand a little on the words I said earlier today in congratulating the noble Lord, Lord Trafford, on his appointment. He managed to utter a few stumbling words earlier in the day, but this is the first opportunity for him to make a speech. He has already proved his skills, ability and knowledge from the Back-Benches, and I think his presence will add information and experience to our debates on the health service. I shall greatly appreciate that. I wish also to convey my thanks to the noble Lord, Lord Henley, who has always been extremely helpful, diligent and caring in his approach. He has also been helpful to other Peers. I am delighted that he has been promoted and is now a real Minister and not simply a Whip pretending that he is. I wish him every success in the future.

I am very grateful to my noble friend for opening this debate and for the quality of his speech. I warmly support his proposals for a health promotion foundation. Whether it should be linked with the Health Education Authority or whether the Health Education Authority should have a broader mandate than simply education and should take on the task of promotion are matters for consideration.

As I have said to my noble friend, while I warmly support the initiative, I could not support the proposed method of funding it. There are difficulties in the idea of hypothecation and earmarking certain types of taxed funds as a means of financing certain activities. Once one goes down that route one creates precedents for all types of expenditure. However, I believe that the Government should, because of their great wealth from smoking, contribute much more substantially to either a new foundation or one that is linked with the Health Education Authority.

The Government do not appear to care very much about these issues. In the White Paper on the reform of the National Health Service very little has been said about health promotion. It is almost all about the management of a sickness service.

Having spoken so far about smoking, I warmly welcome everything that was said by the noble Baroness, Lady Masham. Not only do I support what she said but I should like to pay tribute to the extraordinary amount of work which she does both in the field of drug addiction and to combat drink addiction. We are talking about a variety of types of addiction and I regard smoking as being largely an addiction. I do not believe that many people really want to smoke. I believe that an enormous number of people who smoke recognise the difficulties and would like to give it up but are addicted to it.

The issues raised by my noble friend are clearly extremely important. I must therefore be frank in what I have to say, and some of my noble friends who are themselves smokers, if they are present, might disagree with some of what I have to say. Smoking is by far the greatest preventable cause of disease and death in the United Kingdom. That should be recognised. We all know that it is true. Government policy should be formulated around that fact.

Apart from contributing to coronary heart disease, which is so prevalent in Britain, it contributes to a great many types of cancer, many of which can kill. As I think my noble friend said, smoking kills about 100,000 people a year. Thus one in four smokers dies of his or her addiction, usually about 10 years earlier than they might have died from some other cause. When people say that you have to die from something, of course that is true, but we do not have to die as early as many smokers die.

I believe that the time will come when we have to ask why tobacco should for some extraordinary reason somehow continue to miss being caught as a dangerous drug, bearing in mind that it kills incomparably more people than illegal hard drugs—and I do not underestimate the importance and significance from the health point of view of hard drugs. It is extraordinary. I suppose that it is simply history and that people have smoked down the years. There has been a voluntary campaign to discourage people from smoking, but some time or other we shall have to face up to the fact.

It also seems quite extraordinary to me that with all that is known about its effects on health any Minister can continue such a dangerous practice while holding ministerial office in the Department of Health. Obviously I am thinking of the Secretary of State himself. It is no wonder that the Government seem not to care about the effects of smoking on society. I cannot see how a Minister can throw himself into an anti-smoking campaign if he is himself an addict.

I had to face that on the day when I became the Minister of State for Health some 21 years ago. I was a smoker. I was honoured to be appointed Minister of State for Health. It was a week before a press conference in which, without the Health Education Council, the department itself was launching a campaign against smoking. I knew that I had to give it up. There was no alternative. I cannot understand how Ministers can go about puffing cigars and cigarettes when they recognise the appalling lead that that sets for other people. It is no wonder to me that the Secretary of State for Health used his powers to veto stronger health warnings in the European Community. If the noble Lord tells me that it was for some other reason, I would say that it is no wonder that many people are misled and misunderstand the situation when there is a Minister in that position.

Almost every other aspect of government policy on smoking seems to be ineffective. I found it extraordinary that in the Budget last year there was no increase in the tax on tobacco products. I recognise why that was done. It was done to take one step to stop the rising rate of inflation, but it was done at the expense of a rising number of people purchasing cigarettes. The facts prove that to be so.

Smoking among children is a serious problem. A recent OPCS survey showed that 17 per cent. of 15 year-old boys smoke and that 22 per cent. of 15 year-old girls smoke. I see that another report has been published today which mentions that the number of school children who smoke has fallen. It did not give the figures in the report that I read but it stated that: Fewer children who tried to buy cigarettes in 1988 were refused by retailers than in 1986, according to the Office of Population Censuses and Surveys, which carries out a study every two years of schoolchildren's smoking. More than 90 per cent. of children who tried to buy cigarettes succeeded in doing so the last time they tried … The report says about a quarter of all children interviewed had tried to buy cigarettes. Only 8 per cent. had been refused last time they tried". That is an extremely disturbing factor and the Government must turn their mind to ways in which we can be more effective in discouraging children from smoking. The facts show that those who start smoking when they are children are much more likely to be smokers as adults, in the same way as the surveys show that children are much more likely to smoke if they are the children of smokers. Recent research shows that parents' smoking influences children's smoking. Children, particularly girls, are more likely to smoke if parents, particularly mothers, smoke. Even stronger is the influence of the parental attitude to smoking, whether or not the parents smoke. Children are seven times more likely to smoke if they consider that their parents approve. The Government must therefore apply their mind to parents' attitudes to children smoking.

Advertising of smoking products should by now be prohibited. That matter has been under debate for many years. The method of voluntary agreements was entered into originally by a previous Labour Government of whom I was a supporter. We have reached the time when it is nonsense that advertising should be permitted at all. Many other countries have abolished it. How we can tolerate the advertising of something that is so damaging to health quite escapes me. The evidence linking cancer with smoking is much clearer than it was 10 or 15 years ago. We must examine the attitude of the Government on that question.

We must ask why tobacco companies are so keen to sponsor sports and entertainment. I agreed very much with what the noble Lord, Lord Addington, said about the importance of sports sponsorship and of more money being available to help young people in their sporting activities, as well as about the sponsorship of public sports and sports training. Like him, I was a rugger player. I do not quite understand how someone on the three-quarter line did not know about the scrum. I was in both. However, there it is, and that is another matter.

We recognise why the tobacco companies are so keen on sponsorship. Certainly it is not their love of sports. It represents cheaper advertising. As my noble friend said, it is a method of getting round the inability to advertise where advertising is not possible. It also gets round the current voluntary agreement between the Department of Health and the tobacco industry. That agreement on tobacco advertising, promotion and health warnings says: Advertisements should not imply that smoking is associated with success in sport. They should not depict people participating in any active sporting pursuits or obviously about to do so or just having done so, or spectators at any organised sporting occasion". As my noble friend said, sponsorship of sport by tobacco companies clearly breaches at least the spirit of that voluntary agreement. Research has recently shown that in 1987 Embassy snooker received 110 hours of coverage while Benson and Hedges snooker had 31 hours. Other research indicates that in 1988 tobacco sponsored televised snooker contained 21 references per hour to the name of the sponsor. That means that the company was getting advertising at a very cheap rate.

Quite obviously it is children who are the main targets of the sponsorship. A high proportion of children are sports fans who either watch a sport directly or on television. As I have already said, I believe that Ministers who smoke are not suitable to carry through policies designed to reduce smoking. The Government must face up to that issue. Perhaps it is a little late for us to say that when the Prime Minister has just done her reshuffle. Perhaps the next time that she gets round to it she will think of that point.

I want to give my absolute support to the proposal put forward by my noble friend. Even if the Government turn down this proposal they will have to come up with some very positive ways in which they will seek to change attitudes toward both smoking and drinking. I think that they have had some success in the area of drinking, although perhaps not enough, and I am sure that the Ministers involved recognise that fact. But we have not seen from the Department of Health anything like the same campaigning zeal and the same encouragement given to people not just to understand the dangers but to live a healthy life.

I think that the whole concept described by my noble friend is one that the Government ought to seize; even if they do not, they ought to consider it very carefully. New to his post as the Minister is—and he has only had a few hours to consider whether he supports the idea—if he wants to turn this proposal down tonight he should at least leave his mind slightly open in order that we may come back to this issue on another occasion.

10.2 p.m.

Lord Trafford

My Lords, first I should like to thank the noble Lord, Lord Rea, for the kind words that he uttered when he started his speech. I should also like to thank the noble Lord, Lord Ennals, for his remarks which were a continuation of those that he made earlier this afternoon when I said in reply that I hoped the honeymoon would last longer than the Recess. My noble friend Lord Henley will wish me to associate him with these thanks to both noble Lords and to thank them for the kind comments about his services as health spokesman in your Lordships' House.

I turn to the Question that is before us; namely that a health promotion foundation should be established to promote sporting and cultural activities and medical research, and that it should be funded from moneys raised through excise duty on tobacco. The proposal is a very interesting one. I am quite certain that it is one which might be expected to attract very considerable support at first sight. The difficulty is that as a scheme it has a certain number of complications. It also raises a number of wider issues. That is not to pour cold water on the ideas that the noble Lord has expressed so clearly.

I do not disagree with a word that the noble Lord, Lord Rea, said about the effects of smoking. I do not disagree with him in any respect about the desirability of campaigns to control smoking, in particular for the young. I do not disagree with the statement that he made on the evil effects of smoking. I pay tribute to him for his known work for the prevention of coronary artery disease.

I take issue with him on two points. First, he was being a little pessimistic. It is true that we have a higher rate of coronary artery disease than some other nations. Although I am tempted to launch into a professional dissertation on the matter I shall resist the temptation. I merely comment that in the last decade the incidence has dropped in this country by 25 per cent. Those who wish to continue to be pessimistic will say that this is not as great as the United States, where the figure is believed to have dropped by nearly 40 per cent. in 15 years.

The problem is that to establish the exact casual relationship as to why this has happened is extremely difficult. Many people who are concerned with the control of blood pressure, diet, cholesterol, diabetes, alcohol, smoking, and so forth have tried to claim a slice of the credit for this fall in the incidence of coronary artery disease. One recognises that they have a perfect right to do so. As I happen to believe that causation is multifactorial, I suspect that the decline is multifactorial. However, we should not fail to recognise that we are looking at some successes. We appear to be following the same trend, starting a little later, but I hope continuing until we reach the same lower level. We are therefore doing some things right, whoever may be doing it.

Secondly, it is only in one year that the decline in smoking levelled off. The noble Lord, Lord Ennals, quoted the report that came out yesterday from the OPCS which shows some quite encouraging features: for example, that the habit of smoking among secondary school children in England in 1988 is probably continuing to decline since the last survey and the prevalence has fallen. It has not fallen to nought, which is what most noble Lords who have spoken in this debate would like, but it has decreased considerably.

Overall the prevalence of smoking—which used to be totally acceptable and running at high levels, with high figures—is now down to 30 per cent. of the population. In other words, it applies to about one third of the population. Furthermore, there has been a differential approach by the Government—and, to be fair, by previous governments—with regard to the type of smoking. It is well established that cigarettes are the known and proven bad aspect of the use of tobacco.

The work of the noble Baroness, Lady Masham, in the field of alcoholism, in particular with regard to adolescents, is widely recognised. I am sorry that she did not receive her Whip a little earlier in order to recognise that the Unstarred Question was ultimately confined to tobacco. I accept entirely what she had to say. I was very interested in what she said about the high price of low alcohol products. As she may be aware, there have been some changes. The ministerial group on alcohol misuse, which is trying to tackle some of these vexing problems, of which I am sure she is aware, is improving public education. It has indentified a number of research projects which it is felt should be proceeded with on alcohol misuse. The group is currently considering the question of sponsorship of the relevant projects in co-operation with research councils and the drinks industry. Perhaps the noble Baroness will forgive me if I do not wander off into the subject of alcohol since we have mostly talked about tobacco.

I do not think that any noble Lord would disagree with the comments on the value of sport, coaching and so forth that the noble Lord, Lord Addington, made. I share those thoughts. It is always depressing when they do not get beyond the third round of Wimbledon, as the noble Lord said.

To return to the central question, at first sight this is an attractive proposition but it raises some problems. The main difficulty is that it would require a fundamental change in our methods of tax collection and expenditure. Your Lordships will know that it is a general principle of our taxation system that revenue from individual taxes is not allocated to any particular item of government expenditure. To do otherwise would make the efficient management of total public financing much more difficult. I think that the noble Lord, Lord Ennals, implicitly recognised this fact when he said that there were difficulties with this proposition.

It has been suggested in the past that various forms of hypothecated taxation should be introduced for various purposes. If that were to be introduced there would be hundreds, if not thousands—or more—calls for the hypothecation of tax revenue in all directions, not just this one. It would be extremely difficult to control public expenditure and therefore to control inflation.

One might say to the noble Lord, Lord Rea, that one of the problems is that there is so much money involved not only in tobacco but in alcohol that it has a significant effect on inflation, on public expenditure and so forth. Nonetheless this Government have increased the price of cigarettes in real terms by over 30 per cent. during the past seven years. One of the reasons for not increasing it as much as some people would have liked was the fact that that would have raised the general level of expenditure.

Lord Rea

My Lords, the noble Lord says that the real price of cigarettes and alcohol has gone up by 30 or 40 per cent. over a period of years. The real income of people generally has gone up by at least that percentage, if not more. Therefore the price in relation to income has not gone up: rather, if anything, it has gone down.

Lord Trafford

My Lords, it would be very nice to know that the standard of living was rising so fast that even though one increases the price of a product by 30 per cent., nonetheless one can afford it even more easily. If we treble the price of something and increase people's income by six times it will be very beneficial. We then wander into a terrifically difficult area in which in one field the freedoms of individuals are significantly curtailed with regard to costs and prices. And yet the same people would be very unhappy if their freedoms were curtailed in other directions. One must bear in mind the balance of freedoms in this kind of matter.

It is generally felt that the pooling of revenues by the Government means that they can take a balanced view and ensure that resources can be applied more flexibly, and directed as necessary, according to expenditure needs in any given year. However, even though the specific suggestion made by the noble Lord cannot be taken further, we ought to consider whether there is a need for an institution such as he outlined. The funding would raise very significant problems.

As noble Lords will know, the Government set up the Health Education Authority in 1987 to give increased impetus to health education. It now has a budget of around £25 million. It has an increasingly important role in helping to bring about improvements in health through its campaigns on smoking, alcohol abuse, AIDS and coronary artery disease. There is a sporting and cultural element to this work. The "Look after your heart" local grant scheme has supported many exercise and sports-related activities. It is involved in giving advice on healthy living through cultural activities, particularly in respect of ethnic minorities. It also has close relationships with the Sports Council. It has been given a specific remit to undertake research to support health education activity.

I should like to interject on a purely personal note that I am very much a supporter of prevention in health. I think that the noble Lord, Lord Ennals, was a little unfair when he castigated the White Paper for not having mentioned health promotion. Part of the aim of the changes in general practice and elsewhere is to encourage the trend that has continued for some years. I am sure that the noble Lord, Lord Rea, would recognise from his own practice that advice on healthy living and smoking is not the rarity that it was 30 years ago but is commonplace. One is very glad to see this.

The main agency for direct research which the Government support is the Medical Research Council which receives more than £175 million a year from the Department of Education and Science. The job of the MRC is to promote the balanced development of medical research, and to advance knowledge which will improve health care. It undertakes numerous research programmes and projects. In this way it is able to complement the research resources of universities, polytechnics, hospitals and those more immediately connected with the care of patients.

Noble Lords will also be aware that, in common with other commercial enterprises—tobacco and alcohol are not the only ones—they sponsor many sporting and cultural activities. To turn to the tobacco sponsorship of sport, the Government have a voluntary agreement with the tobacco industry. That has already been referred to. The most recent restraint made significant changes in the amount of money to be spent on certain kinds of advertising. For example, it cut by half poster advertising and banned advertising in cinemas. The situation has been steadily tightened up since the time when the noble Lord, Lord Ennals, was responsible and even before when the first voluntary arrangements were made with the tobacco industry.

As I have already said, many businesses not associated with tobacco sponsor sports and cultural events. In the field of privately sponsored research, the tobacco industry provides considerable financial support for research into health promotion in fields that I agree are other than smoking, as the noble Lord, Lord Rea, said. These funds are administered by the Health Promotion Research Trust. It has supported about 130 projects. The industry also supports a number of other projects through the Tobacco Products Research Trust on the effects of modified tobacco products on human health.

I believe that this has proved to be an interesting debate. I personally share many of the views that have been expressed tonight on the evils of smoking. I accept that it is an addiction, and that it should be regarded as such. I welcome and encourage any and all measures to try to reduce the incidence of teenage smoking, and smoking by children in particular. I have tried to show that there are two sides to the question. There is great difficulty with the problems that have been put forward. I have also tried to show that there is considerable activity going on. It is a blend of activity by the Government and in the private sector. Its coverage is much wider than that which could be achieved by one foundation. One might say that it has many different tentacles. Therefore, even if it were possible to set up such a fund in that way, I believe that it would be extremely difficult. Many problems would be raised regarding funding, as that might narrow the range of its activities.