§ Mr. Carter-Jonesasked the Secretary of State for Social Services (1) to what he attributes the high infant mortality rate in Wolverhampton in 1976; what action has since been taken to reduce it; and if he will make a statement;
(2) to what he attributes the high infant mortality rate in Salford in 1976; what action has since been taken to reduce it; and if he will make a statement;
(3) to what he attributes the high infant mortality rate in Rochdale in 1976; what action has since been taken to reduce it; and if he will make a statement;
(4) to what he attributes the high perinatal mortality rate in Kirklees in 1976; what action has since been taken to reduce it; and if he will make a statement;
(5) to what he attributes the high perinatal mortality rate in Barnsley in 1976; 323W what action has since been taken to reduce it; and if he will make a statement;
(6) to what he attributes the high perinatal mortality rate in Salop in 1976; what action has since been taken to reduce it; and if he will make a statement;
(7) to what he attributes the high perinatal mortality rate in Dudley in 1976; what action has since been taken to reduce it; and if he will make a statement;
(8) to what he attributes the high perinatal mortality rate in Sandwell in 1976; what action has since been taken to reduce it; and if he will make a statement;
(9) to what he attributes the high perinatal mortality rate in Wolverhampton in 1976; what action has since been taken to reduce it; and if he will make a statement;
(10) to what he attributes the high perinatal mortality in Rochdale in 1976; what action has since been taken to reduce it; and if he will make a statement;
(11) to what he attributes the low infant mortality rate in Suffolk in 1976; what lessons he has drawn for national application; and if he will make a statement;
(12) to what he attributes the low infant mortality rate in Oxfordshire in 1976; what lessons he has drawn for national application; and if he will make a statement;
(13) to what he attributes the low infant mortality rate in Gloucestershire in 1976; what lessons he has drawn for national application; and if he will make a statement;
(14) to what he attributes the low perinatal mortality rate in Suffolk in 1976; what lessons he has drawn for national application; and if he will make a statement;
(15) to what he attributes the low perinatal mortality rate in Berkshire in 1976; what lessons he has drawn for national application; and if he will make a statement;
(16) to what he attributes the high infant mortality rate in Calderdale in 1976; what action has since been taken to reduce it; and if he will make a statement;
(17) to what he attributes the low perinatal mortality rate in Oxfordshire in 1976; what lessons he has drawn for 324W national application; and if he will make a statement.
§ Mr. MoyleI am advised that high perinatal or infant mortality rates are almost invariably associated with a multiplicity of factors, including the relative prevalence of families in social classes IV and V and more particularly disadvantaged groups such as one-parent families and recent immigrants; with family size; with poor housing, atmospheric pollution and other environmental disadvantages; with variations in climate; as well as with factors relating more directly to the provision of medical services and the use which people make of them. Thus the nine areas which my hon. Friend mentions as having the highest perinatal or infant mortality rates show a marked concentration of such unfavourable factors, while the four areas with the lowest rates for perinatal or infant mortality, are correspondingly favoured in most or all of these respects.
The rates of perinatal and infant mortality—and the associated morbidity—in the worst areas are plainly unacceptable; but it will require sustained effort on a broad front to reduce them to levels comparable to those prevailing in more favoured areas. The Government are already making, and intend to develop and sustain, a broad attack on these problems through their partnership schemes for inner city areas and the urban programme. In 1976, health authorities were specifically asked to review their facilities for the care of the newly-born in the light of the report of professor Oppe's working party on the prevention of early neonatal mortality and morbidity; and the priority attached to these services was emphasised in "The Way Forward" in 1977.
The planning guidelines to health authorities issued in March of this year reaffirmed these priorities and drew particular attention to the need for improving take-up of ante-natal services and to my right hon. Friend's Eleanor Rathbone lecture in which he called for a major effort to reduce the toll of child deaths in the worst areas. Concurrently, regional health authorities have been asked to cover in detail in the strategic plans which they are required to submit in January 1979 the subject of perinatal and infant mortality and handicapping, and their plans for improvement in areas with 325W persistently poor figures. The Government have also taken a number of steps to increase public and professional awareness of the issues.
§ Mr. Carter-Jonesasked the Secretary of State for Social Services (1) if he will list the area health authorities which reduced their perinatal mortality rate by more than 15 per cent. between 1974 and 1976; what factors he believes were responsible for the fall in each case; and if he will make a statement;
(2) if he will list the area health authorities which reduced their infant mortality rate by more than 15 per cent. between 1974 and 1976; what factors he believes were responsible for the fall in each case; and if he will make a statement.
§ Mr. MoyleThe following list names areas in which infant and perinatal mortality rates were reduced by 15 per cent. or more between 1974 and 1976. In my reply to my hon. Friend's other Questions today, I have emphasised the multiplicity of factors which appear to influence the incidence of infant and perinatal deaths and it seems probable that the factors which contributed to their improvement in each of the areas listed were equally many and various, although I have no doubt that the conscious and sustained efforts of health professionals will have made a major contribution in each case. In this connection, I draw my hon. Friend's attention to the paper by kin Chalmers, Josephine Weatherall and others published in the May 1978 issue ofHealth Trends which reiterates the inadequacies of crude perinatal mortality statistics for judging the effectiveness of perinatal health services, and offers some suggestions for overcoming these limitations; and to the comments of my Chief Medical Officer on page 15 of his report "On the State of the Public Health" for 1976, on possible factors associated with the improvements in perinatal and post-neonatal mortality during that year.
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AREA HEALTH AUTHORITIES WITH 15 PER CENT. OR MORE IMPROVEMENT IN INFANT AND/OR PERINATAL MORTALITY RATES BETWEEN 1974 AND 1976—IN RANK ORDER Area Health Authority Percentage improvement in infant morality rate Wirral … … … … 44.9 Tameside … … … … 42.0 Sunderland … … … … 37.6 Bradford … … … … 36.2
Oldham … 35.9 Bury … 34.5 Suffolk … 34.2 Leeds … 30.7 Kingston and Richmond … 30.1 Oxfordshire … 29.4 Liverpool … 29.1 Walsall … 28.9 Gloucestershire … 27.8 Wakefield … 27.7 St. Helens and Knowsley … 27.3 Redbridge and Waltham Forest … 26.8 Trafford … 25.6 Sefton … 25.4 Lambeth, Southwark, Lewisham … 25.0 Merton, Sutton, Wandsworth … 22.8 Essex … 22.8 Sheffield … 22.1 Enfield and Harringay … 21.8 Coventry … 21.7 Lancashire … 20.8 Manchester … 20.8 North Yorkshire … 20.0 Humberside … 19.5 Avon … 19.5 Hampshire … 18.4 Somerset … 18.2 Cleveland … 17.2 Solihull … 16.6 Northamptonshire … 16.4 Stockport … 15.3 England—Percentage reduction … 12.4
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Area Health Authority Percentage improvement in perinatal mortality rate Tameside … 43.9 Bury … 37.9 Wirral … 36.8 Camden and Islington … 36.1 Gateshead … 31.9 Merton, Sutton, Wandsworth … 31.8 Oldham … 31.6 Walsall … 28.1 Kingston and Richmond … 27.9 Suffolk … 27.6 Durham … 26.5 Humberside … 26.0 Redbridge and Waltham Forest … 25.8 Trafford … 24.4 Sunderland … 23.2 Salford … 23.1 Solihull … 23.0 Northumberland … 22.2 Oxfordshire … 21.6 Liverpool … 21.5 Rotherham … 20.9 Hampshire … 20.8 Devon … 20.5 Lancashire … 20.0 Wakefield … 19.7 Lambeth, Southwark, Lewisham … 19.6 North Yorkshire … 19.2 Gloucestershire … 19.1 Bedfordshire … 19.0 Leeds … 18.9 Berkshire … 18.7 Avon … 18.7 Essex … 18.3 Barnet … 16.8 Sandwell … 16.6 St. Helens and Knowsley … 15.8 Cumbria … 15.2 England—Percentage reduction … 13.0
§ Mr. Carter-Jonesasked the Secretary of State for Social Services, further to his reply to the hon. Member for Eccles on 11th May 1978, whether the reason for the mortality figures for half the countries listed being no later than 1974 lies in the failure of those countries to produce later information; and if he will make a statement.
§ Mr. MoyleThe figures quoted were the latest then available in the Office of Population Censuses and Surveys where arrangements exist with the various countries concerned for regular exchange of statistical publications as they become available.
§ Mr. Carter-Jonesasked the Secretary of State for Social Services (1) what is his estimate of the number of children in the United Kingdom who will die in the first year of life in 1978 if (a) the infant mortality rate remains the same as in 1977 and (b) the infant mortality rate falls to the rate of 8.3 deaths per 1,000 live births which obtained in Sweden in 1976;
(2) what is his estimate of the number of children in the United Kingdom who will be stillborn or who will die in the first week of life in 1978 if (a) the perinatal mortality rate remains the same as it was in 1977 and (b) if the perinatal mortality rate falls to the rate of 10.7 deaths per 1,000 live births obtained in Sweden in 1976.
§ Mr. MoyleThe estimated numbers are as follows
Deaths under one year of age (a) 9,400, (b) 5,500;Stillbirths and deaths under one week of age (a) 11,600, (b) 7,200.