Part of the debate – in the House of Lords at 8:16 pm on 27 October 2003.
My Lords, I, too, thank the noble Lord, Lord Chan, for initiating the debate. I should like to explore the definitions of poverty and, more importantly, enlarge on the remarks of the noble Lord, Lord Chan, to illustrate how a simple behaviour change could result in those currently living in poverty having their health so much improved that they could be healthier than the rich.
The European Union definition of poverty is not particularly helpful—it is an income of less than half the European Union average. The World Bank has set the international poverty line at an expenditure level of one US dollar per person per day. As regards the present day interpretation of poverty, the general public hold ideas about the necessities of life which are rather more wide ranging than is ordinarily represented in expert assessments. People of all ages in all walks of life do not restrict their interpretation of the necessities to the basic material needs of a subsistence diet, shelter, clothing and fuel. There are social customs, obligations and activities that substantial majorities of the population also identify as among the top necessities of life.
People's perceptions of poverty tend to change as countries get richer. In this sense, the definition of poverty will always depend on what people in a particular society at a particular point in time perceive as "poor". A report by the Joseph Rowntree Foundation on poverty and social exclusion in Britain showed that the majority of people believe that it is more important to have heating in their home rather than to have a damp-free home. The majority nowadays also place more importance on a telephone than they do on a fridge freezer.
The report concluded that since 1990 poverty appears to have become more widespread but not more severe. This would seem to indicate that it is a change of people's perception of poverty rather than the problem itself becoming more severe. A realistic definition of poverty is that in order to survive one needs adequate food, water and shelter. This will cost an individual, on average, in this country, £80 per week. This includes housing, council tax, food and fuel. A realistic present day situation is to take the example of an unemployed single person, aged 25 or over, who is in receipt of job seeker's allowance. He receives a total of £109.11 per week before housing costs. After rent and council tax, this leaves an individual with a total of £55 per week. This equates to the unemployed male, each week, being able to afford fuel and power for his house, the necessary requirement of food, a can of lager each evening, the luxury of a satellite television, any medicines and travel by bus. After all this, he still has £14 in his pocket. Nevertheless, it is quite clear from the noble Lord, Lord Chan, that the inequalities in the North West are very obvious, as the noble Lord, Lord Clement-Jones, has also mentioned.
Poverty is very closely associated with early death from heart disease, lung cancer and stroke in the North West. Our figures show that approximately 84 per cent of premature deaths in the North West from coronary heart disease can be attributed to poverty. Yet how do we know that poverty is the problem rather than a desperate need for a behaviour change?
Professor Sir Charles George, the British Heart Foundation medical director, said that the differences in the social class between rich and poor are the cause of thousands of deaths from coronary heart disease in the UK each year. He said:
"People from lower socio-economic groups are more likely to smoke and less likely to eat fruit and vegetables than people from wealthier backgrounds".
The noble Lord, Lord Chan, has already mentioned that. Professor Sir Charles George continued:
"They may also be less likely to report any warning signs of coronary heart disease such as angina . . . By helping people to change their lifestyles and increasing health education we can help turn the tide on these figures and reduce the devastating burden of coronary heart disease in the UK—for everyone".
With this in mind, I would like to point out six ways in which health could be dramatically improved without any increase in expenditure. The first way is food. In 1939, one third of the British people were underfed or fed on the wrong food. That figure obtained in the United States. The introduction of food rationing changed that overnight, as people ate the right food in the right quantities. The only obese people in those days were those on the black market. It was a high roughage diet and included the national loaf which was grey, not brown. Brown bread is brown only because it is dyed. Calcium was added to counteract the effects of phytic acid in the bran, which tends to prevent the absorption of calcium.
The first action, therefore, for better health, would be to eat the foods which are conducive to good health. A single man can buy such food in Sainsbury's in London for £25 a week—I have tried it. That includes wholemeal bread, five helpings of vegetables and fruit a day, eggs, fish, cheese, and so on. A single unemployed man seeking work has £55 a week. The first way to improve his health is to change his eating habits.
The second proven way of greatly improving health is to avoid all drugs which produce ill health. It is a cast-iron fact that smoking produces ill health and premature death. Stopping smoking not only improves health but leaves more money for a healthier lifestyle. An alcoholic binge in an evening can cost up to £100. Crack cocaine, for a buzz of a little over a few minutes, costs £100.
Then we come, thirdly, to safe sexual habits. In Uganda, President Museveni, one of the most outstanding leaders in Africa, was faced with a huge problem of AIDS and venereal disease in the 1980s. To the astonishment of the world, he achieved a remarkable reduction in new cases from 31 per cent to 7 per cent. How did he do this? His solution was to be honest and to encourage the people to change their behaviour by adopting the ABC policy. A is for abstinence, B is for be faithful in marriage and C is for condoms if you cannot do that. He was the first national leader to have the guts to say the obvious. Working with schools, churches and various groups, he got his message over—"Change your behaviour".
Fourthly, there is exercise, which is what the noble Lord, Lord Bassam of Brighton, frequently does. He goes for a run for miles around the streets of Westminster and appears as fresh as a daisy at the Dispatch Box, without a care in the world. I suppose that it is a relief to survive running around this place.
The fifth way in which to improve health is for those unemployed to offer their services free, particularly in charitable work. That happens on quite a large scale. Finally, housing can be improved by local charities, which may help the occupants of substandard accommodation to improve their premises by enhancing security, decoration and insulation.
Some noble Lords have mentioned improving NHS facilities but, apart from immunisation, the NHS has a very marginal effect on people's health. There are no easy solutions to tackling the health inequalities in the North West, which are extraordinarily complex. However, one solution is to increase the number of people who help those in poverty to improve their health by adopting more appropriate lifestyles. What is required are improvements in eating, housing, exercise, work and the avoidance of habits that maim and kill.