My Lords, I very much welcome the debate and appreciated the way in which the Minister introduced it. Over the last 10 years or more, I have worked mainly in Africa and have come to understand the Commonwealth much better—what extraordinarily strong links we have as a member of the Commonwealth; what a powerful voice in the world it is and could be; and how important it is, particularly for the poorest countries and particularly in Africa.
I know that these points are reflected in the Foreign and Commonwealth Office’s priorities for the Commonwealth—I think here particularly of the last three. The third priority is:
“Promoting Human Rights, Democratic Values and the Rule of Law”.
I understand the enormous challenges in all three of those areas. I think in particular of the rights of people who are lesbian, gay, bisexual, transgender or intersex, which were so eloquently discussed by the noble Lords, Lord Scriven and Lord Cashman, and by others. As the UK strengthens its role in the Commonwealth, it is very important that it continues to speak up about these rights and voice its concerns, about not only those rights but other human rights abuses.
The fourth area of priority for the Foreign and Commonwealth Office is:
“Supporting sustainable development and prosperity”.
Those issues are important for the UK, as well as for every other member. Its final area is about “Championing understanding within” this wonderful, worldwide diverse community.
Against this context, I want to speak specifically about health, development and prosperity, and the links between the three. I stress the links because too often they are treated as if they are separate issues, but they are intimately connected. I want to put forward the argument that an emphasis on these three together should be made within the Commonwealth and should feature at the Heads of Government meeting next April. Doing so will contribute enormously to these wider goals.
I will make three main arguments, give a current example that is very effective and put forward a specific proposal for the future. The first argument is about the economic impact of health. This is often neglected and we think about health and health services as a cost. It is time that we showed that that assumption is wrong. There are costs and benefits from investment in health. It is perfectly true that the wealthier a country is, the more it can spend on public services including health, but it is equally true that good health is a driver of productivity and that poor health destroys it. We need only look at the HIV/AIDS epidemic in Africa to understand how it reduced economic growth over many years with detrimental impact throughout the southern part of the continent at least. We equally need to look at other countries where they have had improved health which has led to improved productivity and economic performance. There is also the demographic dividend, which is that as children get healthier and survive more often, families become smaller and the dependency ratio within a country reduces. It is really a health dividend that we should be very conscious of in thinking about policy.
There is more to it than that. The recent UN commission on health employment and the economy demonstrated that employing more health workers is beneficial to the economy, improving health, education and economic prospects in the country as a whole, but there is even more to it than that. Health is the fastest growing major industry in the world. It is growing at 5% globally and at 8% in south-east Asia. Commonwealth countries need to have their share of it. We in the UK know that the biomedical and life sciences need to be a major part of our industrial strategy. We have 4,800 companies in this sector, turning over more than £55 billion. We heard from my noble friend Lord Broers who spoke eloquently about the need to work with Australia and other Commonwealth countries to invest and grow this sector, whether it is through the prosperity fund or other routes.
My second argument is about the links between health and all other aspects of development. There is abundant evidence that health and education are linked. We know that in India the children of girls with five years of education are 40% more likely to survive to the age of five, but we also know that it is the other way round as well and that ill-health impacts on education and opportunities. For example, in some southern African countries about 40% of children are stunted. That impacts on their mental development, all their achievements and subsequently on the economy and everything else. We should not see these issues as separate; the central point here is human development, or human flourishing, as Amartya Sen would call it.
My third argument turns to the House of Lords report on soft power, which was chaired by the noble Lord, Lord Howell. It emphasised that the UK is the best-networked country in the world. He and others have expanded on the idea of the Commonwealth as a network today. Health is an extraordinarily influential network. There are 6 million or so nurses within the Commonwealth and doctors are intimately linked with their partners in other parts of the world. There are any number of partnerships between UK institutions and health institutions throughout the Commonwealth. I am reminded of the health partnership scheme promoted by the Government and hope that it will indeed continue. People care about health; they link with each other and share. Health is one of the streams that will help us to have greater understanding within the Commonwealth. Investment in health provides wide-ranging economic and social benefits and the Commonwealth should see it as a priority.
Let me turn to my examples. The first is the current one: the Queen Elizabeth Diamond Jubilee Trust has money raised from the Commonwealth. It has set up a trachoma initiative with £41 million, which is being managed by Sightsavers. I had the great privilege to chair the organisation at the time, although I no longer do so, and I declare my interest. It is having an extraordinary impact in the Commonwealth: 11 million people have been treated and it has great partnerships. There are all the benefits that have been talked about. It benefits the poorest most, it benefits women most, because women, surprisingly, are more likely to be blind, and it allows people suffering from this disease, and their carers, to return to work.
My second example for the future is to urge that the Commonwealth should play a major role in a new global campaign for the development of nursing. Members of your Lordships’ House will well understand how vital nurses are in every country in the world, but particularly in low and middle-income countries where very often they may be the only health workers that anyone sees. A recent study by the UK’s All-Party Parliamentary Group on Global Health, which includes Members of your Lordships’ House, with the support of the Commonwealth Nursing and Midwives Federation looked at the development of nurses globally. It made three very important points. First, universal health coverage will not be achieved without developing nursing globally. They are the largest part of the profession. Secondly, nurses are very often undervalued and underutilised within the system, perhaps because they are women or perhaps because they are not doctors. We very often train them to a high level and then, in practice, we do not permit them to work to that level. Nurses could have an even more significant impact in the future. Thirdly—and this is a very important point—developing nursing will have a triple impact in contributing to three of the sustainable development goals: improving health, promoting gender equality and strengthening economies.
As the result of the popularity of our report with people around the world, we have decided to launch a global campaign to raise the profile of nursing globally, support the empowerment of women globally through employment and develop local economies. I am delighted to say that the World Health Organization has already given its support, and we are in very positive discussions with the Commonwealth. That has partly been with the Commonwealth Secretariat—I echo the comments of other noble Lords about support for the noble and learned Baroness, Lady Scotland, in the important and very difficult role she is playing at the moment. But we have also had discussions with a large number of members, and already Ministers, senior officials and health leaders in countries as far apart as Jamaica, India and Tanzania have given their support. My noble friend Lady Watkins and I are meeting with the Commonwealth Advisory Committee on Health next week to present this proposal. Planning is under way.
I very much hope that the Government will give serious consideration to including health, development and prosperity, linked together, and in particular this global nursing campaign on future Commonwealth agendas and at the Heads of Government meeting in April next year. I ask the noble Baroness, Lady Anelay, whether she would be willing to meet with my noble friend Lady Watkins and me, and the leaders of the campaign, to take this forward.