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Social Inclusion

rose to call attention to the Government’s policies on social inclusion; and to move for Papers. The noble Baroness said: My Lords, I am delighted that we are having this debate today—if a little earlier than expected—and that so many noble Lords are taking part. Social exclusion is a real blight upon this country. It wastes lives and taxpayers’ money. Progress has been made since 1997, but tackling social exclusion and promoting social inclusion is as important today as it was then. Social exclusion still matters to more than 4 million people living in families where no one works and to the one in 10 children who grow up experiencing severe poverty. I believe that social exclusion can and must be tackled. This Government have committed to building a stronger, fairer Britain. Tackling social exclusion is at the heart of that, and I believe that your Lordships’ House has an important duty to scrutinise this central plank of government policy, to examine progress and to debate the key challenges ahead. The Government have taken some important steps forward. Economic stability and growth, plus a strategy to make work pay and support for the most vulnerable have added up to some impressive figures for the Government. There are 2 million more people in work, 700,000 fewer children in poverty, 400,000 fewer children living in workless households and 700,000 fewer pensioners in poverty today. There can be no doubt that that has helped some of the worst off. On Tuesday, my honourable friend the Minister for Local Government, Phil Woolas MP, stated that there are now 1.1 million fewer socially excluded people than in 1997. However, that leaves more than 3.5 million, or 5.2 per cent, of the working-age population still excluded. That gives us some sense of scale of the problem we face. I am sure that the term ““social exclusion”” has many academic definitions but, for me, social exclusion describes situations where people and their families are experiencing problems so severe that they cannot take part in normal life. In other words, if we set a minimum standard for the things in life we take for granted, social exclusion is life below that level. Social exclusion is a difficult concept, because it does not refer simply to one dimension of life, such as income. It occurs when people become overwhelmed by problems and lose their ability to cope with the shocks that life throws up. Experiencing a problem in one area of your life can make you more vulnerable in another. You lose your job, so you have a lower income. That might mean moving to cheaper housing in an area with higher crime and fewer job prospects, and so the cycle goes on. The Government’s Social Exclusion Unit defines social exclusion as being,"““when people or places suffer from a series of problems such as unemployment, discrimination, poor skills, low incomes, poor housing, high crime,  ill health and family breakdown””." The scope of social exclusion is wide open, encompassing almost all areas of life. Factors that trigger exclusion are not conveniently located in one departmental remit or policy area. One of the main reasons that the Social Exclusion Unit is such a crucial resource is that it can take a wider perspective. Its recent report, Breaking the Cycle, highlights five key areas in need of further attention if the Government are to reach the millions left behind. I imagine that your Lordships may wish to add to this list today. The first key area is inequalities in educational attainment. We know that poor educational attainment can lead to poor employment prospects and low income. The second is being out of work. Worklessness is increasingly concentrated in the same locations and households. It is a key factor driving child poverty, which we know can pass from generation to generation. The third is homelessness. Lacking a permanent address leads to difficulties getting a job or opening a bank account. Homelessness also leads to problems with mental and physical health and well-being. The next key area is crime and fear of crime, which is most likely to affect the most disadvantaged people in the most deprived areas. The final key area is health inequalities. I hope that we can tease out some of the factors that link these issues and how they impact on some people and places more acutely than others and can begin to look at ways to push the debate forward and make real progress. I now want to outline my personal concerns. I bring to this debate a background as a patient advocate, and I am particularly concerned by the appalling health inequalities that we see in the UK today. Health and well-being profoundly affect quality of life and opportunity, but experiences of health and well-being are very different, depending upon an individual’s social and ethnic background, region or even neighbourhood. For instance, in the short distance between Westminster and Canning Town on the Jubilee Line there are six stops and the average lifespan of the population drops a year at each. South Asians in this country are 50 per cent more likely to die of coronary heart disease than anyone else. Men in unskilled manual occupations can expect to live seven years less than their professional counterparts. Some of these inequalities are increasing. The gap in infant mortality rates between the lowest and highest social classes increased from 13 per cent to 19 per cent in the short time between 1997 and 1999. The equivalent gap in life expectancy has risen by 5.7 per cent for women and 1.4 per cent for men. Tackling health inequalities has been a priority for the Government since 1997, and there are key targets in place. The 1999 White Paper, Saving Lives: Our Healthier Nation, set national targets to combat particular diseases across the population. We now have floor targets to close the gap in mortality rates from key killer diseases between disadvantaged areas and the rest of the country by 40 per cent by 2010. In addition, Tackling Health Inequalities A Programme of Action, was published in 2003. It set out 12 headline indicators, and progress against them was assessed in a report published in August this year. At the top of the list of the indicators we find increased survival of the big killers: cancer and heart disease. Data take time to collect and are particularly poor with regard to black and ethnic minority groups and people with disabilities, so it is not always easy to assess how progress is being made. Although inequalities persist and grow, experts suggest that we have made progress against some of the wider causes of ill-health and that, in time, this may reverse the trend. As I have said, top of the Government’s list of headline indicators that underpin these targets is a reduction in cancer mortality. I should like to take a few moments to discuss that in more detail in order to illustrate the enormity of the task and the diversity of the challenge in public health. Cancer affects one in three of us in this country, and there is a clear association between survival chances and affluence. On the one hand, there is great news: cancer survival rates are increasing for all sections of the population, but they are increasing faster in the most affluent rather than in the deprived groups.Vital research by the charity Cancer Research UK shows that exposure to cancer risk factors varies across socio-economic groups and that smoking is the biggest cause of inequalities in cancer incidence and survival. Smoking causes one in four cancer deaths and nine out of 10 cases of lung cancer, but it also increases the risk of cancer of the bladder, cervix, kidney, larynx, mouth, oesophagus, pancreas, stomach and some types of leukaemia. Around 15 per cent of the most affluent smoke as apposed to around 45 per cent of the least well off. But, most importantly, 70 per cent of all smokers want to quit. We know that the Government’s smoking cessation programmes are reaching people living in deprivation, but, not surprisingly, people with tough lives find it harder to quit. I believe that all the Government’s public health policies should tackle health inequalities. Therefore, I await with interest the arrival of the Health Bill into your Lordships’ House in order to understand how this new raft of policies will reduce health inequalities. I believe that health inequalities also stem from unacceptable delays in diagnosis and unequal access to services. I see this as a key point, which needs greater attention. For example, in cancer, we know that the uptake of screening in deprived groups is poor. The National Audit Office recently reported that certain groups, including older people and people from deprived areas, are more likely to present with cancer at a later stage than the general population—with all the effects of survival that entails. While we would like to believe that once someone enters the system they will get the best treatment, regardless of their affluence, this may be far from the truth. For example, women with breast cancer from deprived groups are much more likely to undergo radical mastectomies rather then the more modern breast conservation surgery. I am concerned that if we are to achieve the hugely stretching targets the Government have set for reducing health inequalities, we need to integrate public health initiatives and priorities into the core of other department agendas. The ODPM is key in that because of its focus on location and community engagement in deprived areas. Yes, we need a comprehensive smoking strategy and to promote diet and lifestyle changes in the population, but to reach these targets we need to address the problems of the worst off in the worst performing areas. That means improving early diagnosis of the big killers in hard-to-reach groups in deprived neighbourhoods through better access to services and better outreach into the community. Sadly, there is remarkably little evidence of what works well, but I believe that the voluntary and community sector and some PCTs are leading the way. For example, this week we heard that Cancer Research UK has launched a major targeted campaign to raise awareness of mouth cancer in disadvantaged groups starting in Tower Hamlets and Gateshead where survival could jump from 50 per cent to 90 per cent with early diagnosis, and all the benefits and quality of life that that could bring. Dr Foster, in partnership with the Department of Health, has developed a tool for identifying specific locations at high risk and a methodology for engaging and energising local communities to self educate. They have had great results in Slough, working with the Asian population at risk of diabetes, and are now working in East London on breast cancer and in Brent on teenage pregnancy—a very important issue for our discussions today. The Big Lottery Fund, for example, has supported a number of innovative projects. The lessons from these initiatives seem to be that involving diverse communities is vital and tightly targeted interventions are necessary to make an impact. If there is read-across from these ideas through into other disease areas, it is clear to us all that there is a huge challenge in tackling health inequalities in this country. So we need a better understanding and a common approach to these issues. We must ensure that we act decisively through all departments, not just the Department of Health. I have concentrated on health issues, as I would, but even so I have not had time to touch on issues such as AIDS, as it is World AIDS Day today, mental health or childhood obesity—big issues for this subject. But we must move on because there is not time and I want everyone to have time for this discussion. There are many reasons why people become disadvantaged and excluded. There are complex inter-relationships between factors, and I know that speakers will want to raise those. I look forward to a challenging debate and I hope that we can give my noble friend the Minister some real food for thought in this vital area of government policy. I beg to move for Papers.