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Vision 2020

My Lords, it is a privilege and a pleasure to introduce this debate. In asking for it, the aim was to raise the profile and to argue that blindness and eye health should be much more mainstream in international development. It is reasonable to say that we have already got a degree of success in raising the profile by the large number of noble Lords who have decided to speak, to whom I am very grateful. I am very much looking forward to hearing the contributions from so many Peers, including their experience and their concerns. I know that we will be hearing about this in the context of India and Africa. I am only sorry that there is such a short allocation of time. My task is setting the scene. I will be brief and will ensure that I do not go beyond my more generous time allocation. First, I declare an interest: I am proud to be chair of Sightsavers International, which for almost 60 years has promoted and provided programmes and services to prevent and treat blindness, and to support blind and partially sighted people in partnership with local organisations in 33 countries. Sightsavers International is a founding member of the International Agency for the Prevention of Blindness, which brings together the world's leading eye organisations to deliver Vision 2020: the Right to Sight as a joint programme with the WHO. We are tied in with the IAPB and the WHO. In declaring that interest, perhaps I may also say that Sightsavers International and the IAPB enjoy generous support from the Standard Chartered Bank through its Seeing is Believing campaign, which was launched in 2003, and whose previous chief executive, now the noble Lord, Lord Davies of Abersoch, has been such a personal and prominent supporter. Additionally, Merck, the drug company, has provided large quantities of the drug, Mectizan, to help control river blindness. My point is not just to declare an interest and record appreciation, but to say that there is an enormous unity of purpose among eye organisations, excellent corporate support and good support from the World Health Organisation. I would like to see the Government give eye health an even more prominent place in their thinking and give it more support. I should say to the Minister that I understand that the Government have not ignored eye health and that £50 million has been allocated for neglected tropical diseases, which includes, for example, onchocerciasis, for which allocations will be made. I am disappointed that it does not also include trachoma, a neglected disease which particularly in many cases affects women. Let me be clear about what I am asking about progress and Vision 2020. Vision 2020 was launched in 1999 with two aims; first, to eliminate avoidable blindness by 2020 and, secondly, to prevent the projected doubling of avoidable visual impairment by 2020. So there are two very clear aims. This is a big problem but we can deal with it. I want to describe the problem and make it clear that action can be taken. I shall give a few figures to illustrate why we should act and give this issue greater prominence. Three hundred and fourteen million people live with severe visual impairment, of whom 45 million are blind. Those are very big numbers. Seventy-five per cent of that blindness is treatable or preventable. Most of it comes from cataracts, trachoma and river blindness, all of which are perfectly treatable or preventable. I know that some noble Lords will speak about these diseases and what can be done. My third, and sad, statistic is that 90 per cent of blindness occurs in poorer countries. That statistic speaks for itself. Less well known—I apologise to noble Lords for producing all these statistics—is that this is also a gender issue. The best estimate suggests that two-thirds of blind people in poorer countries are women. The reason for that is twofold. First, they are more likely to be affected by conditions such as trachoma because they look after the children, deal with the dirty water and are exposed to infection. Secondly, in most cases they are, sadly, less likely to get help, so they are hit two ways. As I say, the best estimates suggest that, consequently, twice as many women in poor countries are blind than men. This is not just about blindness as if blindness were a simple and single thing; it also affects people’s life chances. We need to ensure that we do not see it just in terms of health. According to research from the International Centre for Eye Health, a blind person who gets their cataracts dealt with returns to something like their previous economic status within a year once their blindness is treated. In other words, they are able to resume some kind of economic activity, or at the very least their carer can resume that activity. This is about the economy and employment. It is also about education. A third of the world’s children not attending primary school are disabled, although not necessarily blind. I know that progress is being made—this is all doable—and I shall be interested to hear what the Government say. When I say that it is astonishingly cheap to tackle this problem, what I mean is that doing so represents astonishing value for money. It is feasible to talk about eliminating trachoma over the timescales that we are talking about. The organisation that I work with, Sightsavers, works with BRAC in Bangladesh and we are looking at how we can eliminate the backlog of cataracts in one of the major provinces. Enormous things can be achieved. I said at the outset that I wanted to gain greater prominence for this issue within the Government and more widely, and to "mainstream" it, as eye health is too often left out of the thinking. I talked recently in Mali to an American involved in international development who thought it was strange that eye doctors were being trained there when the country had other pressing needs. He ignored the fact that eye health affects so many people in a community. I fear that that sentiment is relatively common. Eye health should be seen as key to the millennium development goals, including education, women's rights and employment. I want to make three suggestions to the Government and I look forward to the Minister's response. First, there is, rightly, renewed emphasis on primary care. A great deal of eye health disease can be dealt with very easily in primary care; for example, the more minor conditions, not necessarily cataracts or trachoma but diseases arising from poor hygiene, living in dusty and desert conditions and sometimes from using traditional remedies. These are too often missed out. We want to see eye health emphasised as part of primary care, so that when you are pushing forward your policies on primary care, eye health is a central part. Secondly, there is a growing emphasis on human resources and training more health workers in Africa. It is equally important that eye health is part of this, not separate. Training is needed from the most local level of community worker to deal with the most local issues to the specialist. There are a lot of innovative models of mid-level workers in eye care. Thirdly, greater prominence should be given to disability in DfID programmes. Education, employment and rehabilitation need to be addressed to achieve all the millennium development goals. Disability is implicated in, if it is not the cause of, at least 20 per cent of world poverty. These are the three big issues for mainstreaming: ensuring that primary care policies relate to eye health; ensuring that human resources policies relate to eye health; and giving disability greater priority. Finally, I ask that DfID looks again at its whole support for eye health and Vision 2020. A good start might be a meeting with the Minister and the IAPB—I do not think that this has happened yet but, if it has, it has not happened recently—to demonstrate how seriously committed the Government are to this and to mainstreaming. Let me end on hope. This is a big problem, but there are solutions. Most of these conditions are treatable or preventable, and treatment can have quite a quick impact. There is a great deal of interest in this, as shown by those noble Lords who are speaking in this debate, as well as support from the corporate sector in the form of the Standard Chartered Bank and from the WHO. Eye health organisations are also well organised, and we want even clearer government policy working alongside us.