Health and Community Care Committee, 19 Jan 2000

Meeting date: Wednesday, January 19, 2000

Official Report 208KB pdf

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Progress Reports

Three sub-groups were set up. One, involving Hugh Henry, Duncan Hamilton and Ben Wallace, examined smoking. The poverty sub-group involved Kay Ullrich, Irene Oldfather and Malcolm Chisholm. The third sub-group was on access, and involved Mary Scanlon, Richard Simpson, Margaret Jamieson and Dorothy-Grace Elder.

We will follow that order. Does anyone from the smoking sub-group want to make any comments about what they have been doing?

We have a summary paper of how far we have progressed. We had a meeting on 29 September. We set out the division between smoking and passive smoking and the issues involved in each. Since that, we have pursued evidence and have consulted various groups, as listed on the paper. If members could quickly read through our priorities, we will take questions.

The paper's first section asks:

"Does the Committee need to commission further independent research?"

Do you want to comment on that question?

The answer is that we do not know yet.

It is just that we have money available at the moment.

Studies have been carried out in America. The most recent—or most topical—one was the New Zealand study into passive smoking. Since then, there have been a few criticisms of that report. If the sub-group could consider what has been said since publication in September, we might be able to return with a formal request for additional research, however I do not think that we can do that at this stage.

The EU is also doing its own investigation.

Those of us who met the Westminster Select Committee on Health on Monday discovered that its members are also doing work on the same issue, in particular on the tobacco industry. It is progressing from the past agenda to examining the industry itself. It would be a good idea to dovetail with it and see what it is coming up with.

Are there are any other comments from any—I was going to say smoking members, but you know what I mean: smoking sub-group members, or others?

I am not in the smoking sub-group, but I suggest that it examine the revenues obtained by the Treasury from smoking—it is about £5 billion or £10 billion a year. It is big, big dosh relative to the amount that successive Governments—not just the current one—have spent on education against smoking. I think that it is only about £3 million in Scotland. That matter needs to be brought up to date.

That is covered by an assessment of the Government's current position and the resources that lie behind it.

It is a question of the money itself. It will be useful to explore the matter, as we will be able to challenge the tobacco companies as well as the Government.

I want to pick up on Dorothy's point. If we consider this matter across the European Union, we find that massive farming subsidies are given to support tobacco growing in Mediterranean countries. The proportion of money set aside for health promotion and anti-cancer information is infinitesimally small in comparison.

I am glad that you raised that, Irene. I recall that, a couple of years ago, President Clinton was unable to visit Virginia for political reasons, because he was anti-smoking.

If we take the example of California—although we do not want to do so on many loopy things—

Dorothy, are you from California?

Let us not go into that.

Everyone holds up California as the great example of a state that has managed to quell smoking. It is a great example, but I believe that it has spent six times as much as Britain on such measures—proportionately.

That could also be taken as part of the international comparison, which we are considering.

I think that the programme as set out in the sub-group's paper is excellent. However, I would like there to be some emphasis on underage and young smokers. Children seem to be smoking at a younger age. When I was preparing for the drugs debate, I was told that the earlier children start smoking, the more likely it is that they will start dabbling with drugs.

That is a good point. It might also come under our consideration of the strategy currently being adopted by the tobacco companies. It may relate to how the companies are focusing on different market sectors—different socio-economic groups and age groups. I take Mary Scanlon's point on board.

Education in schools is perhaps also relevant to that.

The Treasury makes £10 million a year in tobacco revenue and VAT from child smokers in Scotland alone. That figure comes from the amount of cigarettes assumed to be sold illicitly to children.

We will return to time scales at the end, but I would be grateful if we could now have a report from one of the members of the poverty sub-group.

This is obviously a massive subject. We have met only briefly, but we have been doing other work. I have read a lot of the pertinent literature. Nobody can dispute the facts. Everybody knows that there is a link between poverty and poor health. That was highlighted in the news recently: the University of Bristol report drew attention to the various Glasgow constituencies.

The facts are undisputed; what is in dispute is the precise mechanisms or pathways by which social and health inequalities are generated and maintained. There are many different theories, some of which are complementary rather than contradictory—I am not sure members want me to go into that now. I think that we have decided that the sub-group will survey the literature on that, and that we will try to contact certain individuals in Scotland—many of the key academics on the subject are in Scotland, including Professor Hanlon, the professor of public health at the University of Glasgow.

The second major question is what effective actions can be taken to deal with the situation. There is reading to be done, but that is also where we can make our main contacts. We discussed going to talk to various organisations and individuals who are trying to address matters locally. We have done a lot of preparatory work and we are now prepared to meet people and organisations.

I do not know whether members want me to cover all the territory. Probably not, considering the time. In general, though, this is a key subject for this committee, so our investigation will just have to go on for a long period of time. If we can crack this, we will have made the biggest breakthrough on health policy.

I always thought that poverty was the biggest challenge to the Parliament. One of the fundamental questions is about the extent to which we can tackle it through health policy. The reality is that we can do only a bit through health policy.

The Acheson report, produced by the Department of Health in England, was one of the most interesting things that I have read. Sir Donald Acheson, the chief medical officer at the time, said:

"We consider that without a shift of resources to the less well off . . . little will be accomplished in terms of reduction in health inequalities by interventions addressing particular ‘downstream' influences".

That is a very radical challenge from a pillar of the establishment in England. It does not mean that we give up on all the health policies and interventions, but it does provide some context.

Two people whose work has interested me are Wilkinson and Barker. Wilkinson's basic point is that income inequalities are most closely correlated with health inequalities—that is controversial and has great political implications. In our meeting with Scottish Executive officials, we learned about the great deal of work that is being done on the influence of low birth weight on later life. That puts another perspective on the matter. The theories about accumulated effect have enormous practical implications for health policy, but they do not contradict other theories.

We have not given up on this—we are trying to tackle this enormous challenge.

Your main issue is probably what to focus on in tackling it.

I return to what I was saying about seeing how individuals are trying to address poverty, using a community development approach to tackle it at a grass-roots level. Many such projects are under way. The question is—it was asked when we considered the Arbuthnott report—how health boards spend their money and the extent to which they focus on poverty.

I cannot claim that the sub-group has come to any conclusions, but we are more familiar with the territory—I am; Irene is already an expert, so she did not have to do so much preparatory work.

Shall we go to the expert, then, or are you happy with what Malcolm has said, Irene?

I think that Malcolm summarised the situation very will.

Are there any other comments for the poverty sub-group? If not, we will move on to the next one, on access.

We have decided to meet in the very near future. We have not so far agreed on a time when we are all together, but we have briefly discussed a possible framework of reference and a structure for this enormous subject, and a structure under which we will pursue our investigation.

Our report is therefore not very long.

Are there any suggestions or comments for the access sub-group?

I would like to move to the timetable for the sub-groups' work. We are all well aware of everyone else's work load, and I appreciate that our own was particularly great in the first few months. Some of us may be getting more to grips with it now. I do not think that there is anything to be gained, in any of the three subjects, by rushing to conclusions. I think that it is much better to allow things to develop. It is obvious just from the three reports that we have heard now that members are at different stages.

I suggest that we give this another three months and ask sub-group members to return in three months' time with further progress reports. We will decide then whether to put forward the timetable for the finalisation of reports or whatever we want to do with the work that sub-group members have done up to that point.

The access group members were wondering whether it would be appropriate for us to consider social inclusion partnerships in greater detail. We wondered whether that would fit in with access.

I would not have a problem with that. It is in the hands of sub-group members.

Damp housing was another thing that we discussed.

There are overlaps.

Social inclusion partnerships is something for us to consider.

If members want to make visits or do anything else that they think would be helpful in progressing their work, they should make the clerks and me aware of it, and we will do what we can to facilitate anything that would be useful or helpful, apart from going to California—unless the convener can come too.

Meeting closed at 12:09.