Contribution
My Lords, I rise to speak to Amendment 159, to which I have added my name, and a series of amendments in my name. I apologise to the Committee that they had to be put in individually for procedural reasons, but essentially they would add to the list in Clause 44, and they all have to be done twice because it appears twice. I hope to keep this as short as possible. As the noble Baroness, Lady Bennett, said, these amendments were all suggested by researchers into the determinants of health to bring the clause into closer alignment with current research on the subject, as well as definitions, such as those used by the World Health Organization.
Everyone is delighted to see Clause 44 because there is good evidence that structural changes without changes in resourcing can make measurable differences to people’s health. I hope I can delight the noble Baroness, Lady Griffin, further by picking on Manchester as another well-studied, brilliant example of the effects of devolution. The results showed higher life expectancy in the lower income areas, which researchers think are related to improved collaborations between different services rather than more money being spent. If this is a causal effect and can be replicated elsewhere, it would obviously be great, and it would be great to measure it. This is why the researchers want to get right the things being measured and being taken account of by a mayor.
This is where my little list comes in. First, it is important to take account of the right health outcomes. Researchers suggested the list of health outcomes in Amendment 159, which I did not prepare to speak about, but I think they are self-explanatory, so we can leave that there. The series of amendments in my name alter the list of determinants of these outcomes. They are things that we know might affect someone’s health, so we have to keep an eye on them. Some that are known from research are missing in the current draft of Clause 44. Amendment 167A would add the availability of housing to standards of housing in new Section 24A(5)(a) because homelessness and housing security, which are known to affect physical and mental health, would not technically fall under standards of housing.
Amendment 167B would add noise pollution as one of the environmental factors in new paragraph (b). It is well recognised by those who study public health that exposure to noise pollution can contribute to cardiovascular risks and poorer mental health, so we need to take it into account like we do other forms of pollution.
Amendment 167C would put educational opportunities and attainment alongside employment and earning prospects in new paragraph (c). In the WHO’s report, A Conceptual Framework for Action on the Social Determinants of Health, education is a key underlying structural determinant that can affect jobs, income and all the other downstream aspects. So improving access to educational opportunities is key to reducing inequalities, including in health.
Amendment 167D is more specific on the sorts of public services referred to in new paragraph (d), making it clear that they should include retail and health and leisure facilities—they can, therefore, include the negative effect of retailers of less healthy foods, for example, or the absence of active transport facilities—as well as education, employment and access to health and leisure facilities, encompassing all the key services that are known to shape people’s health.
Amendments 167E and 167F would modify new paragraph (e). As drafted, it is about the use of tobacco, alcohol and other lifestyle factors that may be harmful to health. Amendment 167F would explicitly add diet and physical activity as important determinants to be considered. Of course, we know how much these can positively or negatively affect health. Amendment 167E would therefore add “exposure to”, as well as “the use of”, to recognise that some people are passively exposed to not just tobacco but advertising for tobacco, alcohol and less healthy foods; this is a known determinant of health and driver of inequalities.
Finally, Amendment 167G would specify that
“any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors”
should include
“social and structural conditions, including social class, gender, race, ethnicity and any other characteristics or forms of social inequality that influence exposure to advantage or disadvantage”.
That would better cover the remainder of other determinants of health that are well recognised and to which we would want mayors to have regard.
I hope that the Minister will consider the substance of these amendments because, although they are not professionally drafted, they are based on professional research in the field and, I think, get at exactly what the Government hope to achieve: a great step forward in public health.