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On behalf of other members of the Select Committee, I inform the House that many of them are abroad on a visit to the middle east but would have spoken in the debate had they been here. It would be wrong for me to indicate how they would have spoken or whether, like me, they support the Bill, but I will put on the record one or two comments previously made by members of the Committee. As long ago as 2011, my hon. Friend the Member for Stafford (Jeremy Lefroy) said in a debate on the CDC:“It is extremely important that the Government should continue to support CDC.”—[Official Report, 14 July 2011; Vol. 531, c. 169WH.]An IDC report on jobs and livelihood in the last Parliament stated:“We are encouraged that CDC has followed our recommendations and has refocused on job creation.”A final Select Committee example is a recent report on the sustainable development goals, which stated:“The Government must ensure that the work it carries out to encourage private sector investment, through CDC…is focused on developing and fragile states”.It went on to mention“a positive impact on the achievement of the SDGs”,which the CDC had the potential to achieve. It was interesting to note that in response the Government stated:“CDC’s mandate is aligned with achievement of the Goals”.Before I touch on a few of my prepared remarks, I would like to deal with some of comments made by another member of our Select Committee, the hon. Member for Cardiff South and Penarth (Stephen Doughty). He mentioned his concerns about the effectiveness, the poverty focus and the coherence of the CDC’s work, and I would like to respond to these.The hon. Gentleman said that there should be more emphasis on health and education. However, the CDC’s development impact is amplified by the billions of pounds in local taxes that are generated by the companies it invests in. These help to support the public services such as health and education in developing countries. Over the past three years alone, these companies have generated over £7 billion-worth of local tax revenue. It is important to remember the impact that these taxes can have on those kinds of essential services.The hon. Gentleman spoke about coherence, and he and others have mentioned transparency, but DFID works very closely with the CDC to ensure that it is at the forefront of global standards of transparency in development impact. Information about all the CDC’s investments is available on a comprehensive database on its website, with details of the name and location of every investment in the portfolio. I am sure that further information would be made available if members of the Select Committee requested it. If DFID is working, as we know it is, with the CDC on a new results framework, this will result in an even better capture of the broader impact of investments on development—even beyond job creation and tax revenue generated.Finally, the hon. Gentleman raised his concerns about investment by the CDC in a private, fee-paying hospital in India, stating that this might be at odds with DFID’s general approach towards the expenditure of UK aid. I have to say, however, that I clearly remember the Select Committee visiting a private, fee-paying school in Africa not so long ago, and Committee members agreed that DFID’s support for that school was, in fact, well spent, particularly when there was no other option for children in that area to obtain an education. I believe these issues need to be looked at in context, and I am not so sure that support for this hospital is so out of line with DFID’s general approach.
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The hon. Lady raises the issue of private fee-paying education and health. The issue is about where we focus our efforts. Does she not accept that if we continue to support the expansion of private healthcare and education as opposed to supporting public systems that enable free access to healthcare and education, we will effectively supplant countries’ ability to provide national healthcare and education systems that support all their citizens, including the poorest? -
As with so many of these cases, it is not an either/or. It is often both when the need is clearly there and the money can be well spent.I shall move on to my few prepared remarks about the Bill. I absolutely support the Bill and speak in favour of it. It is essential to look at how to support capital investment in countries where there is a paucity of it. A 2014 report from the UN Conference on Trade and Development calculated a £2.5 trillion annual investment gap in key sustainable development sectors, so the CDC has a very important role to play. It is important to remember that the Bill will allow DFID and the British people, as the CDC’s motto states, “to do good without losing money” on an even greater scale than hitherto. I cannot believe that anyone, even aid sceptics, could really object to that.The NAO report, published yesterday, chronicles the many positive steps that the CDC has taken, and the many improvements that it has made. We have heard many references to the report. It says that through“tighter cost control, strengthened corporate governance and closer alignment with the Department’s objectives, CDC now has an efficient and economic operating model.”This morning I spoke to NAO officers who had produced the report over eight months and had visited many projects, including some in Africa. They said that DFID now had a really good grip on the CDC’s work, that there were good lines of communication between the CDC and DFID, and that DIFD’s in-country know-how was being utilised, while it was rightly not interfering in day-to-day management. They identified several cases of CDC investments in areas where the private sector would not have initially dared to go, but three years later private sector money had come in. Indeed, in several instances they saw the results of what they described as “catalytic” investments. They said of the 13 or 14 funds they had inspected in Africa that, with one exception, they were “transformational”. I think that we have a really positive report on which to act.Of course, there are views about previous investments, but I think it encouraging that 98% of investments are now in Africa and south-east Asia and 82% are in one of the seven priority sectors identified in DFID’s key objectives, which were devised in 2012 following the excellent review conducted by my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell).Without further ado, I shall end my speech, although there is much more that I would like to say in praise of the CDC
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Tuesday, 29 November 2016
Commonwealth Development Corporation Bill
Thursday, 24 November 2016
Reducing Health Inequality
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On the doorstep of No. 10, our Prime Minister, taking up her leadership mantle, gave an inspirational social justice speech, aimed at ensuring that we reduce health inequalities, including by addressing the stark realities of the mental health challenges that so many families in our communities live with daily. I want to speak about that, about the importance of healthy early relationships in life—even beginning before birth—and about the mental health challenges that can be involved. I would like to conclude with a reference to the implications of alcohol harm, wearing my hat as the chair of the all-party parliamentary group on alcohol harm.Building healthy relationships—beginning before birth—and establishing them in our earliest years as building blocks in our family and community life are absolutely key for the prevention and reduction of mental health problems in childhood and throughout later life. That starts in the womb.Let me commence by setting out some key facts from the early lives of our children here in the UK. Depression and anxiety affect from 10 to 15 of every 100 pregnant women. Over a third of domestic violence begins in pregnancy. One million children in the UK suffer from problems such as attention deficit hyperactivity disorder, conduct disorder, emotional problems and vulnerability to chronic illness, which are increased by antenatal depression, anxiety and stress. The UK has the world’s worst record for breastfeeding. Some 50% of three-year-olds experience family breakdown. Some 15,700 under-twos live in families classed as homeless.By addressing some of those social determinants of health inequality, beginning even before birth, we could help exponentially, in terms of not just the physical but the mental health of so many of our young people, and that help would last their whole life long. We need to support our youngest, so that we can increase their life chances and reduce the health inequalities that get in the way of their achieving their full potential.Points on the compass of scientific advancement are increasingly showing us the direction of travel in terms of the social determinants of health, and they significantly point towards the experiences of bump, birth and beyond. The top policy recommendation in Marmot’s “Fair Society, Healthy Lives” report, which was referred to by the hon. Member for Glasgow East (Natalie McGarry), and which was published as long ago as February 2010, was to give every child the best start in life. The “1001 Critical Days” manifesto, which is the UK’s only children’s manifesto with the support of eight political parties, was launched three years ago in response to that report.A child’s development is mainly influenced initially by their primary care giver—usually their mother but often their father—and by others who are engaged with helping with their parenting. Parenting begins before birth. We have known for a long time that how we turn out depends on our genes and on our environment. Scientists now realise that the influence of the environment begins in the womb, and how the mother feels during her pregnancy can change that environment and have a lasting effect on the development of the child. So we all need to support and look after pregnant women, for their sake and that of future generations.A stable and secure home learning environment is critical in the early months. Children, right from their infancy, need to be protected, nourished, and stimulated to think and explore and to communicate and interact with their parents and others. Babies are primed to be in relationships, and their earliest relationships really matter for the “ABC, 123” building blocks that lead to school-readiness. A young child’s earliest relationships develop their social brain, which will influence their later life. Eighty per cent. of our brain significantly develops in the earliest years and through our earliest relationships. I am focusing on that because it shows that healthy relationships really matter for our health and well-being throughout life.
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I know we are trying to make this a non-partisan debate, but does the hon. Lady recognise that all the things she is talking about require resources? Some of our most needy communities have seen a loss of those resources in recent times, and we need to do something to redress that.
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I thank the hon. Gentleman for that intervention.We need to focus on the fact that learning about and enjoying healthy relationships is a key determinant of future health, both physical and mental. Between 1.3 million and 2.5 million years of lives are lost as a result of health inequality in England. Many children never reach their potential throughout their life partly because of a lack of healthy relationships in their early years. Relationship breakdown is a significant driver of poverty and health inequality. A comprehensive cross-departmental strategy to combat health inequality must include measures to strengthen healthy relationships and combat relationship breakdown, which is at epidemic levels in our country.I am chair of a mental health charity for children in my constituency called Visyon, which is overwhelmed by requests on behalf of children as young as four. When I asked its CEO how many of the problems of the children it helps are the result of poor early relationships in the home, he looked at me and said, “Virtually all of them.” This is an absolutely critical factor in a child’s early development and healthy life, particularly in relation to mental health. Interestingly, a wide-ranging survey by the Marriage Foundation published in May 2016, involving thousands of young people, found a noticeable difference between the self-esteem levels of children who were brought up in stable households and those who were not. Self-esteem acts as a predictor of a range of real-world consequences in later life.When relationships break down, as they do in all socioeconomic groups, it disproportionately affects children in low-income families because they are less resilient in combating the impact. Half of all children in the 20% of communities that are least advantaged now no longer live in a home where they have healthy relationships—where, for example, both parents are still with them by the time they start school. I am not saying that a child cannot have a healthy relationship with one parent or another, but it is important that we grasp this nettle and appreciate that healthy relationships with a range of people—including, ideally, a mother and a father—are good predictors of early health. We should support that, and the Government and Health Ministers should be brave enough to tackle the issue. For too long, Ministers have shied away from looking at healthy relationships, yet we are happy to help and educate young people about how to build healthy bodies for physical health in life.Relationship breakdown is a root cause of poverty. When relationship breakdown happens, households often suffer dramatic income reductions. There is also an impact with regard to infant mortality rates, hospital admissions and mothers in poor health.I agree that we need more funding to strengthen relationships, to provide the early support that is needed in many different ways. We need to consider extending children’s centres so that they can become family hubs that provide support for the whole family. The recent report of the all-party parliamentary group on children’s centres, of which I am the chair, made that recommendation. We need to look at the availability of couple relationship advice, not just parenting advice. Sex and relationship education lessons in schools need a much stronger focus on relationship education. We need to provide a family services transformation fund, so that local authorities can share best practice. We need to do all of that to ensure that we give children the best start in life, and in particular to tackle the serious challenge of the mental health problems experienced by so many schoolchildren. So many headteachers say that it is a major issue with which they have to grapple.In the final part of my speech, I want to refer to the different but not entirely linked issue of alcohol harm. I say that it is not entirely linked because people who experience or fall into addiction are often looking for a source of comfort in life that is missing from their relationships. I am not saying that it is not right to enjoy drinking, but it needs to be healthy drinking. Alcohol harm is a major issue in our society and I do not believe that the Government are doing enough to address it.The Government must do more to tackle health inequality. For example, in January the chief medical officer published her recommendation that it is wisest for women not to drink during pregnancy. Pregnant women are advised to make that choice, yet there has been wholly inadequate publicity for that recommendation. I speak as the vice-chair of the all-party parliamentary group on foetal alcohol spectrum disorder. We have heard heartrending evidence of the impact of alcohol on children’s lives, including their physical and mental wellbeing. It is particularly important to note that, according to the evidence that we have heard, women’s bodies tolerate alcohol at different levels, which is why the best advice is to not drink at all during pregnancy. I challenge Health Ministers, particularly in the run-up to Christmas, to get that message out so that pregnant women hear it and can make that choice.Alcohol harm impacts on the health not just of the individual, but of those around them. One in five children under the age of one live with a parent who drinks hazardously. Alcohol is implicated in 25% to 33% of child abuse cases, and it generates a substantial bill for UK taxpayers with regard to the impact on emergency services. The all-party parliamentary group on alcohol harm will publish a report on that on 6 December, and I am pleased that my hon. Friend the Member for Totnes (Dr Wollaston) has contributed to it. I hope hon. Members will take note of it, because alcohol abuse has a disproportionate impact not only on emergency services, but on the number of accidents and fires in the home. The report will spell that out. The charity Balance has shown that between 2014 and 2015, the rate of alcohol-related admissions in England from the most deprived decile was more than five times greater than the rate for those from the least deprived decile. That puts pressure on already burdened systems.I want to finish with a point that now arises continually in my work on alcohol harm, namely the impact of cheap alcohol. Let me tell Members a fact that may surprise or even shock them; it shocked me when I first heard it. For the cost of a cinema ticket, it is possible to buy almost 7.5 litres of high-strength white cider, containing as much alcohol as 53 shots of vodka. Many homeless people, and many people who are in a vulnerable state in life, are drinking that product, which has been likened to a death sentence. In the hostels run by the homeless charity Thames Reach, 78% of deaths were attributed to high-strength alcohol. Not for the first time, I urge Ministers, for the sake of the health of the most vulnerable in society, to consider a minimum unit price for all alcoholic drinks. That is a targeted and effective intervention that would save lives and reduce health inequalities considerably. Potentially, according to the Institute of Alcohol Studies, eight out of 10 lives saved as a result would be from the lowest income groups.We need better education to inform young people about the effects of alcohol harm, so that they can make better choices and so impact on their own health. We need improved alcohol treatment services because they are inadequate. More than half of drug addicts receive treatment, but only one sixteenth of alcohol dependants do. We need to invest more in recovery for those who are suffering the effects of alcohol addiction and harm. We need better and more effective alcoholism diagnosis in our hospitals and better rehab programmes. We need to support education better to help people not to fall into such difficulties in the first place.
Sustainable Development Goals
It is a pleasure to follow the excellent speech of the Chair of the International Development Select Committee, the hon. Member for Liverpool, West Derby (Stephen Twigg). He provides great leadership to our team, and I support everything he has said in this debate.
In September 2015, when Britain backed the global goals, the then International Development Secretary applauded them as
“a major landmark in our fight against global poverty”.
If I recall correctly, shortly after that a DFID Minister said in reply to a question I asked in the House that each in-country office would be reviewing their in-country plan in light of the goals. It is extremely concerning to me, as a member of the International Development Committee, to know that as of today—more than a year since the SDGs were fanfared—there is still no clear narrative, as our Chairman described it, on DFID’s approach to the SDGs or the practical actions and practical plan for each goal in each country where UK aid is spent. Can I echo his call for a plan to be produced quickly and for that to include specific reference to the SDGs in each country where UK aid is spent? When can we expect that?
I was extremely disappointed that the recently produced civil society partnership review contained no specific reference to the SDGs—I am echoing our Chairman’s remarks. It was long awaited but disappointingly short. If the Government were serious about the SDGs being a major landmark, as DFID has stated, and
“a historic opportunity to eradicate extreme poverty and ensure no one is left behind”,
the SDGs should be front and centre in such key DFID documents. I hope that that will be the case when we see the multilateral aid review and the bilateral aid review.
DFID made a promise to leave no one behind. That is a key theme of the SDGs, and the UK Government pledged to work together with citizens, civil society and others to eradicate extreme poverty. I was pleased that in DFID’s published promise in November 2015, it made commitments to:
“Listening and responding to the voices of those left furthest behind, such as people with disabilities, children, older people and those who face discrimination on the basis of who they are”.
I am pleased, too, that in that same promise, DFID commits to
“sustainably address the root causes of poverty and exclusion”,
and to challenge
“the social barriers that deny people opportunity and limit their potential, including changing discrimination and exclusion based on gender, age, location, caste, religion, disability or sexual identity.”
I have detailed that promise because I want to look at how DFID can work better with civil society in developing countries, particularly to achieve goal 16, which is a new and very ambitious goal.
Specifically, I want to touch on a theme that I have continually raised in Parliament, almost since I became a member of the Committee. I am optimistic that current Ministers may at last, following their appointment, have ears to hear it. It is the importance of promoting inter-religious dialogue to help prevent the dangerous pathway of extremism within societies, which is a root cause of poverty. I will elaborate on that. If we do not have freedom of expression, thought and belief within societies, there is a dangerous pathway; intolerance can lead to discrimination and ultimately to persecution by state and non-state actors. We now see that across the globe. It may initially start with marginalisation, inequality and a denial of civil liberties such as free speech, but it can lead on to discrimination in terms of access to education, a job or a home. More gravely, that can lead to displacement and violence. The pathway is now a major contributory factor in the considerable increase in refugees across the globe. Indeed, in the past two years alone the number of refugees has risen by 5.8 million, from 59.5 million to 65.3 million. In many areas of the world, intolerance of others’ beliefs has ultimately led to that catastrophe, on which so much UK aid is spent.
Would it not be a good investment and good value for money to consider spending a proportion of UK aid on tackling more profoundly the root cause of civil society instability, which is so often religious intolerance? Expending money in that way would be a wise investment. Prevention is better than cure. In many of the countries that our Select Committee is currently concerned about such as Burma, Bangladesh and Nigeria, religious intolerance is a direct cause of displacement and poverty. It is one of this century’s greatest plagues. It is a global cause of profound poverty and distress, and it cannot be ignored.
I welcome the recognition on pages eight and 11 of the civil society partnership review of the importance of improved working with faith groups, of recognising the unique contribution they can make and of DFID’s commitment to increasing opportunities for engagement with in-country civil society organisations, including DFID country offices working better with faith groups. It is so important because we cannot ignore this phenomenon any longer. There is now a 21st-century phenomenon, which is the rise of hyper-extremism. It is a wrecking ball. It is primarily but not exclusively violent Islamic hyper-extremism, and it is determined to do nothing less than eliminate all other beliefs, including moderate Muslim beliefs, and develop a monoculture. The aim is nothing less than the elimination of diversity—particularly, but not exclusively, religious diversity. Women in particular are often subject to inequality as a result of this hyper-extremism.
Those involved in hyper-extremism target basic rights and freedoms. That is why the aims highlighted in goal 16 are so important. Goal 16 is to:
“Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels”.
This 21st-century hyper-extremist phenomenon is not a distant threat. It resonates here in the west, where violent terrorist atrocities have been perpetrated in many countries—from Sweden to France to Australia—including 17 countries in Africa. If, as our current Secretary of State has said, UK aid should work in our interest as well as in the interests of those in developing countries who wish to help, surely it is an area that we need to focus on more closely.
How can we do that? Well, I welcome the paragraphs in the letter from the Secretary of State that the Committee received just today. It is hot off the press. I think I was given it two minutes before I walked down to this Chamber. I will refer to one or two elements in it. I am pleased that the Secretary of State acknowledges that she is
“concerned about the trend of increasing restrictions on civil society activism, media freedom, social movements and human rights in many countries…As part of the Civil Society Partnership Review I am committed to supporting civil society abroad and to standing alongside civil society against encroachments against freedom of thought, association and expression”,
and that that includes working alongside the Foreign Office. She goes on to say that it works on a “case-by-case basis” and adds:
“We work…with the FCO to raise concerns with governments at the appropriate level.”
That is good, and I welcome it, but DFID needs to be much more proactive. It needs not just to stand alongside civil society or deal with individual cases but to take a lead globally and work proactively to prevent these kinds of horrendous civil disturbances in the countries where we work. Ministers should consider how that could be done.
It is critical that we all work to improve interfaith relationships and promote community cohesion, in this country as much as in any other. I highlighted that as chair of the all-party parliamentary group on religious education in a report we produced a few months ago, entitled “Improving Religious Literacy – A Contribution to the Debate”. That was about understanding others’ beliefs. It is in our interests and the interests of developing countries to promote dialogue between people of different faiths and no faith—dialogue about cultural and religious heritage, experiences and religious practices—to bridge gaps in understanding and to help communities to live together in freedom and peace and accept one another. Without that, in a global world of increasing religious intolerance, it will be all too easy for misunderstandings to develop into hatred and for hatred to result in violent action; for intolerance to develop into discrimination and for discrimination to result in persecution. As we all know, the poorest in the world are the least resilient when affected by such issues.
To give just one suggestion to Ministers, we need to consider training teachers in the developing world to conduct classroom discussions about combating racism and inter-religious tensions. That would help young people deal with differences and ensure that potential conflicts can be diffused. It would teach young people to understand the complexities of such situations, in the same way as we are now teaching how important it is not to shut out women and girls from their potential leadership positions in society but to give them an equal place and equal opportunities. It is critically important that we teach young people not to shut out those with other beliefs and to combat exclusivism in order to help build a more peaceful and just world.
Through its diplomacy, the FCO has already come a long way on this issue in the last few years. I pay tribute to FCO Ministers; they have frequently attended debates that I have spoken in over the last few years in this House on the issue. However, DFID Ministers have been notably absent, and I do hope that will change. Although through diplomacy the FCO already substantially and increasingly promotes freedom of religion and thought throughout the world, DFID must take action not just to follow that lead but to provide its own lead. There is a great need to encourage inter-religious dialogue and promote freedoms—religious and other freedoms—in aid work with civil society in-country, at local government and community level and with non-governmental organisations. If religious freedom goes, so many other freedoms fall as a result, such as freedom of belief, thought and expression, as I have said.
Promoting inter-religious dialogue is just one way in which DFID could make a valuable contribution to tackling this 21st century challenge of hyper-extremism—there may well be others—and I challenge Ministers to consider it. It would go a long way towards attaining goal 16. If DFID is serious about tackling that goal, it must make religious freedom an explicit priority now more than ever.
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