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I hope the Minister will have noted that we are talking about more than 45 million people with total blindness and a further 269 million with poor vision. A fact that we often seem to forget is that if one breadwinner in a family loses their sight, it is likely on average to affect the development of at least four or five members of that family. Therefore, we are talking about a much wider problem. Those of us who have travelled in many parts of the world, particularly in undeveloped countries, are aware that unless we take drastic action and develop proactive programmes, the number of blind people worldwide will increase substantially. It is estimated that we can add a further 30 million to the present number of 45 million by 2020. We also know that there is a direct link-I am again grateful to the noble Lord, Lord Crisp, and a number of other noble Lords who have spoken about it-between blindness and poverty. This disadvantage often results in families who are unable to afford the often simple treatments that could retain their sight.

Earlier today, the noble Lord, Lord Patel, mentioned the link between premature birth and cerebral palsy. Yesterday, when I spoke to him in the corridor about this debate, he said that a similar link could be established with blindness on the same principle, which is interesting. At this stage, some of the research may ultimately lead to a solution, but we now need to put initiatives in place so that the projected increase in the number of blind people does not happen. The Government's record in tackling poverty is not bad, but that does not mean that it could not be better. We must remember that poor people will suffer most during the economic depression. Millions of people could build a sustainable life if their sight was restored.

I welcome the initiatives taken by Vision 2020. At the national level, a strong partnership between ministries of health, NGOs, professional organisations and civil society groups, all of which have been brought together by Vision 2020, should facilitate the development and implementation of effective and sustainable national eye care plans worldwide. I hope that the Minister will be able to comment on the role in place for developing and assisting in the strategy that has been developed by Vision 2020. It should not be difficult. Examples have been cited in this Chamber. Pharmaceutical firms and medical providers now operate at the global level.

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If one of the millennium goals is to eliminate poverty, which is often supplemented by blindness, this is an example of how effective co-operation and co-ordination of effort can assist. A very interesting example was cited by the noble Lord, Lord Bilimoria, about the partnership that could provide this initiative.

The overall objectives of Vision 2020 are entirely commendable; namely, to increase awareness within the key audiences of the causes of avoidable blindness and to look for the solutions. The other aim is to secure the necessary resources to increase prevention and treatment activities. I ask the Minister if he could throw some light on the type of resources that we are making available to tackle this problem.

There can be no excuse. Blindness prevention strategies are among the most cost-effective in healthcare. There are blind people around the world who should not be blind because their condition is treatable. In so many cases, had there been a comprehensive eye care system available, they would have got that treatment and would not be blind. It is imperative that the good work of Vision 2020 is built on and developed further. Support from the Government must be wholehearted and the continuation and furthering of partnerships between the private and public sectors must be actively encouraged. In this way, a future envisaged by Vision 2020 will be realised; that is, a world in which no one is needlessly blind.

6.33 pm

Lord McColl of Dulwich: My Lords, I thank the noble Lord, Lord Crisp, for initiating this debate. He rightly emphasised that addressing gender inequality needs to be a key component of future efforts to develop the eye-care industry because this involves childhood access as well. We need to remember that although the number of blind children is far smaller than the number of blind adults, the number of blind years is almost the same. Assigning priority to blindness conditions should be considered, therefore, in terms of blind years rather than just the absolute number of blind people.

The noble Lord, Lord Crisp, asked me to describe the cataract work that we do on a mercy ship in West Africa. This is a hospital ship with six operating theatres, two of which are devoted to eye surgery. We can treat 40 cataracts a day because there are no EU restrictions on the number of hours we work.

The joy of being able to see again after years of blindness is really quite indescribable. I shall never forget my first cataract operation. When the bandages were taken off the man the following day, he shrieked with joy, threw his hands in the air and for the next five minutes praised the Lord-I mean the real Lord, not me. We have witnessed some amazing scenes. Twin boys aged two who had been blind from birth and had never walked were carried onto the ship. It is unusual to see twins in West Africa because they usually die in childbirth. Their eyes were sunken, expressionless and wandering around. The cataracts were removed and on the following day when the bandages were removed, these two little chaps began looking around in total amazement. They had never seen anything before, so they saw each other for the first time and then their mother. It was an emotional scene. They began to

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walk within an hour. I must tell noble Lords the whole story. The next day, being boys, they started fighting each other, so they were perfectly normal in all respects.

One problem is that in the western world cataracts are removed through a 3 millimetre incision using very expensive ultrasound equipment. Most developing countries cannot afford this kind of machinery, so we do without it and teach the locals a technique that uses a 6 millimetre incision which is almost as good, and in many ways is better because African cataracts tend to be much harder. There is a need to ensure that western countries include this alternative technique in their training programmes so that doctors can visit Africa and teach the local staff how to do it. Perhaps the Minister could encourage this.

6.37 pm

Lord Brett: I begin by adding my congratulations to the noble Lord, Lord Crisp, on securing this debate and bringing the important issue of blindness, whether avoidable or unavoidable, to our attention. I know that over many years he has made a great contribution to health, including more recently in developing countries. I also thank all the other contributors to the debate who have brought to it their experience, interest and knowledge. The noble Lord, Lord Crisp, effectively set out three challenges which I hope to answer as I go through the narrative of my speech and respond to questions. On the fourth challenge, his reward is an immediate "Yes" to the question of meeting Ministers. That is a given and can be arranged.

I can certainly confirm the statistics used by the noble Lord and others that, globally, some 340 million people are visually impaired and 45 million are blind. As has been said, the vast majority-almost 90 per cent-live in poor countries with weak health systems and little or no immediate access to health services which could prevent or treat blindness. It was also pointed out that cataracts, which can be removed using a relatively simple surgical procedure, continue to be one of the main causes of blindness. However, they are avoidable if healthcare is available at a reasonably simple level, and I am grateful to the noble Lord, Lord McColl, for his expertise in describing the treatment. The noble Earl, Lord Sandwich, also raised the issue.

Trachoma is the second most common disease. It is linked to extreme poverty and poor sanitation, but even the simple acts of face and hand washing are not easy if there is no access to water. Glaucoma cannot be detected early enough where there are no systems for eye checks. Childhood blindness often arises from poor diet, inadequate sanitation and through diseases like measles, for which a vaccine exists. Onchocerciasis, which henceforth I shall call river blindness-although I got the pronunciation right once, I may not do it a second time-is a parasitic infection that infects the poorest of the poor. They are the people who find it most difficult to access the necessary drug treatment.

There is no need for me to dwell on the huge suffering that blindness brings to individuals because it has been graphically described by other noble Lords. The $64,000 question, or perhaps the rather more expensive question to ask, is what are we doing about it. The important thing has been said already: there

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are many health challenges across the world, and when it comes to avoidable blindness, it does not have to be this way.

In the vast majority of cases, tried, tested, simple and cost-effective interventions already exist for blindness and other visual impairments. They are preventable and treatable-as indeed they are in developed countries. Let me put that statement into context. We are therefore talking about poor countries-countries where Governments have to contend with manifold health priorities, if not crises, including HIV, TB, malaria, complications in pregnancy and childbirth and other neglected tropical diseases; where there are few doctors and ancillary services; where the system for delivering health care is often dysfunctional; where resources are limited; and where, sadly, health is often not the top priority on the Government's agenda. Here, I am at one with the noble Lord, Lord Bilimoria, in believing that access to health is a public and human right. Therefore, it seems to me that a Government, whether rich or poor, should put that high on their list of priorities.

The question is: what has the UK done and what are we doing to contribute to the elimination of avoidable blindness and to support those who are unavoidably blind? The causes of visual impairment are numerous, so we must address them as part of a global effort on multiple fronts. The noble Lord, Lord, Lord St John of Bletso, raised the important issue of river blindness in Africa. DfID is a long-standing supporter of the African programme of onchocerciasis control. That is a global partnership led by the World Bank and the WHO. In 2008, the programme treated 120,000 communities affected by the disease. The UK also supports research into that and other tropical diseases. The clinical trial of the drug moxidectin, which could dramatically speed up the elimination of river blindness across Africa, was launched last year.

We are addressing vitamin A deficiency and measles vaccinations through core funding to UNICEF-by £21 million in 2008. We support the GAVI Alliance-by £30 million in 2006-08. Through our bilateral programmes in Sudan, 6.5 million children received vitamin A supplements through one such programme and, in 2008, thanks to the work of DfID, more than 3 million children have been vaccinated against measles.

There are clear linkages between malnutrition and the level of blindness, especially among children, so we are now stepping up our efforts against malnutrition with the new nutrition strategy. However, those interventions are not sustainable unless countries have underlying strong and lasting healthcare systems-another point made by the noble Lord, Lord Jay. Those systems must be able to deliver. As noble Lords, including the noble Lord, Lord Crisp, said, that means having a trained workforce, the infrastructure and systems for drugs delivery and healthcare, including eye care, where they are needed. That is why last year the Secretary of State for DfID committed £6 billion until 2015 to improve health systems and services. That is why the UK has led the development of the international health partnership to support developing country Governments who want to improve the health of their people according to their priorities.

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In addition to raising additional funding for health systems, we set up the high-level task force chaired by the Prime Minister and the president of the World Bank, Robert Zoellick. The task force reported this year and helped to secure $3.2 billion funding for improved health services across the developing world. However, developing country Governments must lead the way by investing more of their own money in healthcare systems and meeting the Abuja target of 50 per cent of government spending towards healthcare.

I echo the point made by the noble Lord, Lord Crisp, that this is a partnership that is both public and private, national and international, and the task that we have can be achieved only if we work together. The noble Lord, Lord Crisp, made three points. One concerned making sure that primary care included eye healthcare. We agree that it is important that eye care is integrated into primary healthcare. DfID funds health sector plans of developing countries, with a focus on primary healthcare and the diseases of poverty. We also agree that it is important to improve the number and quality of healthcare workers, and healthcare workers at community and health centres will be trained across a range of priority issues, including eye health.

The third point related to the desire for disability to have greater prominence in DfID. DfID recognises that disabled children are excluded in many instances from access to education and that disabled adults are excluded from other services. This is clearly damaging not only to the individual but to families and the local economy. That is why disability is clearly on the DfID agenda.

The noble Lord, Lord Low of Dalston, talked about dismantling copyright barriers, which, as he rightly says, is being discussed in Whitehall. I would welcome any more information that he has on that so that I can take the matter further and discover precisely where matters are and how we can assist. He also asked about DfID's support for education. DfID has provided £8.5 billion over a 10-year period-from 2005 to 2015-for education. That includes funding to support disabled children, a large number of whom are blind.

The noble Lord, Lord Patel, made a number of important points, including one about diabetic retinopathy. Important though they were, however, they relate to the United Kingdom and its health service, so I am happy to pass them on to my colleagues in the Department of Health. DfID has an interest in their impact in the developing world, but I am glad to say that other ministerial colleagues have the responsibility for them here in the UK.

The noble Earl, Lord Sandwich, talked about avoidable blindness. We support action to prevent blindness by funding international organisations and partnerships and by giving countries bilateral support for research. This support will have a direct and indirect impact on avoidable blindness. We also support the strengthening of healthcare systems. The kind of money that I am talking about is £6 billion to improve healthcare systems between 2008 and 2015; £13.14 million to the World Health Organisation for 2009-10; and £30 million, which I have already mentioned, to the Global Alliance for Vaccines and Immunisation. I also mentioned the

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African programme to eliminate river blindness. This is dealt with through the World Bank, which manages donor-pooled funds-currently £500,000 per year-and we as a country have supported it continuously since 1974. UNICEF has £21 million of core funding to provide food and other humanitarian aid.

I see from the clock that I have spoken for 10 minutes. I shall have to speed up, which will be of great sadness to the Hansard writers. I am already too fast for most people to understand, which is not always accidental.

India was mentioned. We are supporting the health sector in four states with a total population of 260 million. We are giving West Bengal £100 million from 2004 to 2010, Andhra Pradesh £40 million from 2007 to 2010, Orissa £50 million from 2007 to 2012, and Madhya Pradesh £60 million from 2007 to 2012. That includes support for work on tropical diseases, blindness, and child health and nutrition, the focus of which is on poor and excluded groups, including the disabled and the blind.

I will have to respond in writing to a number of points that noble Lords have raised or I will fall foul of the Deputy Speaker, which I would hate to do. The noble Lord, Lord Jay, made the important point that we need a political context and cross-border collaboration between government departments. I agree. In recent months, we have seen closer co-operation between DfID, the MoD and the FCO on health issues, including a cross-departmental Whitehall group that always includes the Department of Health.

Finally, the noble Lord, Lord Dholakia, pointed out that the recession will clearly have a damaging impact on the world's poor. We agree, which is why we have made a commitment to continue to support health. Eye care is central to this. We do that best by supporting the kind of programmes that we are supporting and by remaining on track to achieve the UN target of giving 0.7 per cent of our national income by 2013.

I will write to noble Lords on any points that I have missed. I will also ensure that my ministerial colleagues in the Department for International Development have a copy of this debate, so that they can see noble Lords' awareness of this issue and their desire to raise it. This has been a matter of importance to your Lordships, and the quality of the debate has been excellent.

BBC: Humanism

Question for Short Debate

Tabled By Lord Harrison

6.51 pm

Lord Harrison: My Lords, sometimes "Auntie" is hard to love. Recently, the BBC, the venerated home of public service broadcasting, gifted the British National Party a public platform while we humanists are still denied even a walk-on part on "Thought for the Day".

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Tonight I argue that the BBC has failed the humanist community in Britain both in the spirit and in the letter of the Communications Act 2003, which requires the BBC to schedule programmes on religion and other beliefs, including humanism, as was made clear in the debate by the then Minister, the noble Lord, Lord McIntosh.

The Human Rights Act and other equality and anti-discrimination law similarly accord humanism the status of a belief, but humanism is ignored by the BBC. We humanists are atheists who do not have a Bible or a Koran, or indeed a Moses bringing tablets down from the mount, to fix our beliefs. We make do with our human nature and our life experiences to establish our moral values. We believe in a naturalistic explanation of life provided by patient scientific inquiry and careful reason. We share a respect for human rights, celebrate individual responsibility and social co-operation, and promote mutual respect. We create, if we can, our own meaning to our one-off lives. The humanist tradition established by the Greco-Roman thinkers predates monotheistic religions although it has, of course, influenced Christians' own version of humanism. We arrive at our beliefs independently by reason and experience, not by dogma or indoctrination.

Humanism in the UK is significant and substantial in number but still single and silent in expression. None of us marches under a humanist banner in anger, arms or hatred. Nevertheless, we are subject to verbal excoriation; witness the gratuitous attacks on the courageous Professor Dawkins by those who should know better. We have been quiet, perhaps for too long. Now that established religion loses heart, congregations and credibility, it searches for a scapegoat and chooses us. I believe that our voice should now be heard in the public square, and especially in the BBC. We do not want just to take part in others' scheduled religious programmes, although our voice is seldom heard in, for instance, the otherwise excellently chaired "Sunday" programme. When we are called, we perform the obedient role of token members of God's loyal opposition, but we have a distinctive voice. We want programmes made for us-humanists talking humanism to other humanists on a variety of issues that interest us. These might include how we conduct non-religious funerals or how to educate free from the straitjacket of rigid religion. I would love to debate with humanist colleagues our common admiration for church music, or why we appreciate listening to Bach or Handel in the architectural settings of England's finest churches. The BBC can and should provide a platform for these searching debates. It should encourage a new set of cultural and intellectual programmes tailored to humanists. Similarly, combined debates of humanists and religionists could examine issues of common interest such as the environment, poverty reduction, your Lordships' House or what new uses our wonderful churches could be put to in a modern, secular age. We have common humanist concerns that can unite us across the religious divide in the face of crass commercialism.

Unfortunately, the BBC treats humanism as the absence of religious belief, ignores its noble and ancient history and underestimates the strength of the humanist community in Britain. According to the Social Trends 2006 survey, 46 per cent of us are non-religious. However,

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we remain a community disregarded. The BBC quaintly argues that the vast majority of its output is secular; but have you ever watched a humanist "Match of the Day" or an atheist "Strictly Come Dancing"? The truth is that religious public broadcasting is growing while Anglicanism contracts. Mark Thompson confesses that the liturgical or contemplative religious content occupies some three hours each week on Radio 4. Basically, it is Christians talking Christianity to other Christians-and the output is doubled at Easter and Christmas. However, not a single minute is allowed to humanists.

Other forms of Christianity are given public space alongside the established Church of England-but not us. This is at a time when the Church of England is dwindling as our constituency grows. We still have no town crier to speak up for us in the public square. Why not? In a pluralising Britain, many non-Christian religions are rightly and readily invited to the public debate. Why not humanists? Even the 5.45 am slot "Prayer for the Day", once the brief intonation of a short prayer, has elongated into a mini "Thought for the Day". It is a form of mission-or should I say missionary?-creep.

My concluding thought for the day is that the title "Thought for the Day" does not guarantee an exclusive religious viewpoint-but that is what it is, and it is discriminatory. By excluding us, the BBC implies that humanists are bereft of a moral compass; or worse, that we are amoral or immoral. It implies that we have no way of commenting sensibly on contemporary events. The BBC's excuses are strange and strained, as well as offending the spirit of the BBC charter. It says that "Thought for the Day" is an oasis of religion in a stream of unremitting news. In the BBC's taxonomy, items on sport, politics or culture are bizarrely classified as humanist.

Does the BBC really believe that only the religious can be spiritual? I respond to sunsets, Shakespeare and song, but I do not find God filtering my emotions. The Reverend Giles Fraser, a contributor to TFTD, said it would be madness to let secularists in-this from a man who recently hosted a rerun of the famous Putney debate in the 17th century when his church rang to the rafters with unorthodox views. The BBC fears that humanists will stridently attack religion, but all we want to do is tell a listening and willing audience what humanism is about and what it has to offer. We leave internecine religious squabbling to those who are best at it-witness the unseemly exchange on last week's "Sunday" programme provoked by the Pope's recently proffered pastoral chalice to unhappy Anglicans.

I conclude by saying to my colleagues that I understand that the BBC is about to make a decision on this, and I hope that it will be influenced by tonight's debate. We do not want to oust religious believers from the church pew or the park bench, but we do ask them to budge up a bit and let us be heard in the public square. Finally, I invoke the Church Times which supported our cause in 1994, and I ask our colleagues from the church who will speak later in the debate that, when they wake up tomorrow morning, they might remember the words promoted by the Church Times that:

"Believers have no monopoly on illuminations on dark mornings".

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7 pm

Baroness Massey of Darwen: I am delighted that my noble friend Lord Harrison has given us an opportunity to debate this very important topic and I look forward to the contributions from all sides-by which I mean faith sides. I shall be speaking up for respect for diversity. I declare an interest as a happy humanist and should say how impressed I am by the British Humanist Association's spirited stance in support of those who profess no religion but who certainly have moral codes. I wish that the BBC would recognise the strength of the arguments and the need to recognise the varying forms of individual and collective morality.

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