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Health in Scotland 2009 Time for Change

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Health in Scotland 2009 Time for Change Annual Report of the Chief MediC al OffiCer health in SCOtland 2009 []time foR ChanGe Annual Report of the Chief Medi C al OffiCer health in SCOtland 2009 []time foR CHANGe © Crown copyright 2010 ISBN: 978-0-7559-9789-3 (web only) This document is also available on the Scottish Government website: www.scotland.gov.uk The Scottish Government St Andrew’s House Edinburgh EH1 3DG APS Group Scotland DPPAS10144 (11/10) v contents 01 17 32 INTroDuCTIoN CHAPTEr 2 CHAPTEr 5 Scotland’s health – time for a change Work and health An outbreak of anthrax infection in drug users in Scotland Role for employers 18 02 the scottish Public sector 19 36 CHAPTEr 1 Impact of the recession 20 Trends in life expectancy Implications for healthcare services 20 CHAPTEr 6 and the continuing widening Welfare benefits 21 Significant trends in the incidence of the of health inequalities communicable diseases of public health An ageing workforce 22 importance in 2009 step changes in health status 05 the next generation 22 Achieving a step change 06 Gastro-intestinal and foodborne infections 36 What is salutogenesis? 06 23 Bloodborne virus and sexually transmitted infections 37 What would a “salutogenic” approach CHAPTEr 3 Healthcare associated infections 37 to health look like? 07 Scotland and problem drug use Vaccine preventable diseases 38 Asset based health improvement in action 09 A person’s journey 24 tuberculosis 39 Healthy Living centres 11 shared care 25 conclusion 40 Achieving a step change in health 15 An evolving healthcare problem 26 41 27 rEfErENCES CHAPTEr 4 Influenza A (H1N1) The Pandemic 2009 health in scotland 2009 contents 01 In last year’s Annual Report, I indicated that, men and 1.1 years for women while men and IntRoDUctIon although life expectancy (Le) has continued to women in the rest of scotland have seen improve in scotland, other western european increases in HLe of 2.9 and 2.3 years Scotland’s health – countries have experienced faster increases in respectively. the pattern of slow improvements the health of their populations. Most of our in health status in poor areas of scotland with time for a change closest european neighbours are reporting the wealthier improving faster, mirrors longer life expectancy at birth for both men and scotland’s international position. countries in women than in scotland. However, wealthier Western europe with higher life expectancies scots continue to experience a faster growth in than ours are often improving at a faster rate. life expectancy than their neighbours in poorer Unless scotland accelerates gains in life areas and in the past year, these trends have expectancy, particularly amongst the poorest continued. since 1999, life expectancy in males communities, it will continue to fall behind living in the poorest 15% of areas in scotland other countries. Many of the policies and has increased by 1.4 years while life projects currently underway have been expectancy for males living in the rest of designed to produce a change in approach and scotland has increased by 2.1 years. the to accelerate improvements. However, we need corresponding figures for females are 1.2 years to do more. At a time of economic uncertainty, for those living in the poorest areas and threats to the health of disadvantaged 1.6 years for the rest of scotland. individuals increase and, if scotland is to continue to progress and to do so at accelerated the widening gap is even more apparent when pace, new approaches to health creation need considering healthy life expectancy - the length to be considered. of time an individual might expect to live in good health. since 1999, residents of the DR Harry Burns poorest 15% of areas have seen a gain in The Chief Medical Officer for Scotland healthy life expectancy (HLe) of 2.1 years for health in scotland 2009 Scotland’s Health – time for change 02 Figure 1 updates the trends identified in last wellbeing with residents of the more affluent cHAPteR 1 year’s report. there is a continued slight areas pulling away inexorably from their narrowing in the gap between men and women poorer neighbours. At present, scotland has the Trends in life in terms of life expectancy but, overall the lowest life expectancy of all Western european trend is disappointingly stable. countries. We sit between the countries of West and east europe (Figure 3). there is, however, expectancy and the Figure 2 is a statistical projection of the rate of evidence that some areas of eastern europe growth in Le in scotland for the next 2 decades. are achieving the kind of step change in health continuing widening It is likely that this average rate of growth will that seems likely to allow them to overtake continue to mask a widening difference in of health inequalities scotland in the coming years. Figure 2: expectation of life at birth, Scotland, 1981-2033 Figure1: life expectancy and healthy life expectancy at birth, 1980 to 2008 85 90 Projected1 85 80 80 75 75 70 Age 70 65 LE/HLE in Years 60 65 55 60 50 1983 1988 1993 1998 2003 2008 2013 2018 2023 2028 2033 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year Year 12008-based projections Males Females Men LE Men HLE Women LE Women HLE health in scotland 2009 chapter 1 – trends in life expectancy and the continuing widening of health inequalities 03 there have been numerous initiatives over highest in Western europe, the male rate women) and breast cancer mortality, the past decades which have had positive has reduced considerably since the mid although still relatively high, have been effects on health in scotland and there have 1970s and is gradually moving closer to the falling and appear to be converging towards been significant reductions in mortality average for Western europe. this the Western european mean. Rates of from many of the most significant causes of encouraging trend is, in large part, a stomach cancer and pancreatic cancer death. the scottish Public Health reflection of the success of scotland’s mortality are close to Western european observatory monitors these trends. In a efforts to reduce smoking rates. Rates of average. report comparing scotland with other colorectal cancer mortality (for men and countries in europe, the scottish Public Health observatory concluded that, over Figure 3: life expectancy at birth, 2007, selected countries, males 90 the last 50 years, mortality from all causes has fallen in scotland in line with trends 80 across the rest of Western europe (scotPHo 70 2009). However, while mortality rates for scottish children are close to the Western 60 european average, mortality among 50 working age scots, both men and women, is the highest in Western europe and has been 40 since the late 1970s (Leon et al 2003). 30 scotland’s poor health is at its most obvious amongst working age men and women. 20 Life expectancy (years) trends in mortality amongst working age 10 adults (15-74 years) varied considerably when different causes of death were 0 Italy considered. For example, scotland now has Spain Malta Latvia France Greece Poland Cyprus Ireland Austria Estonia Finland EU - 27 Sweden Belgium Bulgaria Portugal Slovakia Slovenia Hungary Romania Germany Denmark the highest rates of oesophageal cancer in Lithuania SCOTLAND Netherlands Western europe for both men and women. Luxembourg Czech Republic United Kingdom However, while, lung cancer mortality rates Country for men and women remain among the Source Eurostat and the Office for National Statistics (ONS) health in scotland 2009 chapter 1 – trends in life expectancy and the continuing widening of health inequalities 04 there have been significant reductions in mortality rate for suicide is now twice the mortality from ischemic heart disease and level it was in 1955. one encouraging cerebrovascular disease for both men and observation is the fact that, mortality from women over the last half-century. Despite road accidents in scotland has declined this, mortality rates in scotland from both since the mid-1970s and scottish death causes remain among the highest in rates are now lower than in the majority of Western europe. However, there are signs Western european countries. (scottish that the gap between scottish mortality mortality in a european context 1950–2000 rates and the Western european average is An analysis of comparative mortality narrowing. Again, these encouraging trends trends. http://www.scotpho.org.uk) reflect, in part, the success of smoking there are, therefore, encouraging trends in cessation programmes as well as significant the reducing incidence of premature deaths improvements in treatment offered by the from a number of causes. Many of the nHs. Mortality rates from chronic conditions that are falling in incidence have obstructive pulmonary diseases such as been the subject of considerable effort on chronic bronchitis are among the highest in behalf of successive governments and the Western europe, although mortality for public health community within the nHs males has fallen considerably since the and local government over many years. 1960s. this observation suggests that organised Most worryingly, scottish mortality rates efforts to improve health in scotland have from chronic liver diseases such as those had a significant impact. However, there is caused by excess alcohol consumption have evidence that other regions of europe have risen steeply since the early 1990s among made a more rapid change – a step change – in men and women. Rates of mortality from health status. the rate of improvement in liver disease for scottish men and women these regions, which seem to be similar in are now the highest (or close to the highest) their socio-economic conditions to deprived in Western europe.
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