Public Health in Scotland Association of Directors of Public Health 29 th November 2006
Sir Henry Littlejohn and Sir William Gairdner
Child Health in 19th century Glasgow
Glasgow slums in 1870
Glasgow s West End
Health inequalities in 1861 Servant: Resident IMR/1000 births West end 1 : 2.8 17.8 Central 1 : 67.8 260 John Strang City Chamberlain
Infant mortality trends 1848-1999 Infant mortality per 1000 live birth 200 150 100 50 England & Wales Scotland 0 1840 1860 1880 1900 1920 1940 1960 1980 2000 Source : Birth Counts, 2001
20 th century trends in life expectancy in Scotland and 16 other Western European countries Males 80 Life expectancy in years 70 60 Scotland 50 40 30 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Year of birth
Glasgow slums in 1990
Deprivation in 1981
Deprivation in 1991
Deprivation in 2001
16 14 Excess Standardised Mortality Age & Sex (Scotland v. E&W) Age, Sex & Deprivation Excess Mortality (%) 12 10 8 6 4 2 0 1981 1991 2001
Comparison of lung cancer mortality in West of Scotland and 3 major cohorts 500 West of Scotland 400 Average annual death rate 300 200 /100,000 100 UK doctors American Cancer Society volunteers US veterans 0 0 10 20 30 40 Average number of cigarettes smoked daily
Lung cancer mortality by social class 100 80 manual 60 Rate per 10,000 40 20 non-manual 0 never 1-14 15-24 25+ daily cigarette consumption
Age-standardised mortality per 100,000 Coronary heart disease mortality Men aged 15-74 years 600 500 400 300 200 100 1950 1960 1970 1980 1990 Denmark Finland Norway Sweden Scotland
Changing Needs 1900-1950 Infectious Diseases 1950-2000 Episodic Care 2000-2050 Chronic Care?
Trends in life expectancy - males
Improving Scottish life expectancy
Improving Scottish life expectancy
How to improve health The provision of medical care, the development of healthier personal habits, and the creation of a more just social environment each hold the potential to improve health. J Bunker 1995
How to improve health The gains from increased investment in medical care would begin to be seen at once, the benefits of health promotion only as rapidly as as the public responds [and] the redistribution of wealth and resources for the sole purpose of reducing health inequalities in health would be a long term strategy of uncertain success.
Our vision for the NHS is to reapply its founding principles with vigour to meet the needs of the people of Scotland. Delivering for Health means a fundamental shift in how we work, tackling the causes of ill-health and providing care which is quicker, more personal and closer to home.
Future model of healthcare Current view Evolving model Geared to acute conditions Geared to long-term conditions Hospital centred Embedded in communities Doctor dependent Team based Episodic care Continuous care Disjointed care Integrated care Reactive care Preventative care Patient as passive recipient Patient as partner Self care infrequent Self care facilitated Carers undervalued Carers supported as partners Low tech High tech
Health Improvement and Health Inequalities CHD Mortality (Under 75s) Rate per 100,000 250 200 150 100 50 0 Target 81.7 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2.6 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 Inequality Ratio Most affluent quintile Most deprived quintile - Target trend Most deprived quintile Inequality Ratio
Health Improvement and Health Inequalities CHD Mortality (Under 75s) Rate per 100,000 250 200 150 100 50 0 Target 81.7 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2.6 2.4 2.2 2.0 1.8 1.6 1.4 1.2 1.0 Inequality Ratio Most affluent quintile Most deprived quintile - Target trend Most deprived quintile Inequality Ratio
Reducing health inequalities / Prevention 2010 Targeted resources to reach people in disadvantaged areas Primary care teams to identify people at risk and offer anticipatory care Health checks, screening, health advice or referral to community services or treatment
Cholesterol lowering drugs East Glasgow Best available evidence suggests that uptake of this therapy is likely to be around 20% lower than estimated need. Currently, it is thought that around 8,000 patients in east Glasgow are on this therapy, suggesting that 1500 more should be getting it. If these patients were identified and treated around 120 significant cardiac events would be avoided in the CHP each year
Controlling high blood pressure In east Glasgow, there are 225 admissions for stroke each year from its 60,000 population. If all patients with high blood pressure were identified and treated, and if treatment was 50% successful, 16-76 admissions for stroke would be avoided each year. Around 10 deaths might not occur.
Smoking cessation services In east Glasgow CHP, it is estimated that there are 220 smoking related deaths each year. If everyone living there was offered smoking cessation advice, based on current success rates, 14-48 of these deaths could be avoided each year.
East Glasgow causes of death Number of deaths Current SMR Heart disease 186 146 113 Possible SMR Stroke 77 112 98 All cancer 215 135 122 Lung cancer 72 168 132
Public Health in Scotland Health inequalities the principle focus Epidemiology and rational application of evidence Medical public health remains important Single system for health care in Scotland Public Health Medicine needs to work closely across boundaries