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Health in Scotland 2001

CHAPTER 1: HEALTH DETERMINANTS

INTRODUCTION: WORKING IN PARTNERSHIP TO IMPROVE THE HEALTH OF SCOTLAND

Working Together for a Healthy, Caring Scotland has been the theme of many of the documents published by the Health Department over the past year and is the key message of this Report. The ways in which we are working together in Scotland to deliver better health are woven throughout the Report, highlighted and emphasised in each chapter.

Scotland's health is crucially important. However, it lags behind other Western European countries and many areas of the rest of the UK. Scotland has the potential to be a much healthier nation. It has been held back by deprivation and inequality on a substantial scale as was highlighted in last year's report, Health in Scotland 2000. Improvements in health have been achieved but have yet to be shared equally by all members of society. Scotland is keeping track with health improvements in the rest of the UK and Western Europe, but to date remains persistently behind. Scotland has not yet achieved the additional health gains necessary to close the gap and catch up with comparable European countries. This requires widespread appreciation of the importance of health to Scotland's social, cultural and economic well-being, and the expertise, capacity and determination across society to make a difference.

Why Scotland Needs a Step Change in Health

In the autumn of 2001, the Public Health Institute of Scotland (PHIS) produced a report entitled Chasing the Scottish Effect - why Scotland needs a step change in health if it is to catch up with the rest of the UK and Europe. The analysis shows that in Scotland life expectancy, although improving, lags behind comparable Nordic countries like Norway, Sweden and Denmark. Figures 1.1a-d males and 1.2a-d females show life expectancy for males and females by year between 1988 and 1998 for Scotland and selected EU countries. It can be seen that:

• Scotland's life expectancy (with the exception of Portuguese males) is consistently lower than all the other listed EU countries.

• Each country's life expectancy appears to be on a generally upward trend, with Scotland's improving at neither the worst nor the best rate. This latter observation is confirmed in Figures 1.3a and b which show the percentage increase in predicted life expectancies for each country for males and females.

It is clear that if Scotland is to catch up with comparable countries in Europe, our life expectancy needs to improve at a faster rate.

Fig. 1.1a Males: Scotland, Belgium, Denmark, Germany, Greece, Spain

Fig. 1.1b Males: Scotland, France, Ireland, Italy, Luxembourg, Netherlands

Fig. 1.1c Males: Scotland, Austria, Portugal, Finland, Sweden

Fig. 1.1d Males: Scotland, Iceland, United Kingdom, Norway, Switzerland

Fig. 1.2a Females: Scotland, Belgium, Denmark, Germany, Greece, Spain

Fig. 1.2b Females: Scotland, France, Ireland, Italy, Luxembourg, Netherlands

Fig. 1.2c Females: Scotland, Austria, Portugal, Finland, Sweden

Fig. 1.2d Females: Scotland, Iceland, United Kingdom, Norway, Switzerland

Fig. 1.3a Estimated trends in life expectancy: percentage increase between 1988 and 1998 in predicted life expectancy for selected countries (males)

Fig. 1.3b Estimated trends in life expectancy: percentage increase between 1988 and 1998 in predicted life expectancy for selected countries (females)

In partnership with others, much of the Public Health Institute of Scotland's (PHIS) work will concentrate on how this "step change" in health can be achieved. The "step change" concept was also central to the Healthy Scotland Convention in November 2001, where participants collectively identified the actions needed to bring Scotland's health in line with comparable nations.

The Contribution of NHSScotland

NHSScotland is crucial to success in achieving the necessary step change in health, but cannot alone improve the health of the Scottish people. Healthcare services aim to improve the health of people who are ill and the NHS makes a major contribution to Scotland's health. For example, there have been important improvements in 5 year survival for a range of cancers. As outlined in Health in Scotland 2000, important health targets for the year 2000 for coronary heart disease and cancer have been met and challenging new targets have been set in the NHS plans for the next few years. But to prevent ill health NHSScotland must embrace a wider role by leading strategic thinking and working in partnership with other agencies across the Executive to deliver services which people need, in accessible forms and which will deliver tangible health gains. That is the challenge.

The Wider Health Challenge: Social and Personal Well-being

The Executive's role in improving health involves all aspects of its work in partnership with Scottish public and private life. It is bound up in the Executive's social justice agenda and the ways in which resources are distributed.

This wider health challenge requires a shared vision, shared strategies and a sense of shared achievement at individual and community level and action to deliver the step change needed to bring Scotland's health in line with comparable Western European nations.

Cross Sectoral Working

In this Report there are many examples of health problems and of the cross-sectoral work in progress to address them, which demonstrate imagination, commitment and partnership in action to deliver health gain. Local authorities, employers and their employees, communities and individuals are initiating sustained and co-ordinated action to improve health. This is as it should be. Enduring partnerships and commitment are needed to deliver long-term health gains in order to secure the step change in Scotland's health which Scotland's future deserves.

Health Determinants - Maximising Scotland's Health Potential

Many factors determine health potential. Some of these are specific to individuals, such as genetic background, early life experiences and lifestyles. Some relate to socio-economic circumstances including income, occupation and housing quality and others relate to the general environment. However, the factors that determine health are not evenly distributed within Scottish society. Inequalities in the health of people in Scotland are evident and the poorest members of society are those who experience the worst health.

Improving Health and Tackling Health Inequalities

The Executive is committed to improving health and to tackling health inequalities. The Executive's policy reflects the multiple influences on health and involves a threefold approach:

• influencing lifestyles to promote healthy behaviour and minimise lifestyles that cause ill health

• focusing on priority health topics - including action on coronary heart disease, cancer and mental health especially in the younger and older age groups

• improving life circumstances to influence the wider determinants of health.

The rest of this chapter focuses on Improving Lifestyles. Priority Health Topics are considered in Chapter 2 and Improving Life Circumstances is considered in Chapter 3.

Our National Health - a plan for action, a plan for change recognises that good health means more than the absence of disease. Work is underway to promote healthy lifestyles including action on:

• diet

• physical activity

• obesity

• smoking

• alcohol problems

• drugs.

There is a close relationship between people's behaviour and their socio-economic circumstances. Many unhealthy lifestyles are commoner in those who are more economically deprived or socially excluded. While improving lifestyles is important to all Scots, particular effort must be made to encourage healthy lifestyles amongst poorer members of society. Diet and smoking are two important lifestyle factors where inequalities relating to deprivation are particularly evident.

Cause of Death

Deaths from cancer, coronary heart disease (CHD) and stroke (Scotland's Big 3 killing diseases) account for around 60% of all deaths in Scotland every year. Smoking and poor diet are the most significant contributors to Scotland's poor health.

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