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Health in Scotland 2001
DIET
The Size of the Problem
The Scottish diet is unhealthy, being high in fat, salt and sugar and low in fruit and vegetables. Diet is an important risk factor for cardiovascular disease, some cancers and diabetes.
Diet and Deprivation
The diet of Scots is poor but the diet of people in deprived communities is worst of all. An indication of the quality of the diet can be obtained from looking at consumption of fresh fruit and vegetables. Figure 1.4 shows the percentage of adults who eat fresh fruit once a day or more.
Fig. 1.4 Percentage of adults aged 16-64 years eating fresh fruit once a day or more by deprivation quintile
As deprivation increases, the percentage of adults regularly eating fresh fruit decreases. The figure also shows the changes between 1995 and 1998. Since 1995, the percentage of the population regularly eating fresh fruit has increased indicating that diet overall is improving. However, it has increased more in those from the least deprived areas than in those from the most deprived areas.
A significant gap continues to exist between the dietary status of those from low and high income communities. For these reasons, improving diet continues to be a high priority for the Scottish Executive, with a particular focus on deprived communities and children.
Strategic Direction
The Scottish Diet Action Plan
Eating for Health, published in 1996, provides the framework for improving Scotland's diet and sets out a wide range of action to help achieve Scotland's dietary targets for 2005.
Targets
The dietary targets for 2005, set in the Diet Action Plan, recommend:
doubling the consumption of fruit and vegetables
reducing the consumption of total fat and saturated fat by over 5%
doubling the consumption of oily fish.
Progress is being made but further efforts are required in order to meet these targets.
Implementation
Many initiatives are underway at national and local level, including: the Scottish Community Diet Project, the Scottish Healthy Choices Award Scheme and a pilot Focus on Food project. These and others are described below.
Action on Deprivation: Working with low income communities to improve diet |
The Scottish Community Diet Project specifically works with low income communities to improve diet. This Project was awarded the BBC Derek Cooper Award in 2000 for its contribution towards improving diet across Great Britain. Part of the Project's work involves a small grant scheme, which supports the establishment and development of Community Food Initiatives. During 2001, funding for this grant scheme has been increased in line with the commitment given in "Our National Health" to increase support to the Project to allow it to help at least 50% more projects from 2001-2. |
Healthier Food Choices
The Scottish Healthy Choices Award Scheme aims to change dietary habits in Scotland. Support for the scheme has been extended for the next 3 years, and increased to over 100,000 per annum. This will allow the Scheme to meet increasing demand and develop as a successful mechanism within the wider national efforts to change dietary habits in Scotland. The Health Education Board for Scotland (HEBS) continues to promote the Scottish Healthy Choices Award Scheme, which has been shown to have had a positive effect on the consumption of healthier food choices in a range of settings across Scotland.
Working in Partnership to Improve School Food |
The Ministers for Health, Education and Social Justice have recently announced a joint initiative to improve food in schools. This involves the establishment of an Expert Panel to: devise national nutritional standards improve the appeal of school meals minimise social stigma associated with taking free school meals maximise the uptake of free school meals.
This announcement was made in conjunction with the publication of the Scottish Consumer Council Food in Schools Conference report. The Conference, which took place in May 2001, specifically aimed to identify barriers to providing healthy eating choices in schools and proposed practical action to overcome these. The Conference, which was organised by the Scottish Consumer Council, the Food Standards Agency (FSA), HEBS, and the Scottish Executive Health and Education Departments, took a whole school approach towards healthy eating in schools. The report outlined a range of practical actions that could be taken forward at all levels in order to improve healthy eating within schools. |
Scottish Food and Health Co-ordinator
A welcome development in July 2001 was the appointment of the Scottish Food and Health Co-ordinator. The appointment gives further momentum to implementation of the Diet Action Plan and pulls together the various strands of dietary work being taken forward at national level. Work is focused on developing and co-ordinating the national contribution of:
primary producers
manufacturers
caterers and
major retailers.
Food and Health Vocational Training Course
Work is underway to develop and deliver a "Food and Health" vocational training course in partnership with the Royal Environmental Health Institute of Scotland (REHIS), the Health Education Board for Scotland (HEBS), the Food Standards Agency Scotland (FSAS), the Scottish Community Diet Project (SCDP) and Scottish Healthy Choices Award Scheme (SHCAS). Together they plan to develop and launch an Elementary level qualification in 2002, and then consider the need for Intermediate and Advanced level qualifications.
The aim of the "Food and Health" course is to provide basic food and health training to individuals working directly and indirectly with food in a range of settings, for example, local authority and commercial catering establishments, the voluntary sector, the tourist sector, universities and colleges delivering food-related courses and interested members of the public. On completion of the course participants will:
have a greater understanding of health as a concept
understand the concept of a balanced diet, including the "Eating for Health" plate model
have a working knowledge of the nutrient content of a range of common foods
have discussed the relationship between individual dietary components and overall diets and health, including basic information about food allergies and intolerances
have considered how to change foodstuff/diets/shopping habits/retail practices to make a positive impact on health
have discussed the barriers to healthy eating and how these might be overcome.
Encouraging breastfeeding
An important initiative is encouraging mothers to breastfeed. HEBS has continued its activities to encourage breastfeeding through the production of resources and initiatives to support parents and professionals and a new media campaign to promote a pro-breastfeeding culture in Scotland. In October 2001 HEBS issued a new Children in Action publication on nutrition and the under fives which revised guidance on effective interventions in the area.
Health Promoting Schools Unit
Health Promoting Schools and New Community Schools both play a role in improving diet. Health and Education Departments have been working throughout 2001, in liaison with HEBS, CoSLA and LTScotland, to establish a Health Promoting Schools Unit to support schools implementing the health promoting schools concept. The Unit is to be established in early summer 2002.
Action on Deprivation: Breakfast Service Challenge Fund for vulnerable children |
In November 2001, Ministers announced a joint Social Justice, Education and Health initiative to fund a 250,000 Breakfast Service Challenge Fund to expand services which support vulnerable children. This will build on current local activity to improve breakfast service provision in Scotland's most disadvantaged areas. This initiative aims to reduce inequalities in children's health and ensure vulnerable children get help to make the most of their school day. Breakfast is particularly important for children as links have been demonstrated with increased concentration and learning at school and improved physical well-being. As part of a new strategic approach to give children a healthy start to the day, the new Challenge Fund will be based on the principles of provision of breakfast, play and oral hygiene. The first step will be to undertake a Breakfast Service Review to recommend a future framework for breakfast services and to assist the Scottish Executive in deciding how best to target the challenge fund. The review aims to complete mid 2002. |
Nutrition and Older People
Surveys of older people at home and in long-term care have shown that many are under nourished. This impairs health and well-being and diminishes chances of recovery from supervening illness or injury. The new National Care Standards for Care Homes guarantee that older people will receive varied and nutritious meals, taking account of older people's preferences and special dietary needs.
The nutrition of older people was one of the issues highlighted in the report of the Expert Group on the Healthcare of Older People (EGHOP),
Adding Life to Years, chaired by the CMO, which met throughout 2001. The report endorsed the need for standards to be set and met for nutrition of older people in care settings and emphasised the importance of good nutrition in the physical, mental and oral health of older people.
INCREASING PHYSICAL ACTIVITY
The Size of the Problem
Research over the past 50 years has demonstrated that inactivity leads to increased risk of coronary heart disease, stroke and many other health problems. Lack of physical activity is an independent risk factor for the entire population and one that affects people of a normal weight. As is shown in the Scottish Health Survey 1998 (2000), six out of ten men and seven out of ten women in Scotland put their health at risk by being below the minimum recommended levels of physical activity. Among children, the scale of inactivity is of particular concern with three in ten boys and four in ten girls falling short of the amount of physical activity required for good health. Physical inactivity constitutes one of the most widespread health determinants in Scotland.
Strategic Direction
The Scottish Executive intends to introduce policies to tackle the causes of inactivity and to reverse the current trend of growing inactivity amongst the Scottish population. Following the commitment made in the Scottish Health Plan - "Our National Health" the Physical Activity Task Force was set up in June 2001. It is charged with developing a strategic action plan and programme for change to increase physical activity levels in Scots of all ages. It is due to report with recommendations mid 2002. This report will:
HEBS, recognising that lack of physical activity is one of the most prevalent health risk factors in Scotland, has provided professional leadership to the Physical Activity Taskforce in 2001 reviewing evidence, current practice and helping with the development of a much needed new strategy for Scotland.
Targets
The targets are ambitious:
to increase the number of Scottish children achieving the recommended level of physical activity to 80%
to increase to 50% the number of Scottish adults reaching the recommended 30 minutes of physical activity on most days of the week.
To meet these targets action will aim to:
direct policy within the SE to ensure that it is consistent with an active lifestyle
strengthen and support local policies and structures for physical activity.
Implementation
A number of initiatives are already underway to increase physical activity:
Exercise and Children: Class Moves Initiative |
The "Class Moves" initiative is run in collaboration between HEBS and
SportScotland. It encourages daily physical activity and body awareness among primary school pupils. New materials and training for primary schools were produced during 2001 working in partnership with organisations in Wales and the Netherlands. |
On-line Training for Primary Care |
HEBS has developed an on-line training and information resource for primary care on the links between physical activity and obesity/weight management. The initiative also highlights the fact that the benefits of physical activity extend beyond the prevention and management of obesity. It is also beneficial to those of normal weight, or those slightly overweight. |
Exercise and Older People |
Muscle strength declines with age, but it can be maintained and even regained by regular physical activity. Exercise classes provide social and mental stimulation as well as physical improvement. As part of the HEBS "Health in Later Life Programme" the importance of work on strength and balance in the prevention of falls in older people has been highlighted. This has included designing awareness materials and training for acute primary, secondary care services and featured a healthy ageing supplement in collaboration with the
Daily Record. HEBS has funded a pilot project in Dumfries and Galloway working with local partners to determine the physical activity priorities of local communities. |
Exercise and Mental Health
In 2001, HEBS held a training seminar for health professionals to increase awareness of the growing body of evidence linking physical activity with the prevention and treatment of depression.
OBESITY
Obesity in Adults
Based on the Scottish Health Survey 1998 (2000) it is estimated that over 19% of Scottish men and over 22% of Scottish women (aged 16-74) are obese (derived as a Body Mass Index over 30). Other European surveys suggest that the rates of obesity in Scottish women are among the highest in comparable European countries (OECD Health Data 2001).
Obesity in Children
The increasing levels of obesity in Scottish children and the subsequent health implications for later life are of concern. Studies show that although children consume fewer calories than, for example, 40 years ago, levels of obesity continue to increase. Based on the Scottish Health Survey, nearly 8% of boys and 7% of girls are now classed as obese.
Child Health Surveillance System as a tool for obesity surveillance |
"Assessment of the national Child Health Surveillance System as a tool for obesity surveillance at national and health board level" (December 2001) - report of mini project for Chief Scientist Office (CSO) (September 2000 - August 2001) by J Armstrong and J J Reilly in collaboration with the Child Health Information Team, Information and Statistics Division, Common Services Agency. This study found that the prevalence of obesity (8.6%) in children aged 3-4 years in Scotland in 1998/99 was higher than the UK 1990 reference standard of 5%. This is consistent with previous reports that suggest an increase in the trend of childhood obesity. The study also explored the prevalence of obesity in school-aged children and found that, in three NHS board areas in Scotland (Lanarkshire, Borders and West Lothian), it increased from 9% in primary 1 children to 15.1% in secondary school children and was higher at each age than the UK 1990 reference standard of 5%. There was a marked increase between children in primary 3 and children in primary 7. |
Obesity is a risk factor for
heart disease
high blood pressure
arthritis
diabetes.
In recent years there has been an increase in the number of younger people developing type 2 diabetes as a consequence of rising rates of obesity in young people which is discussed further in the section on diabetes.
Strategic Direction
It is well recognised that eating a healthy, balanced diet and keeping physically active help people maintain appropriate body weight. Together, physical activity and healthy eating can contribute towards reducing obesity, whilst contributing towards improved psychological well-being and self-esteem.
The Scottish Executive funded national and local initiatives to increase physical activity and improve diet such as those described in the sections above, will work together to combat obesity and towards improving the health of the Scottish population.
Implementation
On a local level, various initiatives are being taken forward to tackle obesity in response to local needs and priorities.
Pilot Study on Childhood Obesity |
Yorkhill NHS Trust has been involved in a 6 month pilot research study on childhood obesity to identify whether a multi-disciplinary approach succeeds in managing obesity. If successful in helping children choose a healthier lifestyle and fitness level then it would become available as a first line of treatment for those obese children living in the Glasgow area. Together, local and national action to improve diet and increase physical activity will contribute to ensuring that children and adults in Scotland maintain a healthy body weight, and reverse a worrying trend which impacts on both the length and quality of our lives. |
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