The Scottish Government

« Previous | Contents | Next »

Listen

Health in Scotland 2002

CHAPTER 5

HEALTH PROTECTION

Communicable Diseases

Zoonosis

The World Health Organization (WHO) defines a zoonosis as an infection or infectious disease transmissible from vertebrate animals to man. Zoonotic diseases thus include a number of gastro-intestinal foodborne infections, such as salmonellosis, campylobacteriosis, cryptosporidiosis and E. coli O157 infection, as well as conditions such as rabies and Creutzfeldt-Jakob Disease, spread by other mechanisms. Transmission of an avian influenza virus to man is recognised as a possible trigger to a future influenza pandemic.

In recent years there has been increased awareness of the threat to human health posed by new or emerging diseases transmissible from animals to man, including the possible applications of these infections to bioterrorism. Systems are in place to ensure adequate surveillance to detect such problems at the earliest stage and to maximise medical and veterinary liaison at local and national level.

Rabies

Rabies is a viral infection which affects the nervous system. It is endemic in a variety of animals in many parts of the world and can be transmitted to man by a bite or scratch from an infected animal. Immunisation before, or immediately after, infection provides protection but the established disease is universally fatal in humans. In Europe, rabies has been associated with foxes as a reservoir of infection but animal immunisation programmes have significantly reduced this risk. The UK has remained rabies-free through ensuring that animals entering the country undergo quarantine or, more recently, are subject to the pet passport scheme.

Occasionally, cases of rabies are diagnosed in the UK as a result of infection acquired abroad but between 1902 and 2002 no patient died of rabies acquired in the UK. In November 2002 a 55-year-old voluntary bat warden died of rabies in Dundee, having been bitten by a bat approximately six months earlier. The infecting organism was a type of European bat lyssavirus, which is closely related to the 'classical' rabies virus. Although it is recognised that bats in a number of northern European countries carry this virus, ongoing surveillance of bats in the UK over the past fifteen years has identified only two infected bats, both in England, one in 1996 and one in September 2002. This tragic incident has implications for increased surveillance of infection in bats and for guidance regarding prophylactic immunisation of at-risk groups.

Escherichia coli 0157

Since the mid-1990s, between 200 and 250 people in Scotland each year have had laboratory confirmed infection with Escherichia coli serotype 0157 ( E. coli O157). Numbers affected rose during two large outbreaks, in Lothian in 1994 and in central Scotland between late 1996 and early 1997 (Figure 5.1), but have otherwise remained fairly constant. Scotland continues to have higher rates of E. coli O157 infection than other parts of the UK or Europe.

Whilst outbreaks of E. coli O157 infection have affected substantial numbers of people, the majority of cases in Scotland are nonetheless sporadic (Figure 5.2) and the source of infection for these individual cases is more difficult to identify. A study published by SCIEH in 2001 found that the highest risk of infection for sporadic cases was from contact with farm or other non-domestic animals and their environment.

The number of reported E. coli O157 infections in Scotland fell from 235 in 2001 to 229 in 2002, a drop of 3%. However, the number of general outbreaks of E. coli O157 (involving more than one household) rose from 10 in 2001 to 16 in 2002.

Haemolytic Uraemic Syndrome (HUS) is a serious complication of infection with E. coli O157, with kidney failure reported in up to 10% of patients developing HUS. E. coli O157 is generally considered the most important preventable cause of HUS in the UK. In 2002, in response to the report of the Task Force on E. coli O157, the SE agreed funding for enhanced surveillance of all cases of HUS, co-ordinated by SCIEH, starting from January 2003. This new project, called ENSHURE, will identify health outcomes for patients with HUS and further investigate links between their illness and E. coli O157.

Salmonellosis

Laboratory reports of human cases of salmonellosis have continued to decrease over the past five years to the lowest recorded in 25 years. In 2002 there were 1,164 laboratory reports, a decrease of 25% from 2001, the largest decrease seen in recent years.

Norovirus

A pathogen of increasing significance is norovirus, previously termed Norwalk-like virus or small round structured virus. During 2002 a total of 1,476 laboratory isolates of norovirus were reported to SCIEH, an increase of 324% compared with the previous year. An increase was also observed in the number of outbreaks of norovirus infection (confirmed or suspected), which rose by 298% from 45 in 2001 to 179 in 2002, accounting for 66% of all general outbreaks of infectious intestinal disease reported to SCIEH during 2002.

Outbreaks of norovirus infection occurred predominately in healthcare associated settings with 43% reported from residential institutions and 42% from hospitals. Other reported locations included schools, hotels, coach tours and an armed services camp. A further 35 outbreaks of viral gastroenteritis and 29 of unknown aetiology were reported to SCIEH during 2002, some of which may also have been due to norovirus.

Cryptosporidium

Contamination of the public drinking water supply resulted in an outbreak of human cryptosporidiosis in Aberdeen early in 2002. Two further incidents of cryptosporidial contamination of public water supplies occurred in August, one in Glasgow and one in Edinburgh, with no associated cases reported. An outbreak of cryptosporidiosis associated with a swimming pool in Perth also occurred in August.

Cryptosporidium is an intracellular protozoan parasite, distributed widely in the animal world.
The first human cases were recorded in 1976. The true extent of cryptosporidial infection became clearer following the increased number of cases identified amongst AIDS patients who are much more susceptible to severe cryptosporidiosis.

Infection in humans is associated with a low infectious dose (possibly as low as 1 to 10 oocysts), and an incubation period of 7-10 days (range 5-28 days). Gastro-intestinal symptoms predominate with diarrhoea (generally non-bloody) lasting 2-26 days, sometimes considerably longer. Low grade fever, weakness, fatigue, loss of appetite, nausea and vomiting may also occur. Symptoms are generally acute and self-limiting, although complications, including cholecystitis, hepatitis and reactive arthritis, are known.

The incidence of cryptosporidiosis in Scotland varies between 600 and 800 human cases per year. Children constitute the majority of confirmed symptomatic cases, with a decreasing age specific incidence as age increases. There is a peak in late spring and early summer, associated with an increase in the environmental load of the organism due to faecal shedding from young calves and lambs. Transmission of cryptosporidium occurs via person-to-person contact, animal to human contact and by waterborne spread.

Cryptosporidial oocysts are resistant to chlorination and, despite the best efforts of the water supply industry, waterborne cryptosporidium remains a potential hazard and a potential cause of human outbreaks. As a consequence of the incidents in Glasgow and Edinburgh and the level of public and media interest generated, the First Minister set up an Ad-Hoc Group of Ministers on Health and Public Water Supply. The Group's report - which was published in September - contained a series of recommendations, which are being progessively implemented, on improving handling of such situations.

Cryptosporidium continues to exercise Scottish Water in terms of controlling the risk of contamination and eliminating, as far as is practicable, associated waterborne outbreaks. Assessing and dealing with contamination incidents poses a considerable challenge not only to Scottish Water but also to NHS Boards and Local Authorities to mount an effective and timely response and to take appropriate decisions regarding the potential risks to public health. The need to rely on the principles of risk assessment, risk management and risk communication has been underlined by these recent experiences.

Confirmation from the UK Expert Group on Cryptosporidium in Water Supplies, that there is no single health-based standard which can be used to determine whether or not there is a risk of human infection from waterborne cryptosporidium, means that there will be continuing reliance on the professional judgment of those involved in managing any future incidents. Continued vigilance, awareness and training to deal with any future incidents will remain a priority for all concerned.

Tuberculosis (TB)

While the statutory notification of infectious disease (collated by ISD) has provided important information on trends in tuberculosis over many years, the Enhanced Surveillance of Mycobacterial Infections scheme (ESMI) implemented in Scotland from January 2000 enables analysis of detailed continuous information. This will facilitate a number of approaches to TB control through population or risk-group targeting and clinical audit.

The ESMI scheme has demonstrated that the epidemiology of TB in Scotland remains different from in the rest of the UK: the minority of cases (around 22%) in Scotland are persons born outside the UK compared with 60% in England and Wales. The interpretation of trends in reporting of TB cases is confusing but 2002 demonstrated a relatively static number of new cases compared with previous years.

Risk factors for TB are recorded in 22% of cases, with alcohol abuse the leading issue by a wide margin (52 of 89 cases with recorded risk factors, 12% of cases overall). This link was reinforced in 2002 by three outbreaks of TB associated with public houses or social clubs and a number of cases in hostels for homeless men. The number of cases in asylum seekers and immigrants is small but this will remain a challenge for Public Health as individuals enter the UK from areas of higher risk. Encouragingly, cases reported in healthcare workers have fallen to 2% (from 5% in 2001).

Meningococcal infection

Invasive infection due to Neisseria meningitidis is one of the commonest causes of bacterial meningitis throughout the world and still accounts for significant mortality (around 6% in Scotland) as well as long term morbidity in survivors. Of the most commonly circulating meningococcal serogroups in Western Europe, infections with group C organisms are generally associated with more severe disease and higher mortality. A rising incidence of group C infections in the late 1990s in Scotland, the UK and the rest of Europe, coincided with the availability of a new conjugate vaccine (Men C) against serogroup C meningococcal disease. In conjunction with the UK Departments of Health, the Scottish Executive launched a Men C immunisation campaign in 1999, offering protection against group C infection to everyone aged under 18 years of age followed by its incorporation into the routine infant immunisation programme.

More than two years after the introduction of the Men C vaccine programme, evidence from meningococcal disease surveillance data (collated by SCIEH and the Scottish Meningococcal & Pneumococcal Reference Laboratory (SMPRL)) suggests that the intervention has been highly successful leading to sharp reductions in group C disease that have not been restricted to target age groups (Figure 5.3). The overall burden of meningococcal disease has also continued to decline in 2002 as has the previously high mortality rates in the over 20s in whom group C disease is particularly associated with poorer outcomes. The continued extension of the availability of Men C to the 20 to 24 year age group should help maintain these trends as more of the population receive protection against group C disease. (Figure 5.4)

Hepatitis B Virus (HBV) Infection

In late 2002, the UK Joint Committee for Vaccination and Immunisation established a sub-group to review the effectiveness of existing vaccination policy (based on targeting higher risk groups), to prevent hepatitis B virus transmission, and to consider the case for introducing a universal approach, as has been adopted in most other European countries, albeit ones with higher HBV prevalences.

While the overall numbers of HBV diagnoses in Scotland remain steady at 354 each year, the number for whom injecting drug use was indicated as a risk factor has declined to 37, from 115 in 1999. This encouraging trend has coincided with the Scottish Prison Service's initiative to offer vaccination to all its inmates. Data indicate that this initiative has already raised the vaccine uptake rate among this population from a steady state of 20% to around 50%.

The decrease in infection among Injecting Drug Users (IDUs) has, however, been offset by an increase in the diagnosis of infection (mainly chronic) in other populations. It is possible that, as in England, increasing numbers of imported infections are responsible and further investigations are being undertaken.

Hepatitis C Virus (HCV) Infection

The 917 persons in Scotland who were diagnosed with hepatitis C virus infection during the first half of 2002 brought the cumulative total to 14,452. This figure, however, represents only approximately one-third of the estimated number of infected persons in Scotland. Despite needle and syringe exchange, methadone maintenance and other schemes during the 1990s having reduced the incidence of HCV infection among IDUs, its principal target group, evidence indicates that the rate of transmission remains unacceptably high in this population.

A survey of IDUs in Glasgow who commenced injecting after 1995, the era of well-established harm reduction interventions, revealed an annual incidence of 28%. The first HCV incidence study undertaken in the prison environment showed high rates of HCV transmission among inmates who had a history of injecting drugs during their sentence in one of Scotland's long stay prisons. The prevention of infection in this setting poses a major challenge.

Most former IDUs are unaware of their HCV status, so the SEHD, HEBS and SCIEH are developing a two-tiered HCV awareness campaign, aimed at Scotland's population as a whole and at high risk groups, particularly current and former IDUs. An information pack for health professionals was issued in 2002.

In July 2002 the SEHD, in conjunction with the Royal College of Physicians of Edinburgh, held a successful conference on HCV. One of the major recommendations arising was that Managed Clinical Networks should be set up for HCV, this is being taken forward in conjunction with the Scottish Virology Group.

In 2002, new guidance for healthcare workers infected with HCV was introduced: workers known to have HCV viraemia (i.e. HCV RNA positive) are now excluded from undertaking exposure-prone procedures and may only return to such work if they have evidence of sustained viral clearance.

Human Immunodeficiency Virus (HIV) Infection

In 2002, 250 new HIV infections were reported to SCIEH. Since 1987, the annual numbers have ranged between 134 and 182: during this time, a declining trend in HIV diagnosis among IDUs was offset by an increase in heterosexual men and women who had acquired HIV abroad. In 2002, cases among IDUs declined to 10, while the number of heterosexual cases increased to 125. The great majority of heterosexual diagnoses were in African nationals who had acquired HIV in their countries of origin. These observations were most pronounced in the Greater Glasgow NHS Board area.

While there is some evidence to suggest that certain subtypes of HIV usually acquired in Africa and Asia are being transmitted among persons in Scotland who have had no exposure abroad, HIV is still relatively uncommon among Scotland's general heterosexual population. Unlinked anonymous HIV testing of specimens from genito-urinary medicine clinic attendees throughout Scotland during 2001/2002 confirm the disparity in prevalence between UK nationals (0.1%) and those from African countries (9%).

There was a rise in the number of new HIV diagnoses among men who have sex with men (MSM), 85 in 2002, of whom 15 were presumed to have acquired their HIV outside the UK. It is not yet known whether this rise reflects an increase in the incidence of HIV in this group in Scotland, a rise in HIV testing or an increase in the amount of HIV imported into Scotland.
HEBS and SCIEH will launch a major HIV prevention campaign aimed at Scottish travellers in 2003.

Data generated through the unlinked anonymous testing of specimens from MSM attending genito-urinary medicine clinics indicated a decline in the transmission of HIV among this group during the three years up to 2001. It would be unsurprising if the data for 2002, available for analysis by mid-2003, revealed a change in this trend.

Acquired Immune Deficiency Syndrome (AIDS), indicative of severe HIV disease, occurs if there is either treatment failure or treatment absence, usually as a result of late diagnosis. The number of AIDS registrations made to SCIEH rose from 46 in 2001 to 73 in 2002. As a consequence of the introduction of Highly Active Antiretroviral Therapy (HAART) in 1996, the annual number declined to 39 by 2000. The considerable increase in AIDS cases in 2002 was due to the large numbers of persons, many from abroad, being diagnosed with HIV and an AIDS defining illness simultaneously. It is encouraging, however, that in 2002, there was no appreciable increase in the number of reported deaths in HIV infected persons.

In 2002, the SEHD issued guidance that an offer and recommendation of an HIV test should be made to all pregnant women throughout Scotland. NSD, HEBS and NHS Boards are working towards implementation of this policy, which is likely to confer considerable public health benefits, by April 2003.

Sexually Transmitted Infections (STIs)

The infections which best gauge changes in sexual risk behaviour are generally those which cause acute symptomatic disease such as gonorrhoea and syphilis. In contrast, acute chlamydia and HIV infections are usually asymptomatic and their detection is influenced greatly by testing practice. In 2002, there was a large increase in both infectious syphilis and rectal gonorrhoea among men who have sex with men (MSM). In response to these developments, departments of genito-urinary medicine and public health have alerted MSM populations and relevant healthcare professionals.

There has been relatively little change between 2001 and 2002 in the number of syphilis, gonorrhoea and chlamydia diagnoses in heterosexual men and women. Eight cases of syphilis in heterosexuals in 2002 compares with 7 in 2001, and between 5 and 20 each year since 1990. While the Scottish incidence of gonorrhoea in females was static in the last two years, there were some regional changes - increases in Lothian and in Argyll and Clyde, and decreases in Lanarkshire and Highland NHS Board areas.

After major annual increases in chlamydia diagnoses since 1997, including a 41% rise between 2000 and 2001, there was a smaller increase of 12% from 10,121 cases in 2001 to 11,372 in 2002. Opportunistic screening, especially among females under 25, contributed to 45% of cases being diagnosed in this category. Of particular concern is the increase in diagnoses in females under 16 (from 98 in 2001 to 141 in 2002). Increases greater than 50% in chlamydia diagnoses were observed in Ayrshire and Arran and in Argyll and Clyde.

IIn response to the need to reduce sexually transmitted infections, to enhance the provision of sexual health services and to promote broad understanding of social health and sexual relationships that encompasses emotions, attitudes and social context, a multi-interest Reference Group, led by PHIS, has been established by the Scottish Executive to guide the development of a National Sexual Health Strategy for Scotland.

Healthcare Associated Infection (HAI)

HAI is defined as an infection originating in a medical facility i.e. occurring in a patient in whom the infection was neither present nor incubating at the time of admission. It includes infections acquired in hospital but not apparent until after discharge, those contracted in healthcare facilities by staff and those acquired while receiving healthcare outside hospital.

The SEHD considers HAI to be a priority patient safety issue. The prevention and control of HAI is important for NHSScotland for the safety and wellbeing of patients and the efficiency and effectiveness of the service.

In 2002, a major initiative to control HAI in NHSScotland was launched. A guidance circular HDL(2002)82 details the actions to be undertaken by Trusts and other bodies to implement a wide ranging set of measures. These arise from the Ministerial Action Plan for Preventing HAI, which incorporated materials from a national HAI Convention held in June 2002, and the recommendations of the Watt Report on the Outbreak of Salmonella Infection at the Victoria Infirmary in Glasgow. Priority areas are the development of a Code of Practice for local management of hygiene, mandatory training and induction courses in hygiene and infection control for staff, and the setting of technical requirements for cleaning processes and frequencies. A Task Force has been set up to co-ordinate implementation, to monitor progress, to monitor levels of HAI and to report on progress to the Minister for Health and Community Care. In 2002, CSBS undertook a review of all Trusts' adherence to CSBS Infection Control Standards. Their report was published in January 2003.

The national surveillance of HAI required by HDL 2001(57) is being undertaken in all Trusts in Scotland and is co-ordinated by the Scottish Centre for Infection and Environmental Health (SCIEH). A National Healthcare Associated Infection Surveillance Steering Group has met quarterly since December 2001 and is monitoring progress. Since April 2001, quarterly reports on rates of methicillin resistant Staphylococcus aureus (MRSA) bacteraemia in Scotland have been published. These allow Trusts to examine their own rates of diagnosed MRSA bacteraemia in the context of all the Scottish rates, and to take steps to contain the spread of MRSA. The MRSA bacteraemia rates in individual Trusts ranged between 0.0 and 0.41 per 1000 patient bed-days for the period October 2001 to September 2002. Individual Trusts' rates for 2001 and 2002 will be compared in the report to be published in April 2003.

Surveillance of surgical site infection (SSI) following two operative procedures, one of which is an orthopaedic procedure, was implemented in all acute Trusts in Scotland during 2002. Data are accumulating and the first set of figures on SSI rates relating to the procedures will be published in April 2003.

Other surveillance of HAIs being piloted include SSI following neurosurgical procedures, respiratory syncytial virus infection and bacteraemias in two paediatric hospitals, HAI in intensive care units and outbreaks of HAI.

Antimicrobial Resistance (AMR)

Resistance to antimicrobial agents such as antibiotics is an increasing and serious problem worldwide. Resistant organisms transmitted within healthcare settings pose a particular problem.

The SEHD published the Antimicrobial Resistance Strategy and Scottish Action Plan in June 2002. The Plan covers three main areas: surveillance (of resistant organisms and of antimicrobial use), prudent prescribing and infection control. The scope includes clinical, veterinary and agricultural issues and lays out a large set of actions intended to develop further the extensive work already in progress.

A subgroup of the Advisory Group on Infection has made detailed recommendations for surveillance of AMR. Further guidance HDL(2002)89 established the Scottish Microbiology Forum, which will agree suitable methods for generating comparable data on AMR from Scottish laboratories. The ability to transfer information on AMR to SCIEH is to be piloted in two to four laboratories as part of the future development of the Electronic Communication of Surveillance in Scotland (ECOSS) system. Among a number of other proposals the report recommends the collection of data on antibiotic prescribing and resistance in intensive care units, and work towards an AMR data set that includes isolates from human and veterinary sources.

Decontamination of Medical Instruments

Decontamination is the combination of processes, including cleaning, disinfection and sterilisation, used to render a reusable item safe for both staff and patients. Effective decontamination of reusable medical devices is fundamental to public health. It aims to reduce or eliminate the risk of infection with bacterial and viral pathogens (e.g. MRSA, HIV, hepatitis viruses).

In recent years, there has been additional focus on the need to address risks associated with transmissible spongiform encephalopathy (TSE) agents such as variant Creutzfeldt-Jakob Disease (vCJD). There is well-recognised evidence of transmission of TSEs through tissue transplantation (notably corneal and dura mater transplants), use of natural human growth hormone and via contaminated surgical instruments used in neurosurgery. The finding of the vCJD agent in human lymphoid tissue (tonsil and appendix) suggests that the risk of transmission via surgical instruments is not necessarily confined to surgery on the eye and nervous system.

The provision of effective decontamination services is a key element in the SEHD's strategy for managing the risk of HAI and was the subject of the Glennie Report published in August 2001 (HDL(2001)66). This report contained interim and full technical requirements for decontamination of instruments and set deadlines for compliance. Much progress has been made and SCIEH is currently undertaking a review programme to assess decontamination provision and verify compliance with the interim technical requirements in acute Trusts (including dental schools and hospitals) and independent hospitals. The technical requirements apply equally to Primary Care Trusts and progress is being made to extend the assessment programme to decontamination practice in that setting. SCIEH is also collaborating with Glasgow University Dental Hospital and School in a research project to review decontamination standards in general dental practice.

Action is being taken to ensure effective decontamination of endoscopes, to assist Trusts in procurement of washer disinfectors and surgical instruments and to develop a decontamination training package.

Bioterrorism

The loss of some 200 lives in the bombing of the Sari Club and Paddy's Bar in Bali on 12 October 2002 was a tragic reminder of the continuing threat of terrorism internationally. In addition to violent acts of this nature, concern during the year has also focused on the threats posed by the possibility of deliberate release of hazardous biological, chemical and radioactive substances.

Effective countermeasures demand close co-operation among UK Government Departments and these efforts are co-ordinated by the Home Office. The Scottish Executive has continued to work closely with the other UK governments to ensure that the people of Scotland are appropriately protected against these various threats.

The year began with continuing fears that the anthrax releases that had occurred in the US might be repeated in the UK. A number of other chemical and biological threats have also been reported during the year. Although none has been realised, there is no room for complacency and activities aimed at further increasing the resilience of Scotland to any such attack have remained at a high level.

SCIEH and the Scottish Poisons Information Bureau have continued to work closely with equivalent bodies in the rest of the UK in providing guidance on responding to incidents involving deliberate release. Related training of NHSScotland staff has also been provided. It is recognised that exposure to some pathogens would only become apparent on appearance of the signs and symptoms of related illness. Therefore, SCIEH has also initiated Clinical and Expanded Laboratory Surveillance of Illness of Unexplained or Unusual Severity (CELSIUS) to facilitate the early detection and reporting of severe illness, caused by deliberate release of chemical, biological or radioactive agents or by new, re-emerging or unusual infections.

During 2002, NHSScotland took possession of an enhanced allocation of drugs and equipment, mainly in response to the terrorist threat. This includes stocks of various chemical antidotes and antibiotics, which have been distributed strategically across the country. The Scottish Ambulance Service has acquired new mobile equipment to allow people exposed, either deliberately or accidentally, to chemical, biological or radioactive substances to be decontaminated at the site of exposure. Casualties can then to be treated in the normal way, with no continuing risk to themselves or others. Stocks of protective clothing and respiratory protective equipment have been acquired to allow personnel to work safely in hazardous areas or when dealing with contaminated casualties.

Guidance on the use of this decontamination equipment and personal protective equipment has been produced and a major related training programme for NHSScotland and Scottish Ambulance Service staff is ongoing.

As part of the Government's ongoing preparations against potential terrorist threats, interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication Era were published in December 2002. As indicated in the Guidelines, a Scottish Smallpox Response Group is being established. On a voluntary basis, members of the group will be protected in advance against smallpox by vaccination, to allow them to react quickly and work safely with patients with actual or suspected smallpox.

Against this background, it is important to bear in mind that the principal aim of emergency planning in Scotland is to mitigate the threat of accidental incidents. In this respect the existing arrangements for emergency response in Scotland are well developed and have been tested extensively. There is reason for confidence, therefore, that these same systems, along with the enhanced provisions described here, provide a sound basis for a robust response to any future terrorist activities in Scotland.

Environmental Health

In times past, pollution of air, water and land by industry undoubtedly had a significant adverse effect on Scotland's environment and the health of its people. However, the loss of traditional industries, together with various changes in industrial practice and the introduction of new pollution control legislation, has changed the picture considerably. Despite these improvements, public concerns about links between environmental pollutants and disease persist. Over the past year, these concerns have included particular focus on the potential for disease due to spread of organic waste to land, farm trials of genetically modified crops and heavy metal poisoning.

The SEHD remains committed to ensuring firm control of any such risks of disease but, in the face of falling levels of pollution generally, the emphasis is inevitably shifting. In February 2002, the First Minister stated explicitly that 'a healthy environment contributes to our wellbeing'. An Environmental Justice Action Programme is under development, to include consideration of action needed to promote health improvement and to tackle the social inequalities in health which are of particular concern in Scotland.

The past year has also seen progress on the SE's 'Quality of Life Initiative', with the first allocation of funding being made available to local authorities for two priority themes of Children & Young People and Our Local Environment. Substantial additional funding over the next three years will allow further initiatives aimed at improving the local environment and the quality of people's daily lives.

In recognition of the importance of the link between the environment and human health, the Scottish Environment Protection Agency (SEPA) has appointed a new Policy Adviser on Human Health. The aims are to ensure proper consideration of human health in SEPA's environmental activities and policies and to promote linkages between their own activities and those of agencies with specific responsibility for human health, including NHS Boards and Local Authorities.

May 2002 saw the first meeting of the PHIS 'Healthy Environments Network' which is founded on a recognition that the link between environment and health is crucial to building a healthy, prosperous Scotland and will work to promote the integrated approach necessary to understand and manage this link.

SCIEH has developed a number of disease surveillance systems including an Environmental Health Surveillance System for Scotland (EHS3). The purpose of this system is to collect, collate, analyse and interpret environmental and health data throughout Scotland. The early success of this system has allowed SCIEH to secure substantial additional funding in 2002 from the SE to promote its further development. SCIEH's new Scottish Environmental Incident Surveillance System (SEISS) will conduct surveillance of environmental incidents in Scotland, involving risk to human health.

These are just some of a growing number of initiatives that recognise the complexity and importance of the relationship between environment and health. The development of this new integrated approach, with a firm basis in legislation, will make an important contribution to the improvement in the health of the people of Scotland, with particular effect on the least healthy social groups.

Health Protection in Scotland

Previous sections make clear that health protection means protecting everyone, young and old, from hazards which can damage health, whether from disease or from biological, chemical, radiation and physical processes.

Health Protection In Scotland - a consultation paper, published in November 2002, described the scope of health protection in Scotland and the current organisational arrangements. It posed a number of related questions and invited views on the relative merits of six options for structural change. Responses from health professionals and relevant professional bodies will help shape the institutional, organisational and procedural arrangements needed to optimise health protection in Scotland, with a particular focus on:

• Defining the scope of health protection

• Identifying major issues for health protection in Scotland

• Scoping the organisational and legislative arrangements required for the delivery of health protection in Scotland

• Determining whether, and to what extent, it would be beneficial for Scottish arrangements to link into the Health Protection Agency in England proposed in Getting Ahead of the Curve - A Strategy for combating infectious diseases (2002).

Health protection arrangements in Scotland are being reviewed in the light of

• A background of increasing concern about environmental and infectious threats

• A need to put in place arrangements capable of addressing, monitoring and responding to a widening variety of environmental and infectious hazards

• A critical need for a clear agenda for the development of health protection services, consistent with current and future demands and challenges

• A recognition of public anxieties over such issues, the importance of assuring the general public that systems and procedures are adequate to respond effectively to actual and potential threats, including biological terrorism

• The requirement to ensure that health protection, as part of health improvement, contributes to better health in Scotland.

« Previous | Contents | Next »