The Scottish Government

« Previous | Contents | Next »

Listen

Coronary Heart Disease and Stroke in Scotland

2 Prevention

Strategy Recommendation

NHS Boards should, through their local MCNs, develop CHD and stroke prevention strategies. The strategies should adopt a "population approach" which should be complemented by "high risk groups approach" that includes the most socially disadvantaged groups within the local population.

2.1 Managed Clinical Networks (MCNs) are in the process of developing CHD and stroke prevention strategies in tandem with their local plans for primary/secondary prevention and health improvement. To assist them in this process, the Heart Health National Learning Network has published a guide to the prevention of CHD and stroke that demonstrates how local primary prevention strategies could link into local health planning structures.

2.2 A Quality Assurance template that takes account of primary and secondary prevention has been developed for stroke, and MCNs across Scotland are undergoing the process of accreditation. A similar template is under development for CHD by NHS Quality Improvement Scotland (NHS QIS). This will be piloted from February 2005 prior to a rolling programme of MCN accreditation later in the year.

The National Picture

2.3 Prevention is not just a matter for local NHS Boards and there is much good work to report at a national level. To a great extent, CHD, stroke and diabetes have common risk factors. Scotland's response to CHD and stroke prevention has been considerable and sustained, combining action at local, regional and national levels, with three special focus programmes that include physical activity, smoking cessation and healthy eating. The benefits of these initiatives will influence and improve the main chronic conditions affecting people in Scotland.

2.4 The National Heart Forum has estimated the amount of CHD attributable to five key modifiable risk factors. Although each risk factor is independently important, the risk of developing CHD is strongly related to a combination of risk factors and it appears that the effect is synergistic.

Estimated proportion of CHD attributable to five risk factors
(totals add up to more than 100% as people have more than one risk factor)

2.5 The action set out in the Strategy on risk factor reduction cannot be carried out in isolation. The Scottish Executive has published a number of relevant documents over the last decade. These documents, to a greater or lesser extent, aim to shift some of the emphasis away from treating illness and focus it on preventing the condition in the first place. They all seek opportunities to influence health related behaviour in four key settings: the early years; teenage transition; the workplace; and the community. To support the delivery of this programme, the Scottish Executive established a new fund in 2002 to invest an additional 100m over an initial 4 year period in health improvement.

The Health Improvement Challenge

2.6 The action on risk factor reduction within the Scottish population is set out in the white paper: "Improving Health in Scotland: The Challenge" (2003). This set out three special focus programmes: smoking; physical activity; and healthy eating.

Smoking

2.7 Smoking is the biggest preventable cause of ill-health and premature death in Scotland. It is a main contributor to CHD and stroke as well as a range of other diseases. It is estimated that nearly one in four people in Scotland smokes. A national "smoking atlas" is being prepared. The atlas compares and contrasts smoking prevalence across different regions in Scotland and is based on the 2001 census and 1995/1998 Scottish Health Surveys.

2.8 In January 2004, the Scottish Executive published an action plan on tobacco control. This plan, "A Breath of Fresh Air for Scotland", set out proposals for reducing tobacco related ill-health. The Executive recently undertook a wide ranging consultation process on smoking in public places and has now signalled its intention to ban smoking in enclosed public areas.

Physical Activity

2.9 Physical inactivity is a major independent risk factor for CHD. Physical activity also has a positive effect upon other risk factors for CHD including reducing blood pressure in people with hypertension, improving blood lipid profiles and improving insulin sensitivity. Inactive people have double the risk of dying from CHD compared with those who are less active. The Scottish Health Survey 1998, published in 2000, found that approximately 60% of men and 70% of women put their health at risk by being below the minimum recommended levels of physical activity.

2.10 The Scottish Executive launched the National Physical Activity Strategy in 2003. This stresses the health benefits of moderate physical activity and provides a broad framework for developing this through active schools, homes, workplaces and communities. It identified strategic objectives to develop and maintain environments to support inactive people to become active; provide education and training to a wide range of people so that they can promote physical activity in their area; and raise public awareness of the benefits of physical activity. To develop and strengthen the implementation of the National Physical Activity Strategy the Scottish Executive will set up a Scottish Physical Activity and Health Council. In partnership with SUSTRANS Scotland (a sustainable transport charity), the Executive will launch an active travel programme, aiming to make activities such as walking and cycling a part of everyday life.

Healthy Eating and Diet

2.11 Poor diet - particularly eating too much fat, salt and sugar and not enough fruit, vegetables and complex carbohydrates - is a major factor in the premature development of cardiovascular disease.

2.12 In July 2004, the Scottish Executive published "Eating for Health - Meeting the Challenge", which sets out a Food and Health Action Plan for 2004-05. The Executive aims to develop a stronger dialogue with the Food Industry focused on reducing fat, portion sizes and levels of salt in processed food. The Executive has also set up a Healthy Living Food and Health Alliance, which will monitor and evaluate the effectiveness of food and health policies. This will include reporting on progress towards meeting the dietary targets set out in the 1996 Scottish Diet Action Plan.

The Scottish Primary Care Collaborative

2.13 The Scottish Primary Care Collaborative is a programme run by the Scottish Executive's Centre for Change and Innovation which mirrors an approach that has already delivered results in England. The Collaborative has had considerable success in improving care for patients with diabetes. The Centre for Change and Innovation is considering using the same collaborative methodology in implementing several of the NHS Quality Improvement Scotland recommendations for the care of people who have had AMI. Phase 2 of the programme will bring together primary care professionals for a period of two years to reduce CHD mortality by 10% year on year within the 200 participating practices. Working with the MCNs, the programme will ensure that patients receive the best possible care and the most favourable long term outcomes.

2.14 The programme will look at the validation of registers, active call and recall systems and the use of secondary prevention measures.

2.15 Over the two years, participating practices will work with a designated project manager to implement the standards and provide feedback on a monthly basis. The practices and the local MCN representative will attend a series of three workshops in the first year, where ideas and improvements can be shared with other colleagues.

« Previous | Contents | Next »