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Health in Scotland 2004
FOREWORD
Dear First Minister
It is my privilege to present my fifth Annual Report,
Health in Scotland 2004. This report touches on
the challenges to health and healthcare in Scotland over
the last year. It cannot be a comprehensive account but
rather supplements and draws from a wealth of data
published over the last year which informs debate on these
important issues in Scotland. This report covers activity
in the whole field of public health, in health improvement
and health protection as well as in health services. It has
no single theme but there are three issues which I believe
are worthy of comment in this short foreword.
The first is that of the effect of poverty and social
exclusion on health. I have commented on this matter on
previous reports and action designed to tackle the social
injustice of health inequality underpins a wide range of
Scottish Executive policy. In this report, I have set out
some of the action that is being taken within the Health
Improvement Challenge. I have also attempted to summarise
briefly the exciting new thinking that is emerging from
public health research in Scotland and elsewhere about the
biological processes underlying the complex relationship
between health and wealth.
It is clear from this work that the effect of
deprivation on health is due not only to poverty of
financial capital but also to poverty of social capital, of
aspiration and of hope. Our growing understanding of the
biological effects of these stresses on individuals is
revealing new mechanisms through which evidence of the
effectiveness or otherwise of social and fiscal
interventions will be more easily and quickly demonstrated
than has hitherto been the case in public health research.
I very much welcome the lead that Scotland is showing in
this important work.
I have drawn attention in previous reports to my concern
about the effects of excess alcohol on the lives and health
of Scots and, in particular, of young Scots women. I cannot
but reiterate that concern. This report contains ample
evidence of the adverse effects of excess alcohol on Scots
as individuals and as a society. There are steeply rising
numbers of deaths attributable to alcohol and a parallel
increase in cases of alcohol-related liver disease. Alcohol
is a major factor also in fires, domestic and street
violence, and road accidents. There are clear associations
with poverty and social exclusion, with the most deprived
being many times more likely to suffer or to die from
alcohol-related problems. Efforts must continue to focus
attention and effort on the problems of excess alcohol
consumption in Scotland.
Many Scots, however, are responding positively to the
choice of healthy living for themselves and their families.
This report also celebrates the efforts that are being made
in Scotland to tackle those issues that stand in the way of
maximising the health of Scots. Nowhere was this more amply
demonstrated in 2004 than in the Scottish Executive's
commitment to tackling the scourge of tobacco. The year
opened with the publication of the first ever comprehensive
tobacco control policy for Scotland and culminated, after a
public consultation to which a massive 52,000 individuals
responded positively, with the introduction of legislation
to create smoke-free enclosed public places. This will save
the lives of individuals and improve the health of
generations to come. I very much welcome this effort and
the consistent support which has been shown by Ministers
and colleagues across the Scottish Executive.
This report is the last in the series in my tenure of
office as Chief Medical Officer for Scotland. As ever,
while it has been my privilege to guide and mould its
production, it results from the contribution of many
colleagues within the Scottish Executive and the NHS in
Scotland. My thanks are due in particular to Miss Sandra
Campbell who has once again so ably edited the content and
to my own office team led by Marion Collins and my
Secretary, Eileen Stuart, who have managed the whole
process.
Yours sincerely
Dr E M Armstrong
Chief Medical Officer
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