« Previous | Contents | Next »
Listen
Foreword
Dear First Minister
I would like to present to you my Annual Report, Health in Scotland for 2006.
Any time that Scotland's health is discussed the phrase "sick man of Europe" seems to creep into the discussion. In fact, Scotland's health is not the poorest in Europe. It is improving rapidly and, on the basis of my experience of work being done to improve health in other European countries, I can say that many of the Scottish health improvement programmes are seen by our neighbours as being at the leading edge in terms of design and implementation of such programmes. Although the health of all sections of the community in Scotland is improving we cannot disguise the fact that it is not improving fast enough for the poorest sections of our society. Those who have least access to income, employment and good housing experience much higher levels of ill health. They have a less positive experience of life and less physical and psychological resilience when it comes to meeting challenges. I have no doubt that health inequalities, however defined, remain our major challenge.
Scotland has actively tackled tobacco smoking which is probably the single most important preventable cause of inequality in life expectancy. Our European neighbours have found much to admire in the way smoking has been tackled by Scotland and in the way the Scottish population has responded. There is no doubt that the past year has been of considerable importance for public health.
In this year's Report, I have focussed on the significance of the first few years of life as a basis for subsequent health and well being in adulthood. Work emerging from a number of different countries shows very clearly that the circumstances in which a child is brought into the world and in which he or she lives in the first few years of life can have a major impact on future physical and mental health. Adversity in pregnancy and in the years leading up to school age needs to be tackled if we are to have a positive impact on health inequalities. The educational and social consequences of adverse life circumstances means that children grow into adults who are more likely to be excluded from society and suffer poor health. They are also more likely to cause problems for their own families and the communities in which they live. The number of children in Scotland estimated to be living in adverse circumstances is alarming. A number of initiatives identified in the Report have shown that investment and support of expectant mothers, their infants and young children, can make a real difference to their future health and life prospects. I believe we can identify those at greatest risk and we should develop an effective support programme to ensure that we have every opportunity to maximise their potential for a healthy and fulfilled life.
The Report highlights the vital role which education within schools and other settings can play in achieving this outcome. The challenge is to ensure that all such children are identified and that we work across all sectors to provide them with appropriate and sustained support.
In doing so we must not forget the importance of research and evaluation in identifying the most effective ways of providing such support. Although Scotland has less than 10% of the population of the United Kingdom, our research regularly captures more than 10% of the UK research budget. We have an active and able community of researchers who can support the introduction of new programmes of care for mothers and children and the lessons we learn will influence policy throughout the world.
One of the Chapters highlights the issues of violence and health. Consistent with the major theme in the Report, it highlights the importance of early years, alcohol and drug use and chaotic life circumstances in determining levels of violence. We substantially underestimate the amount of violence in our communities. The Violence Reduction Unit has done much to foster working across sectors to find ways of preventing violence rather than simply treating its effects. There is little doubt that when infants fail to develop their ability to empathise and form attachments to others, there is an increased risk that they will be involved in violence in later life.
Communicable disease respects no boundaries and the past year has highlighted the need for high vigilance in dealing with problems such as E. coli O157. Diseases of animals such as avian flu, foot and mouth disease and other, more esoteric infections have implications for human health and are providing new challenges for Scotland. Immunisation programmes continue to expand and it is essential that we recognise their importance despite the absence of diseases which they are designed to prevent.
I believe that new insights into the way that health is created have emerged over the past few years that are very significant. These insights offer Scotland the opportunity to take the lead in developing new approaches to health development and improvement.
I look forward to working with you and colleagues in the Scottish Government to turn this vision into a reality.
DR HARRY BURNS
Chief Medical Officer
November 2007
« Previous | Contents | Next »