Towards a Healthier Scotland :6

Towards a Healthier Scotland - A White Paper on Health

"Tobacco smoking is the most important preventable cause of ill-health and premature death in Scotland"

"The poor diet of deprived communities is a major reason why they experience such poor health"

Chapter 4 Action: Lifestyles

Reduction in use of Tobacco

36. Tobacco smoking is the most important preventable cause of ill-health and premature death in Scotland. It accounts for at least two-thirds of the excess deaths due to inequalities in health. Each year, smoking accounts for more than 13,000 deaths - one in 5 of all deaths - and the NHS in Scotland spends Ł140m on treating smoking-related diseases. Smoking rates among children and young people - particularly girls - and pregnant women are a special cause for concern. Non-smokers exposed to environmental tobacco smoke are also at significant risk in that they have a 23% greater risk of developing heart disease and a 26% greater risk of lung cancer.

37. The devastating impact of tobacco use on health and the steps needed to address the issue are set out in the UK White Paper, Smoking Kills, which was issued in December, 1998.

38. A sum of Ł5m will be invested over the next 3 years in health education/promotion campaigns in Scotland. Health boards have also been given a further Ł1m in each of the next 3 years to help towards the introduction of specialist smoking cessation clinics with an initial supply of free Nicotine Replacement Therapy.

The Government's headline targets for cutting smoking in Scotland are:

reduction in smoking by 12-15 year olds from 14% to 12% between 1995 and 2005 and to 11% by 2010
reduction in the proportion of women who smoke during pregnancy from 29% to 23% between 1995 and 2005 and to 20% by 2010.

Action

The Government will secure:
new laws to ban tobacco advertising
enhanced health promotion campaigns, targeting young people, pregnant women and low income smokers
new NHS services to help smokers quit
improved facilities in pubs and restaurants for non-smokers
consultation on a better way to reduce passive smoking at work
tougher enforcement of the law against sales of tobacco to children.

Eating Better

39. The Scottish diet is notoriously high in fat, salt and sugar and low in fruit and vegetables. Next to smoking, our diet is the single most significant cause of our poor health, contributing to a range of serious illnesses, which includes coronary heart disease, certain cancers, strokes, osteoporosis and diabetes. The poor diet of deprived communities is a major reason why they experience such poor health.

40. Eating for Health: A Diet Action Plan for Scotland was published in 1996. It provides the framework for the action needed over a 10-year period to improve Scotland's diet. The Green Paper consultation brought widespread support for continuing full implementation of the Plan. It also strongly endorsed the need for action to influence diet from a very young age and to improve access to affordable, healthy foodstuffs in deprived and rural areas. There was general agreement - which the Government accept - that the dietary targets for 2005, set out in the Plan, should continue.

41. Steady progress continues at both local and national level. Particularly encouraging is the contribution of the Scottish Community Diet Project to help improve the diet of communities suffering deprivation. Also welcome is the recognition by major retailers that supermarkets have a crucial role in influencing diet by making products more accessible to low income consumers, increasing the range of healthier own-brand products, reducing salt, fat and sugar content, and promoting fruit and vegetables. But a further sustained push across all elements of the Plan is needed - from primary producers through to consumers - if our dietary targets are to be met. This process will also be assisted, through time, by the new Food Standards Agency which, amongst other things, will improve access to information and advice on a whole range of food-related issues, including the nutritional content of food.

Action

The Government will increase the funding of Diet Action Plan initiatives to over Ł2m over the next 3 years, starting with an extra Ł0.3m for the Scottish Community Diet Project.
The Government will appoint a national dietary co-ordinator to give impetus to implementation of the Plan, with a special focus on developing the contribution of primary producers and major retailers, and encouraging mothers to breastfeed.
The proposed new Food Standards Agency will improve access by people to information about nutrition and food safety.

Physical Activity

42. The contribution of physical exercise through sport to preventing conditions such as cardiovascular disease and osteoporosis was clearly recognised in the Green Paper. The Government are determined to encourage wider participation in physical activity, particularly by younger people, and reverse the decline in school sport. Therefore, we have announced an Ł8.1m package of initiatives over the next 3 years to develop youth/school sport. These include the appointment of a school sports co-ordinator in every secondary school and action to encourage sport in the primary school sector.

43. Moderate physical activity, in the form of everyday activities such as walking and cycling, also makes a vital contribution to positive health and active ageing. The White Paper, Travel Choices for Scotland, sets out proposals to encourage such activity. Although a range of interests and agencies are currently working to encourage active living and physical exercise, their impact could be greatly enhanced through a more integrated approach.

Action

The Government will set up a Task Force to develop a National Physical Activity Strategy for Scotland. It will bring together key agencies in sport and leisure, education, health, fitness, exercise and play, in joint action to help people of all ages and walks of life to enjoy the benefits of physical activity. The Government will make available additional resources to take forward the work of the Task Force and implement its recommendations.

Alcohol Misuse

44. In moderation and at the right time and place, alcohol can be included within a healthy lifestyle. Regular moderate drinking can have health benefits for men over 40 and women after the menopause. On the other hand, excessive drinking carries a heavy toll in illness, accidents, anti-social behaviour and criminal acts of violence, including domestic violence. Its costs in personal, social and economic terms are great, and too often hidden or unheeded. Alcohol misuse is linked with crime, lower achievement, poor mental and physical health, family break-up and poor employment prospects. Of great concern, therefore, is the current upward trend in excessive drinking, not only amongst adults but also in the frequency and level of drinking amongst 12-15 year olds.

45. The Working Group established after the national alcohol conference in October, 1997 has published a new alcohol strategy for Scotland. The response to the Green Paper revealed particularly strong support for primary prevention (linked to work on drug misuse) and the prevention of secondary damage.

The Government's headline targets for reducing alcohol misuse are:

to reduce the incidence of adults exceeding weekly limits from:
33% to 31% for men between 1995 and 2005 and to 29% by 2010.

from 13% to 12% for women between 1995 and 2005 and to 11% by 2010.

Action

New steps to cut alcohol misuse and improve services will be taken in the next 3 years, supported by Ł2.5m. Work in implementing the new strategy will be guided by a new national committee, bringing together experts from the health service, police, local authorities, licensing authorities and the voluntary and private sectors.

Drug Misuse

46. Drug misuse is widespread in Scotland. It damages the health of individuals and communities. Steps to prevent drug misuse - including effective treatment approaches - will benefit health directly and improve community safety and other factors that underlie good health.

47. Scotland needs a national structure which sets the overall strategic direction; provides co-ordination; gives clear guidance with good practice; monitors progress; and facilitates the key work of Drug Action Teams (DATs) and other drug misuse agencies. In particular, we want to see the activities of DATs closely associated with work on the wider problems associated with drug misuse. The Government's current review of the Scottish strategy, set against the UK Drugs White Paper, Tackling Drugs to Build a Better Britain, published in April, 1998, will report shortly.

48. The Government have already announced a package of drugs-specific funding to tackle the problem. In October, 1998, they announced a Ł5m package for better prevention and treatment of drug misuse. This included a Ł2m (20%) increase for Scotland's drug treatment services; a new drug prevention resource; measures to cut drug-related crime; and funding to combat the threat to young people from cheap heroin. Drug safety issues in Scotland's schools are being examined by a new group. A drugs education training programme for primary school teachers is underway through Scotland Against Drugs and drawing on a substantial financial contribution from the private sector.

Action

The Government will publish shortly an enhanced strategic framework to co-ordinate and focus drug misuse measures in Scotland.
New prevention and treatment services will be funded from 1 April, 1999, helping to discourage drug misuse, offer effective treatment and cut drug-linked crime.