Towards a Healthier Scotland :10

Towards a Healthier Scotland - A White Paper on Health

"A group drawn from the public, private, community and voluntary sectors, led by the Minister for Health, will be set up to monitor progress on the implementation of the White Paper and to help ensure that health remains high on the agenda at national and local levels."

Chapter 8 Research, Evaluation, Targets and Monitoring

118. Research, evaluation and monitoring are essential to evidence-based integrated public health policy. Green Paper feedback strongly supported our view that our research effort must focus on the causes of health inequalities and practical means to tackle them. Respondents also called strongly for more active dissemination of completed research.
119. Scotland already has a wealth of academic and research units, advanced health information systems and large studies designed to answer key questions. Next, we must engage all organisations that impact on public health, both inside and outside the health sector, as partners in research.
120. Effective action requires research at all levels, from policy-making to the day-to-day decisions people take and the knowledge, beliefs and attitudes behind those decisions. We especially seek research which helps people and communities mobilise their own resources to improve health. Key research flows from the actions outlined in this Paper. Demonstration projects and interventions on diet, smoking, physical activity, dental and oral health and teenage pregnancies all demand proper evaluation using both research evidence and health monitoring data.
121. The Chief Scientist Office (CSO) of The Scottish Office Department of Health supports a substantial research programme through grant and core funding. Its Research Strategy for the National Health Service in Scotland, published in 1998, identified tackling inequalities as the key strategic aim for public health research. One exciting recent development is the new multi-disciplinary Social and Public Health Sciences Unit in Glasgow, co-funded by the CSO and the Medical Research Council. Other important work includes measuring well-being, evaluating and communicating health risk, investigating emerging threats from infection or the environment and applying new knowledge of molecular medicine and human genetics. Scotland's position as a world leader in biomedical research must continue to develop.

Action The Chief Scientist Office will work with key partners to develop the public health component of its research strategy. This will set clear priorities for collaborative research and dissemination involving the widest possible range of skills and expertise and drawing on the strength of the people of Scotland and their communities so that we can meet our public health challenges.

Targets
122. Targets help focus integrated action and, sparingly used, provide a stimulus to, and yardsticks of, progress towards health improvement. The Green Paper, in inviting views on the indicators and targets which should be set, said that comments received in the consultation process would be referred to an expert group for consideration. That group, which contained representatives from a spectrum of interests, including the NHS and local government, made recommendations which the Government have taken into account in setting the headline targets described earlier in this White Paper. Other targets have been adopted to inform progress in key areas, and these and the headline targets are set out in Annex A to this Chapter. As indicated in paragraph 16, action will also be taken to determine progress in reducing the inequalities gap between different socio-economic groups. In addition, a range of measures is being developed to gauge health and well-being within population groups. The demonstration projects, too, will each have regard to inequalities measurement.

Monitoring Group
123. The Green Paper suggested a new expert working group, chaired by The Scottish Office Minister for Health, charged with drawing up a strategic framework for concerted action to promote health at community level with a particular focus on deprived communities. The responses to the Green Paper were generally supportive but some commentators challenged the use of "experts" in the sense that this meant professionals, arguing that the experience of local activists needed to be utilised. Others were concerned to avoid further analysis of the problem, when the need was for solutions, which were locally sensitive or relevant. Importance was also attached to disseminating information about existing projects, and strategies known to work.
124. The Government, therefore, propose to set up a Ministerially-led group which, building on the responses to the Green Paper, will have a monitoring, overseeing role, in ensuring that the implementation of this White Paper is achieved. Progress reports will be published annually.
125. An important role for the Ministerial group will be to help stimulate and sustain the "grass roots" approach, which has already proven its worth in health-related areas such as diet and community health. The group will have a special responsibility to ensure involvement of people in decisions about their health, and particularly minority groups and people with disabilities. It will not interfere with good work already proceeding at local level but will seek to spread and foster good practice. Membership will be drawn from key interest groups, including those active within communities.

Action A group drawn from the public, private, community and voluntary sectors, led by the Minister for Health, will be set up to monitor progress on the implementation of the White Paper and to help ensure that health remains high on the agenda at national and local levels.

Targets	Annex A
Headline Targets for Scotland

	Indicator	Trend/Level	Target
Coronary Heart Disease	Age standardised mortality rate from CHD in people under 75 years	The year 2000 target - toreduce mortality amongpeople under 65 by 40% between 1990 and 2000 - is likely to be met.	Reduce by 50% between 1995 and 2010: ie from 143 to 72 deaths per 100,000 population.
Cancer	Age standardised mortality rate from all cancers in people under 75 years	The year 2000 target - to reduce mortality inpeople under 65 by 15%between 1986 and 2000 is likely to be met.	Reduce by 20% between 1995 and 2010: ie from 188 to 150 deaths per 100,000 population.
Smoking	Smoking among young people (12-15 year olds)	No current target. At highest level since 1984.	Reduce smoking among young people from 14% to 12% between 1995 and 2005 and to 11% by 2010.
	Proportion of women who smoke during pregnancy	No current target.	Reduce the proportion of women who smoke during pregnancy from 29% to 23% between 1995 and 2005 and to 20% by 2010.
Alcohol Misuse	Prevalence of men and women aged 16-64 exceeding weekly limits of 21 and 14 units of alcohol	The year 2000 target - a 20% reduction in adults exceeding weekly limits - will not be met as excess drinking is on steady increase for both men and women.	Reduce 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.
Teenage Pregnancy	Pregnancy rate among 13-15 year olds	Higher than in most other Western European countries.	Reduce by 20% between 1995 and 2010.
Dental Health	Proportion of 5 year olds with no experience of dental disease	62% of 5 year olds caries free in DepCat1; 20% in DepCat 7 (in 1995/1996).	60% of 5 year olds to have no experience of dental disease by 2010.

Second Rank Targets

	Indicator	Trend/Level	Target
Diet	See Scottish Diet Action Plan	Increasing trend inconsumption of fruit and vegetables and low fat products.	Retain targets for 2005 in Scottish Diet Action Plan.
Smoking	Rate of smoking among adults (aged 16-64) in all social classes	Current target has different age span. Downward trend (since 1972) was reversed in 1996.	Reduce rate of smoking from an average of 35% to 33% between 1995 and 2005 and to an average of 31% by 2010.
Alcohol Misuse	Frequency and level of young people (12-15) drinking	No current target but on increase.	Reduce frequency and level of drinking from 20% of 12-15 year olds to 18% between 1995 and 2005 and to 16% by 2010.
Physical Activity	Proportion of 11-15 year olds taking vigorous exercise 4 times or more weekly	32% in 1994.	Increase proportion from 32% in 1994 to 40% in 2005 and to 50% in 2010.
Physical Activity	Proportion of men and women aged 16-64 taking 30 minutes of moderate activity on 5 or more occasions each week	32% of men and 22% of women in 1995	50% of men and 40% of women to be taking 30 minutes of moderate activity on 5 or more occasions each week by 2005 and 60% and 50%, respectively, by 2010.
Cerebrovascular Disease	Age standardised mortality rate from this disease in people under 75 years	No current target but general trend downwards.	Reduce by 50% from 1995 level by 2010.
Dental Health	Proportion of 45-54 year olds with no natural teeth	17% in 1995 with no natural teeth.	Less than 5% of 45- 54 year olds to have no natural teeth by 2010.

Notes

(a) Drug Misuse

Drug misuse national strategic objectives and priorities have been published and provide a performance framework for the effective planning and delivery of drug misuse services measured against a range of performance and activity indicators. Those delivering the drug misuse information strategy will publish regular updates of progress so that the Government begin to measure, nationally, for the first time, how Scotland is progressing against the wide range of fronts covered by drug misuse. Performance measures will be set, however, in due course, in the context of current work on an enhanced Drugs Strategy Framework for Scotland and the response to the UK Drugs White Paper published in April, 1998.

(b) Life Circumstances

The expert group - see paragraph 122 - emphasised the importance of setting targets or indicators in this vitally important element of our approach to health improvement. Work is ongoing within The Scottish Office to determine, in consultation with relevant interests, appropriate measures of progress in key areas including, for example, social inclusion.