Chapter 5 - Roles, Responsibilities and Action - continued
Eating for Health
129. The Government will press home strongly the Scottish Diet Action Plan,
and work with other interests to secure dietary improvement, including an increase in the
rate of breastfeeding and the prevention and management of overweight and obesity. The
pace of action and change will necessarily vary from sector to sector given the diverse
range of interests involved and the extent to which they already have in play their own
initiatives to encourage healthier eating. But the Government will monitor progress
closely through mechanisms that include the Scottish Health Survey, and see that
the Plan’s implementation is facilitated and maintained.
130. Labelling is important in helping consumers choose healthier food products.
Discussions in the EU Commission are well advanced in introducing more rigorous
requirements for food products labelling. Regulations for Quantitative Ingredients
Description (QUID) will make it compulsory for the label to state clearly the percentage
of ingredients in certain foods.
131. Food safety is of the essence. The Food Standards Agency, which we propose
to set up, with wide-ranging powers and remit, will do much to restore public confidence
in the food we eat. The Government’s proposals are set out in the White Paper, Food
Standards Agency: A Force for Change.24
Views are invited on further measures which can be taken to secure dietary
improvement in Scotland.
Physical Activity
132. Sport can be a healthy, enjoyable and beneficial pursuit for people of all
ages, and can foster social development and a sense of personal achievement. Within its
overall policy of "sport for all", the Government are committed to raising
participation levels, particularly among our young people, through the provision of
sporting opportunities and accessible, good quality and cost-effective sports facilities.
133. The Scottish Sports Council (SSC) is the Government’s advisory body
for sport in Scotland. The Council works in partnership with a range of other bodies
involved in sport and sports development, including local authorities who are the main
providers of sports opportunities and facilities in Scotland. The SSC’s current
priorities are youth sport and the development of sporting excellence. Good habits in
sport and physical activity developed at an early age can last a lifetime, and the Council
has developed a national youth sport strategy for Scotland comprising 5 key elements -
physical activity, school sport, club sport, coaching and equality of access. The
programme’s mission is "to bring sport into the lives of all our young
people": firstly, through the provision of opportunities to encourage and facilitate
participation; and secondly, through the development of pathways to encourage more young
people to remain involved in sport throughout their lives. The SSC is currently developing
action plans to implement the component parts of the strategy.
134. The SSC is also the Distributing Body for the Lottery Sports Fund in
Scotland. To the end of October, the Council has awarded over £46m to 376 capital
projects, thereby enhancing the infrastructure of sports facilities throughout the
country.
135. Work is under way to help develop sporting talent. National success in
sport not only adds to national pride, but provides a great incentive and encouragement to
others, and particularly to our young people, to take up sport. But it is not just about
elite performers: it is important to allow all Scots to develop their sporting talents and
skills, whatever their level of ability.
136. The Government are particularly keen to improve the provision of sport in
schools, within the curriculum and as part of extended curricular activities. It has asked
the Scottish Sports Council to produce a package of measures designed to help sport in
schools, drawing on the resources of the National Lottery. The package will include plans
to extend the current school sport co-ordinator pilot schemes into a national structure
with a co-ordinator in every secondary school in Scotland. The co-ordinator will be a
teacher working in the school, who will be freed from normal duties one day a week, to
organise sports activities within the school. The co-ordinator will also take steps to
develop links both with local primary schools and with sports clubs within the community
more generally.
137. Physical activity is in everyday living, not just through sport.
Encouraging provision of accessible sports and exercise facilities, cycling and walking to
school and work, and other measures to promote safer communities and wider amenities
including open spaces and the countryside will support active living. Healthy living
centres should make a strong impact on local provision.
Views are invited on ways in which physical activity can be further stimulated in
Scotland.
Health Topics
138. Other issues are important in improving and safeguarding health.
Dental and Oral Health
139. Action is needed to address our poor dental health record, which is
particularly bad in children in deprived communities. Individual action such as regular
brushing and flossing, attending for regular dental checks and reducing consumption of
sugar can help prevent decay and gum disease. Health Service actions such as encouraging
early registration with a dental practice, ideally before the first teeth erupt and dental
hygiene advice can also help. But these measures are least likely to reach those who need
them most, that is the children of the deprived communities who currently suffer such an
unacceptable record of dental decay.
140. The evidence shows that fluoridation to the optimum level of one part in a
million can substantially reduce the amount of decay in children from similar backgrounds
and areas. Decay in one part of England where water was fluoridated more than halved
between 1986 and 1995, while a comparable area without fluoridation saw little change.
141. At present, in terms of the Water (Fluoridation) Act 1985, as amended, the
final decision on fluoridation rests with the water authority, taking into account
recommendations from the local Health Board or Boards, which are made following local
advertisement of the proposals and consultation with the relevant local authorities and
the Scottish Water and Sewerage Customers Council.
142. The Government acknowledge the differing views on the issue of water
fluoridation and are concerned to explore ways of bridging the gap between those who are
opposed to any fluoridation of the water supply and those who believe that only in this
way can the children most at risk be protected against the damaging effects of tooth
decay.
The Government would therefore welcome ideas - including any views on possible
changes to the legislation - on how best to test public opinion in particular localities,
but take the view that fluoridation offers an important simple method of protecting the
population from tooth decay and would be particularly beneficial among children in
Scotland where dental health is still very poor.
Teenage Pregnancies
143. A good deal of work has been done aimed at reducing the numbers of teenage
pregnancies. This includes a report by the Scottish Needs Assessment Programme (SNAP) in
1995 which was issued to the NHS and offers guidance about family planning services and
advice which can be made available to younger people. It highlights the importance of
addressing the wider issues of teenage sexuality and inter-personal relationships to
secure a fall in the rate of pregnancies. The need for co-operation between the agencies
providing advice and services is also stressed.
144. The Scottish Office provides financial support for voluntary bodies in the
family planning field, either towards specific projects or as core funding to meet central
administration costs. The bodies given support include the Family Planning Association,
the Brook Clinic and the Natural Family Planning Group. Sex education is provided in
Scottish schools as part of a comprehensive programme of health and social education which
considers a number of issues relating to moral choices and healthy living.
145. The key areas identified as impacting on teenage pregnancy are social and
economic factors, particularly deprivation, education (and not just on sexual health),
access to contraceptive services, information about services and confidentiality.
146. Current policies touch on most or all of these issues. But given that there
is little central monitoring or co-ordinating of policies in this area, it is difficult to
measure success or failure. The one crude measure available is to look at Health Board
targets for reducing teenage pregnancies against the latest statistics of pregnancy rates.
Most Health Boards have set targets to reduce teenage pregnancies by significant
percentages - usually around 25% - by the year 2000. However, as can be seen from Figure
14, progress in reducing pregnancy rates has been limited. There is clearly a need to
review the policy.
Views are invited on how best the question of teenage pregnancy should be tackled.
Would a national strategy be desirable, on which local strategies could be based? If so,
does the SNAP strategy form a good basis on which we can build? What elements should a
national strategy contain? Would a national strategy best be developed by a national group
of relevant interests?
Mental Health
147. Mental health care must be based on an individualised assessment of needs.
This is the philosophy underpinning the Framework for Mental Health Services in
Scotland launched in September 1997 to which Health Boards, NHS Trusts and partner
agencies are working. The Scottish Needs Assessment Programme has also recently produced a
portfolio of reports in the mental health field. It covers particular clinical areas -
dementia, schizophrenia and suicidal behaviour - but also topics which locate mental
health in a wider context. These include public health and mental health gain, mental
health in the workplace, and domestic violence. The detailed agenda which they provide
gives a clear focus for collaborative action.
148. Action can be taken to help protect people who are vulnerable to mental
health problems due to poor social environments or severe adverse life-events. This can
include, for example, high quality pre-school education and support visits for new
parents, and school-based interventions and parental training programmes in relation to
children showing behavioural problems. Mental health problems in children of separating
parents can be reduced by providing focused psychological therapy. The stress often
experienced by long-term carers can be lessened by respite care and some forms of
psycho-social support. Particular attention thus needs to be paid to improving the
scope for good mental health. The NHS will continue to develop and implement local
strategies for mental health in collaboration with social work, housing and other planning
partners, targeting those most at risk.
Domestic Violence
149. Domestic violence exacts a heavy toll on the physical, psychological and
emotional health of women and children. The Government has acted to make clear that
domestic violence is unacceptable, for instance by an award-winning advertising campaign
in 1995-96. In 1995, Greater Glasgow Health Board, supported by funding from the Health
Education Board for Scotland, embarked on a demonstration project, focusing on the role of
primary health care and inter-agency working in Castlemilk in tackling the problem of
domestic violence. The resultant model strategy was published in September 1997. This,
together with the SNAP Report on Domestic Violence,27 and the forthcoming research report
commissioned by The Scottish Office on services to victims of domestic violence, will help
inform the development of the strategic, intersectoral approach which is required to
tackle this harrowing problem.
Accidents and Safety
150. Good progress has been made in reducing the incidence and severity of road
accidents in particular, and the Health and Safety Executive continues to work with
employers, trades unions and others towards improving safety and health at work. Following
the issue of a consultation document in 1996, the Government have recently announced their
intention to set new road safety targets for the period up to 2010. There is ample scope
for further improvement, especially in regard to safety in the home, where the young and
the old are particularly vulnerable.
To help develop its approach to accident prevention, the Government would welcome
views on measures which could most usefully be taken.
Communicable Diseases
151. Good progress has been made, particularly through childhood immunisation
programmes, in minimising the threat of diseases such as poliomyelitis and whooping cough,
which afflicted earlier generations.
The Government will ensure that such programmes are maintained and, where possible,
enhanced in the light of scientific and medical advances.
152. Major public health challenges still remain, however. More international
travel has heightened the risk of serious infections being contracted abroad and brought
back to Scotland, including tuberculosis which is resurgent in many parts of the world.
The recent serious outbreaks of infection from the bacterium E coli 0157 have emphasised
the fact that we cannot afford to relax our defences against infectious disease. The
Scottish Centre for Infection and Environmental Health will continue to play a key role in
this area, including monitoring to provide early warning of the emergence or re-emergence
of infectious diseases.
The Government propose to review existing public health legislation in Scotland to
assess whether additional legislative measures are needed to protect the public health.
Current practice is rooted in the Public Health (Scotland) Act 1897. This has served us
well for a century but the time is opportune to review its provisions. A consultation
document will be issued in due course seeking views on possible changes.
153. The overall total of reported HIV infections each year between 1990 and
1996 has averaged 156 (the peak was 314 in 1986) and there can be little doubt that the
major health promotion initiatives over the last decade, including the introduction of
needle and syringe exchanges for drug misusers, have contributed greatly to controlling
the spread of HIV in the population. However, while in recent years infections reported
among intravenous drugs users have declined, numbers among gay men and heterosexuals have
been slowly increasing. Health promotion efforts need to be maintained and reinvigorated,
especially as a new cohort of young people become sexually active each year.
The Government will continue to make resources available to fund prevention
activity, recognising the wider dimensions of sexual health and linking appropriately with
work on drug misuse.
LOCAL AUTHORITIES
154. Local authorities wield a significant influence on health right across
the range of their functions. Maximising their potential to improve health must be
fundamental to any strategy. Environmental health, housing, economic and community
development, social work, education, police, transport, planning, sports, leisure and
recreational facilities can all contribute substantially to a prosperous, safer community,
in which good physical and mental health can flourish. They also have the lead role in
area regeneration. As in the case of national policy development, it is important that
strategies and policies at local level should take health considerations into account.
The Government seek views on the suggestion, that Health Boards’ Directors of
Public Health (DsPH) should assist in preparing health impact assessments in relation to
key relevant local policy proposals and initiatives.
155. The Government hope that local authorities will increasingly seek to skew
resources and the siting of amenities towards areas of greatest need where the levels of
health are worst. As service providers they have a key role in ensuring that health is
promoted among those they serve; and, as employers, they have a duty to promote health
within their own workforces.
156. The DPH is well placed to give a perspective on how the policies and
actions of Health Boards and local authorities can be brought together to ensure best
health advantage.
The Government believe that the DPH should be fully integrated into the policy
development and decision-making processes at local level. This could include co-option or
appointment to relevant council committees, for example, social work or education, as
appropriate. The Government would welcome views on this suggestion.
157. The close working relationship between the Government and COSLA will foster
the contribution local authorities can make to health improvement.
To help develop the local government input, the Government propose, subject to
further discussions with the Convention, to fund for a specified period a public health
post in COSLA. The postholder’s task would be to draw up, in close consultation with
local government, good practice guidance and other advice bearing on health improvement
for the benefit of local authorities. Views are invited on how local authorities can best
contribute to health improvement.
THE NATIONAL HEALTH SERVICE IN SCOTLAND
158. The prime aim of the NHS in Scotland is to improve the health of the people
of Scotland. This has been a consistent theme of the annual Priorities and Planning
Guidance issued to the Service, and it applies to every part of the NHS and to every
aspect of its work.
159. Health Boards have responsibility for protecting and improving the health
of their resident populations. In this role, they work in partnership with other parts of
the NHS, with local authorities and with other local organisations. With their wide
expertise and knowledge of local health needs, Boards are ideally placed to help other
organisations to target services, funds and personnel where there is greatest need. Boards
have an important role as leaders of local health alliances to improve health and in
ensuring that health is high on the agenda of other partnerships in which they are
involved.
160. The ending of the NHS internal market means that all parts of the NHS are
now working together to identify and address health needs. The key mechanism for achieving
this is the annual Health Improvement Programme (HIP) for each Health Board area, the
first of which are currently in preparation. Boards lead this process but they are working
closely with NHS Trusts and GPs in drawing up HIPs and will involve local authorities and
other organisations. The 5-year rolling nature of HIPs will balance the need to focus on
specific action to be taken in each year and recognition that improvement in health will
take time. HIPs will cover all aspects of NHS activity, in which key components are
service developments and health promotion designed to achieve health gain and tackle
inequalities. They will thus be the vehicles for making a major and sustained impact on
the health problems of every part of Scotland.
161. The new Primary Care Trusts, announced in Designed to Care,
responsible for primary health care and community services, will have a key role in
improving health. GP practice plans should also show how they will contribute to the
implementation of the HIPs. There will be monitoring each year of the implementation of
Programmes and Health Boards will be required to demonstrate that they have implemented
their Programmes and met any targets set.
162. Health Boards will be expected to target health improving action and
resources to help people living in deprived areas and others with special needs. Health
promotion specialists based in Boards, Trusts or in locality teams, have the expertise to
develop initiatives aimed at tackling health inequalities and to train those working with
disadvantaged communities. Community involvement and development, advocacy and working in
partnerships are essential ways in which health promotion specialists seek to enable
people to help themselves and their communities towards better health. Specialist
involvement at the strategic level in Boards and in the development of health promotion
strategies, involving Health Boards and their partners in local authorities, voluntary
organisations, the business community and elsewhere, demonstrates that health promotion is
integral to all areas of Boards’ agendas. Health promotion departments work to evolve
and develop effective programmes to improve the health of all the population in their
areas.
163. The primary care role in improving health is clearly vital. Perhaps more
than any other area of health care, health promotion is dependent for its success on
giving individuals real control of their own choices, rather than imposing choices on
them. The one to one, face to face consultations which are typical of primary care
interventions offer an ideal opportunity not only to put the message across, but to
discuss it with individuals and help them to decide how to respond. Although, therefore,
it is valuable to identify health promotion separately to raise its profile, long-term
success also depends on its integration into the day-to-day working of members of the
primary health care team.
164. The type of health promotion activity which is appropriate depends on the
context. Most people’s initial contact point with the NHS is a primary care
professional - whether that be a dentist, a pharmacist, a GP, a school or practice nurse
or a community nurse or health visitor. Evidence suggests, for example, that GPs see 67%
of their registered patients in any one year, with the figures rising to 90% over 2 years
and 95% over 5 years. A GP can tackle healthy living issues in the context of a routine
consultation. As well as general advice on good health, GPs can focus on the prevention of
certain specific diseases and problems: it is important to see that preventive role as a
vital contributor to public health. Health visitors have the potential to support
vulnerable individuals and deprived communities.
165. Dentists also have an important role in improving health, given that oral
ill health is a major public health problem in Scotland. They provide advice and
educational materials, especially to children, to help them maintain good dental hygiene
and to encourage them towards a healthy, low-sugar diet.
166. Pharmacists provide a range of services to the public and have a direct
impact on public health. Community pharmacists see most adults and many children regularly
- a recent survey concluded that 94% of the population visited a pharmacy at least once a
year. The wide distribution of pharmacies means that professional information and advice
are available in diverse communities on UK and local health initiatives, the avoidance of
further illness, safer sexual practices, drug and medicine safety, smoking cessation,
healthy eating, exercise, sun safety, the management of chronic conditions and alcohol
consumption. Community pharmacists also contribute to local groups tackling the misuse of
drugs.
The roles of these professionals in relation to health promotion can be, and should
be, developed. We would welcome views, in particular, on how health visitors can fulfil
their potential in improving Scotland’s health. |
