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Working Together for a Healthier Scotland |
Chapter 6 - Indicators, Targets, Monitoring and ResearchIndicators and Targets196. Yardsticks are necessary if we are to measure progress towards the health improvements we seek. Emphasis in the past has been on targets in relation to health outcomes and underlying behaviours. The downside of this approach is that it deflects attention from markers of progress towards tackling the circumstances which affect health and lifestyle and fails to recognise the wider environmental influences on individuals, families, groups and communities. 197. The guidance on Intermediate Indicators for Health Alliances, sent to Health Boards last year, identified specific operational indicators for measuring and monitoring the health-related impacts of alliances using a health gain model based on a range of health determinants. This is a useful approach that can be used to measure health gain in a variety of situations. The Government have identified the following key principles for guiding the identification of indicators and targets for the future:
198. In considering the need for indicators and targets, the Government believe it important that these should be kept to the minimum necessary for the proper assessment of improvement in Scotland’s health. Too many indicators and targets diffuse effort and resources. Against that background and based on the foregoing criteria and earlier discussion in this document, the Government suggest that health outcome targets should be drawn from the following priority health topics:
199. National targets would be set but, within them, targets bearing on, for example, socio-economic class or geographical location could also be set in order to trace progress in addressing inequalities. Local targets, taking a lead from those chosen at national level, could also be set. Targets must be seen to have relevance and credibility, and to be "owned" by all concerned. The Government, before finally setting targets, would accordingly welcome views (a) on the priority health topics suggested, (b) on the targets which might be set, and (c) on the period which should be covered. 200. In the light of comments received, the Government propose to establish an expert group which will give advice on the targets to be set. 201. The Government also propose to set targets in relation to the priority lifestyle topics, namely:
Smoking 202. Targets to reduce the levels of smoking by the year 2000 already exist. The 1992 publication Scotland’s Health - A Challenge to Us All aims for a 30% reduction in the number of smokers aged 12-24 years to 21% and a 20% reduction amongst those aged 25-65 years to 32%. The recent Scottish Health Survey, which sampled adults in the 16-64 age group, recorded 34% of men and 36% of women as current smokers. The Government would welcome views on smoking targets. For example, should the present targets be modified? If so, by how much and by when? Is there a need for specific targets for young people and those living on low incomes? Should there be a target directed either at pregnant women or at women of childbearing age? Alcohol 203. In 1991, Health Education in Scotland: A National Policy Statement, set a national target of achieving a reduction of 20% by the year 2000 in the number of Scots drinking above the recommended sensible levels of 21 units a week for men and 14 for women. 204. This target of 19% for men and 6% for women has not been reached and is unlikely to be by the year 2000. The Scottish Health Survey shows that a substantial proportion of the population -33% of men and 13% of women - is drinking in excess of the target limits, and the proportion doing so has increased sharply among both men and women since 1986. Given the large increase in excessive drinking in recent years and the widespread pattern of excessive drinking across social classes and across different regions within Scotland, the potential for reducing excessive alcohol consumption may be limited. This conclusion is supported by HEBS health survey findings, published in 1996, which show a motivation indicator (those drinkers aged 16-74 who want to or intend to cut down on their drinking) of only 6% for men and 4% for women. The main motivational barrier cited to moderating drinking was finding it difficult to cut down or stop when friends were drinking. The same survey showed that only 22% of heavy drinkers were taking action to change their behaviour: 49% were not even considering taking such action. The Government would welcome views on whether the current target for alcohol should be maintained and, if not, specific suggestions for alternative population indicators for alcohol misuse. 205. The most recent guidance on alcohol consumption emphasised daily rather than weekly drinking levels. The recommendations are that regular drinking of 4 or more units a day for men, and 3 or more units a day for women is likely to result in increasing health risk. The Government would welcome views on this latest guidance, against the background of the previous weekly levels. 206. Underage drinking is being viewed as a significant problem in its own right. The inclusion in future of young people’s alcohol consumption in the Scottish Health Survey will be of considerable benefit in this regard. Views would be welcome on setting a new target or indicator for underage drinking. Eating for Health 207. Given that the current dietary targets were set as recently as 1994, are for the year 2005 and are closely related to the Scottish Diet Action Plan, which the Government propose to keep as a framework for dietary improvement, there is merit in retaining the current targets. Views would, however, be welcome. Physical Activity 208. No formal national targets have as yet been set by the Government for physical activity. Views would be welcome on whether targets in this area are desirable and, if so, what they might be. 209. Again, the Government would propose to refer the comments received to the expert group to inform their consideration of appropriate targets. The Government would be grateful if responses could cover the possibility of targets relating to inequalities being set. 210. The expert group will also consider whether indicators and targets relating to life circumstances should be set. Views are invited on whether these are needed and, if so, what they might be. 211. Mental health, drug misuse and HIV/AIDS are among the suggested priorities. It is notoriously difficult to set meaningful national targets in these areas. Views are invited, therefore, on whether targets should be set and, if so, what these might be. 212. Scotland already has health targets set in 1991 and 1992 in Health Education in Scotland and Scotland’s Health: A Challenge to Us All. The year end for these is 2000. One possibility would be to keep the targets in play until they end in 2000, alongside any further targets that may emerge in response to this Green Paper. Views would be welcome.
Monitoring213. Progress towards the targets has to be monitored and evaluated rigorously. The Scottish Health Survey will chart progress. The main focus of the Survey is on a range of diseases and conditions, including coronary heart disease, stroke, dental health and obesity and lifestyle risk behaviours such as diet, smoking, alcohol consumption and physical activity. It is now being extended to collect data on children’s health and, for the first time, comprehensive information on asthma incidence. In addition, the Information and Statistics Division of the NHS collates a wealth of further information, including coverage of cancer mortality. And Health Boards will be continuing to monitor progress towards local targets. Collectively, these data will enable regular and comprehensive reviews of progress to be undertaken which will further inform our policies for improving Scotland’s health.
Research214. This Green Paper addresses the challenge of improving people’s health. A parallel challenge is to learn how to use resources most effectively to make these improvements. A programme of research and evaluation should accompany any public health strategy. 215. While there are a range of indicators which measure health and inequalities, a research programme should begin by building on the work of the Acheson Inquiry and selecting the most accurate measures which identify important health problems and influences. It should identify how to take effective measures to narrow inequality, both in the field of health policy and in ways which make the necessary changes happen. 216. The research programme must look beyond health and disease, just as this Green Paper identifies a range of social and economic changes which are necessary to deliver improved health. And, just as we identify major challenges ahead, we should also select accurate indicators of success. 217. Much useful research is already taking place in Scotland and further afield towards improving public health. Within The Scottish Office, the Clinical Resource and Audit Group concentrates on the contribution of the Health Service to the delivery of high standards of care, while the Chief Scientist Office addresses important public health research questions which range outside the arena of treatment. The Chief Scientist Office is currently revising its Research Strategy for consultation and is considering whether new areas require attention. These organisations will review the contributions of current research work, and consider whether new areas require attention. 218. The priorities in research might include the following:
Views are invited on the priorities which might be set for a research programme to improve Scotland’s health. |
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| © Crown Copyright 1998 | Prepared 3rd February 1998 |