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The NHSiS has three clinical priorities: coronary heart disease/stroke, cancer and mental health. Coronary heart disease (CHD) and cancer are two of the major diseases affecting the population of Scotland, and are two of the key headline health targets in the White Paper, Towards a Healthier Scotland. These targets are:-
Coronary Heart Disease
The mortality rate from CHD fell sharply between 1986 and 1997 (Chart 2), and further substantial reductions should be possible by the year 2010. A reduction of 50% would reduce the standardised mortality rate among people under 75 years old from 143 deaths per 100,000 population in 1995 to 72 deaths per 100,000 by 2010.
Chart 2: Coronary Heart Disease: Age Standardised Number of Deaths per 100,000 under 75 year olds: 1986 to 1997
Coronary Heart Disease remains one of the national priorities for Scotland and wide ranging actions are being pursued to address this issue. These include actions to change the lifestyle factors that contribute to increased risk of CHD and measures to improve the range of treatments provided in hospital and in the community.
Cancer
The standardised mortality rate for cancer among people aged less than 75 years old fell by 10% between 1986 and 1997, with most of this reduction occurring in the period since 1993 (Chart 3). The headline target is to reduce this mortality rate by 20%, from 188 standardised deaths per 100,000 population in 1995 to 150 deaths per 100,000 by 2010.
Chart 3: Malignant Neoplasms: Age Standardised Number of Deaths per 100,000 under 75 yrs old: 1986 to 1997
Cancer remains a national priority service, and significant efforts are being put into the reconfiguration of services, including managed clinical networks, to ensure that patients have access to the highest standards of care. These developments should ensure that continuing improvements will take place in the survival rates from cancer.
Immunisation has a major role to play in the fight against childhood diseases. A 95% target uptake rate among children by the age of two is set for each of the six immunisation programmes: diphtheria; tetanus; whooping cough; polio; haemophilus influenza b; and measles, mumps and rubella (MMR). If uptake for a given programme falls considerably below the target then the risk of an epidemic increases.
In recent years the uptake rate for five of these programmes has remained stable, with the exception of MMR, and has exceeded the 95% target level. Average uptake for MMR in the last two years has been about 93%. As reported in earlier editions of the bulletin, there are practical reasons regarding the later timing of administering this programme, and time delays in reporting uptake which tend to result in a slightly understated uptake than the true level for MMR.
The level of uptake of MMR now seems to have stabilised at 92.0% compared with a general trend for reduction in the last few years. Chart 4 shows that only in Orkney was the 95% target level exceeded in the quarter ended March 1999; but in three Boards (Dumfries & Galloway, Highland and Western Isles) uptake was below 90%.
Chart 4: MMR Uptake by Health Board: January to March 1999
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