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Current challenges to public health in Scotland Dr Gerry McCartney

Current challenges to public health in Scotland Dr Gerry McCartney Head of Public Health Observatory Division NHS Health Scotland gmccartney@nhs.net. Is Scotland the ‘sick man’ of Europe?. Historical international trends in life expectancy.

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Current challenges to public health in Scotland Dr Gerry McCartney

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  1. Current challenges to public health in Scotland Dr Gerry McCartney Head of Public Health Observatory Division NHS Health Scotland gmccartney@nhs.net

  2. Is Scotland the ‘sick man’ of Europe?

  3. Historical international trends in life expectancy Data extracted from the Human Mortality Database for all available nations: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.

  4. Historical international trends in life expectancy Data extracted from the Human Mortality Database for all available nations: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.

  5. Higher overall mortality than comparable nations Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales, Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Spain, Sweden, Switzerland, Taiwan & West Germany.

  6. Higher overall mortality than comparable nations Scotland Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales, Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, Spain, Sweden, Switzerland, Taiwan & West Germany.

  7. Higher overall mortality than comparable nations USA Scotland Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales, Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, Spain, Sweden, Switzerland, Taiwan, West Germany & USA.

  8. Higher overall mortality than comparable nations USA Slovenia Scotland Czech R. Poland Slovakia Hungary Estonia Bulgaria Lithuania Latvia Belarus Ukraine Russia Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.

  9. Higher overall mortality than comparable nations Portugal N. Ireland Scotland Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.

  10. All cause death rates, men 0-64y, 2001 Glasgow City Inverclyde West Dunbartonshire Dundee City Eilean Siar Renfrewshire North Ayrshire North Lanarkshire Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  11. What is getting better about health and the things that influence health? Life expectancy & mortality Infectious diseases Heart disease Cancers Stroke disease Medical treatment and innovation Absolute poverty

  12. Source: Scottish CMO report 2009

  13. Source: Scottish CMO report 2009

  14. What is getting worse about health and the things that influence health? Inequalities in health and the determinants of health (national and international) Obesity Alcohol related harm Mental health Threats of climate change, resource scarcity ‘Scottish Effect’

  15. General acute inpatient discharges with an alcohol-related diagnosis in any position, by gender, Scotland, 1982/3 - 2009/10

  16. Hanlon P, Walsh D, Whyte B. Let Glasgow Flourish. Glasgow, Glasgow Centre for Population Health, 2006.

  17. BMI distribution of GG&C adults (1995) 1995 Source: adapted from the Scottish Health Survey

  18. BMI distribution of GG&C adults (1995-8) 1995 1998 Source: adapted from the Scottish Health Survey

  19. BMI distribution of GG&C adults (1995-2003) 1995 1998 2003 Source: adapted from the Scottish Health Survey

  20. BMI distribution of GG&C adults (1995-2008) 1995 1998 2003 2008 Source: adapted from the Scottish Health Survey

  21. MDP = Measure of Domestic Progress SWB = Subjective Well-Being Source: Chasing progress. Beyond measuring economic growth. London, New Economics Foundation, 2004.

  22. Why is well-being not improving? • Creation of a ‘hedonic treadmill’ • Choice anxiety • Loss of deeper meaning and purpose to life • Loss of hope with satiation • Uncertainty and insecurity • Homogenisation of culture • Deterioration in interpersonal relations • Stresses caused by the ‘pace of life’ • Personal identity defined by own consumption

  23. Health inequalities

  24. All-cause deaths by deprivation decile: directly age/sex standardised rates per 100,000 population, Scotland, 2007 Source: ScotPHO 2009

  25. Male age specific mortality rates by occupational social class. Scotland 1990- 92 Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  26. Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  27. Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007. Age specific contribution to inequalities of specific causes of death across SIMD income quintiles. Men, Scotland 2000-02.

  28. Age specific contribution to inequalities of specific causes of death across SIMD income quintiles. Women, Scotland 2000-02. Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  29. Percentage change in age- and cause-specific mortality rates among men between 1991 and 2001. Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  30. Percentage change in age- and cause-specific mortality rates among men between 1991 and 2001. Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  31. Percentage change in age- and cause-specific mortality rates among women between 1991 and 2001. Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  32. Percentage change in age- and cause-specific mortality rates among women between 1991 and 2001. Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  33. Males - 75.8y Females - 83.1y Hillhead St George’s Cross Buchanan Street Jordanhill Hyndland Partick Charing Cross Exhibition Centre QUEEN STREET Anderston Argyll St. Govan Bridgeton CENTRAL St Enoch Ibrox Males - 61.9y Females - 74.6y Cessnock Life expectancy data refers to 2001-5 and was extracted from the GCPH community health and well-being profiles. Adapted from the SPT travel map by Gerry McCartney. Each stop on the Argyll line travelling East represents a drop of 1.7 years in male life expectancy

  34. Why are health inequalities getting worse? • Black’s 4 hypotheses: • Artefact • Selection • Behavioural or cultural • Structural Rising inequalities in income • Increasing power differences between groups – income, location, wealth, status etc.

  35. Emergence of the ‘Scottish Effect’ Source: Hanlon P, Lawder RS, Buchanan D, et al. Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'. Journal of Public Health. 2005; 27:199-204.

  36. Synthesis for the divergence of Scottish mortality from mid-20th Century

  37. Synthesis for the divergence of Scottish mortality from mid-20th Century

  38. Synthesis for the emergence of the ‘Scottish Effect’ and ‘Glasgow Effect’

  39. Synthesis for the emergence of the ‘Scottish Effect’ and ‘Glasgow Effect’

  40. Synthesis for the emergence of the ‘Scottish Effect’ and ‘Glasgow Effect’ Political attack by the Thatcher government post 1979

  41. Synthesis for the emergence of the ‘Scottish Effect’ and ‘Glasgow Effect’ Political attack by the Thatcher government post 1979 Source: McCartney G, Collins C, Walsh D, Batty GD. Explaining Scotland’s higher mortality: towards a synthesis. Glasgow, Glasgow Centre for Population Health, 2011 (forthcoming).

  42. What explains the Scottish Effect? • No single ‘cause’ is likely to explain the mortality phenomena • There is a greater degree of uncertainty about the divergence of mortality from the mid-20th Century • ‘Downstream’ causes are necessary but insufficient to explain the Scottish Effect and Glasgow Effect • Politics of the 1980s and the cultures arising from this are likely to be important in explaining the recent divergence

  43. Future challenges for Scotland’s health

  44. Demographic change Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.

  45. Climate change

  46. Source: Bodagaj, IPCC, 2008

  47. Climate change impacts often missed • Failure of food supply and accompanying mass migration • Economic disruption • Health impacts more likely to be mediated through economic and social determinants of health than direct climate impacts

  48. Resource scarcity: oil

  49. Source: James L. Williams, WTRG Economics, Houston, Texas.

  50. Economic impact of peak oil • Liquidation of sectors of the economy, increased costs for others • Increased costs for trade in manufactured goods • Global trade in financial services for manufactured goods interrupted • Food prices

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