Health in Scotland 2004
FOREWORD
Dear First Minister
It is my privilege to present my fifth Annual Report, Health in Scotland 2004. This report touches on the challenges to health and healthcare in Scotland over the last year. It cannot be a comprehensive account but rather supplements and draws from a wealth of data published over the last year which informs debate on these important issues in Scotland. This report covers activity in the whole field of public health, in health improvement and health protection as well as in health services. It has no single theme but there are three issues which I believe are worthy of comment in this short foreword.
The first is that of the effect of poverty and social exclusion on health. I have commented on this matter on previous reports and action designed to tackle the social injustice of health inequality underpins a wide range of Scottish Executive policy. In this report, I have set out some of the action that is being taken within the Health Improvement Challenge. I have also attempted to summarise briefly the exciting new thinking that is emerging from public health research in Scotland and elsewhere about the biological processes underlying the complex relationship between health and wealth.
It is clear from this work that the effect of deprivation on health is due not only to poverty of financial capital but also to poverty of social capital, of aspiration and of hope. Our growing understanding of the biological effects of these stresses on individuals is revealing new mechanisms through which evidence of the effectiveness or otherwise of social and fiscal interventions will be more easily and quickly demonstrated than has hitherto been the case in public health research. I very much welcome the lead that Scotland is showing in this important work.
I have drawn attention in previous reports to my concern about the effects of excess alcohol on the lives and health of Scots and, in particular, of young Scots women. I cannot but reiterate that concern. This report contains ample evidence of the adverse effects of excess alcohol on Scots as individuals and as a society. There are steeply rising numbers of deaths attributable to alcohol and a parallel increase in cases of alcohol-related liver disease. Alcohol is a major factor also in fires, domestic and street violence, and road accidents. There are clear associations with poverty and social exclusion, with the most deprived being many times more likely to suffer or to die from alcohol-related problems. Efforts must continue to focus attention and effort on the problems of excess alcohol consumption in Scotland.
Many Scots, however, are responding positively to the choice of healthy living for themselves and their families. This report also celebrates the efforts that are being made in Scotland to tackle those issues that stand in the way of maximising the health of Scots. Nowhere was this more amply demonstrated in 2004 than in the Scottish Executive's commitment to tackling the scourge of tobacco. The year opened with the publication of the first ever comprehensive tobacco control policy for Scotland and culminated, after a public consultation to which a massive 52,000 individuals responded positively, with the introduction of legislation to create smoke-free enclosed public places. This will save the lives of individuals and improve the health of generations to come. I very much welcome this effort and the consistent support which has been shown by Ministers and colleagues across the Scottish Executive.
This report is the last in the series in my tenure of office as Chief Medical Officer for Scotland. As ever, while it has been my privilege to guide and mould its production, it results from the contribution of many colleagues within the Scottish Executive and the NHS in Scotland. My thanks are due in particular to Miss Sandra Campbell who has once again so ably edited the content and to my own office team led by Marion Collins and my Secretary, Eileen Stuart, who have managed the whole process.
Yours sincerely
Dr E M Armstrong
Chief Medical Officer