AGM Slides

Sir Harry Burns

Chief Medical Officer

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

World Health Organization (1997 and 2003)

www.heartstats.org

Prevalence of smoking by country, in 15 year olds by sex, 2000/01, Europe

0

5

10

15

20

25

30

35

40

45

50

Ukraine

Lith

uania

Ger

man

y

Eston

ia

Slove

nia

Czech

Repu

blic

Latvi

a

Finlan

d

Hungar

y

Russia

n Fede

ratio

n

Austri

a

Franc

e

Polan

d

Switzer

land

Spain

Belgiu

m -

Flemish

spe

aking

Croat

ia

Nether

land

s

Belgiu

m -

Frenc

h sp

eakin

gIta

ly

United

Kin

gdom

- Eng

land

Irelan

d

Norway

Portu

gal

Denm

arkIs

rael

Malt

a

United

Kin

gdom

- Sco

tland

United

Kin

gdom

- W

ales

Mac

edonia,

FYR

Gre

ece

Sweden

% r

egu

lar

smo

kers

Boys

Girls

Smoking prevalence - Males

Males

Smoking prevalence - Females

Females

Coronary heart disease mortalityMen aged 15-74 years

100

200

300

400

500

600

1950 1960 1970 1980 1990

DenmarkFinlandNorwaySwedenScotland

Age

-sta

ndar

dise

d m

orta

lity

per

100

,000

Chronic liver disease, including cirrhosis

Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012

Chronic liver disease, including cirrhosis

Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012

Comparison to WE Mean Males

Standardised mortality rates by cause, all ages: Glasgow relative to Liverpool & Manchester

All ages, both sexes: cause-specific standardised mortality ratios 2003-07, Glasgow relative to Liverpool & Manchester, standardised by age, sex and deprivation decile

Calculated from various sources

112.2 111.9126.7

248.5

131.7

168.0

229.5

0

50

100

150

200

250

300

350

All cancers(malignantneoplasms)

Circulatory system Lung cancer External causes Suicide (inc.undetermined intent)

Alcohol Drugs-relatedpoisonings

Sta

ndar

dise

d m

orta

lity

ratio

Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010

Workers in the 1950s

More liveable housing?

Man’s search for meaning

• “Those who have a 'why' to live, can bear with almost any 'how'.”

Viktor Frankl 1902-97

Aaron Antonovsky 1923-1994

“.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement."

Sense of coherence....

For the creation of health....

....the social and physical environment must be:

Comprehensible Manageable Meaningful ......or the individual would experience

chronic stress

00-046

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0 10 20 30 40 50

Months of Orphanage Rearing

*linear trendline

Evening Cortisol Levels Increase withMonths of Orphanage Rearing *

The Founders’ Network

STRESS AND GRADE OF EMPLOYMENT: MEN

0

2

4

6

8

10

12

14

16

18

2008

-8.3

0

10-1

0.30

12-1

2.30

14-1

4.30

16-1

6.30

18-1

8.30

20-2

0.30

22-2

2.30

nmol

/l Higher GradeLower Grade

Salivary Cortisol

Time of DaySteptoe et al. 2003, Psychosomatic Medicine, 65, 461-470

Attachment theory

Ainsworth Deep emotional connection that infant develops with

primary caregiver Reflects an “internal working model”expressing the

infant’s expectations of parental behaviour in meaningful situations

Basis for development of later relationships Increasingly recognised as determinant of later emotional,

cognitive and social outcomes

Adverse childhood events study

Physical/sexual/emotional abuse Neglect (physical/emotional) Domestic substance abuse Domestic violence Parental mental illness Parental criminality

Adverse childhood events risk of alcoholism

Hillis et al 2011

Adverse childhood eventsrisk of perpetrating violenceBoys experiencing physical abuse

Duke et al 2010

The molecular biology of a cuddle

Creating wellness

Sense of coherence

Seeing the world as:StructuredPredictable

Feeling that it is:ManageableMeaningful

Wanting to engage

Resources which enhance resilience

Family Nurture

IntelligenceWork

Material resourceIdentity

Cultural stabilityStable set of answers

Optimism

Events

Stress

Tension

Resolution

Wellbeing

Management of complex systems

The importance of instability – “never waste a good crisis”

Order generating rules – develop a common vision of what you want the future to be

Emergence of solutions – accept that the outcome may not be exactly what you anticipate

Implementing improvement at scale….can it be done?

WillIdeas

Method

NHSScotland Surgical Safety Briefings

Healthcare Associated Infection

23% reduction from median

NHSScotland Surgical Mortality

Implementing improvement at scale….can it be done?

Will = destabilise the status quo

Ideas = order generating rules

Method = allow emergence

Social connectedness 148 studies comprising 308,849

participants, high levels of social integration conferred a 50% increased likelihood of survival.

Complex patterns of social integration conferred a 90% increase in survival.

Simple indicators such as living alone versus living with others conferred a survival benefit of only 19%.

Transforming society in Scotland

Early years collaborative – “Make Scotland the best place in the world to grow up”

Reduce offending and reoffending – “How soon can we close a prison?

Reduce dependency in the elderly –“Make 60 the new forty!”

The Early Years Collaborative - Ambition

To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed.

Workstream 1

Societal Issues

Post-birth actions

Pre-birth actions

Reduce Infant Mortality

A reduction of 15% in the rates of stillbirths

and infant mortality by 2015

Aim Primary Drivers Secondary Drivers

Workstream 2

Societal Issues

85% of all children have all the

developmental skills and abilities

expected of a 27-30 month old by the

end of 2016

Child’s physical &

mental health and

emotional development

Carer’s physical &

mental health and skills

Aim Primary Drivers Secondary Drivers

Workstream 3

Societal Issues

90% of all children have all the

developmental skills and abilities expected at the start of primary

school by the end of 2017

Child’s physical &

mental health and

emotional development

Carer’s physical &

mental health and skills

Aim Primary Drivers Secondary Drivers

Workstream 4

EYC is a strategic priority & underpins

all policy planning and operational

activityProvide the

Leadership System to support quality

improvement across the Early

Years Collaborative

EYC values, culture and behaviours are

modelled by all leaders at all levels

Infrastructure to support delivery of

EYC

Aim Primary Drivers Secondary Drivers

90% of children at Grassmarket nursery school will receive a bedtime story

Alfie

‘I like my bedtime story because it helps me to dream’

Reducing offending/reoffending Management of stressful situations?

–Mindfullness? Management of normal daily life?

–OT project at Craiginches Access to external resources of support?

–Who helps with navigation? A sense of meaning and purpose in life?

–A job?

Jimmy Reid 1971

Rectorial Address “Let me right at the outset define what I mean by

alienation. It is the cry of men who feel themselves the victims of blind economic forces beyond their control. It's the frustration of ordinary people excluded from the processes of decision making. The feeling of despair and hopelessness that pervades people who feel with justification that they have no real say in shaping or determining their own destinies....”

Do something brave today –and don’t forget the hugs!

AGM Slides