ahds 2013 kn1 harry burns
DESCRIPTION
TRANSCRIPT
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