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Dr Alison McCallum
Dr Alison McCallum



" Trust and co-operation has been the response to the flu pandemic both by professionals and by the general public "

I am delighted to introduce the 2008/9 Director of Public Health and Health Policy Report, my fourth independent report on the health of the population of Lothian. Over the past year, we have seen celebrations of the sixtieth birthday of the NHS, tempered by the spectre of recession; unemployment and the emergence of a new strain of flu. This report, like the founders of the NHS, focuses on the importance of a health system founded on the principles of mutuality, and on the need to invest in developing relationships based on trust, sustainability and shared goals. This theme reflects the interdependency between the economic and social health of society, the causes of ill health and the response of the health system. Specifically, it recognises the need to learn from the legacy of ill health and inequality that followed earlier periods of economic and social difficulty and to sustain relationships between health professionals, patients and public that focus on equitable delivery of effective prevention, treatment and care.

The response to the recessions and subsequent economic recovery of the 1980s and 1990s varied between countries. Where national and local governments maintained high quality services for communities and individuals, the adverse consequences were more limited and the recovery less painful. By comparison, during those periods Lothian experienced increased rates of premature and avoidable death and ill health.

We have learned from the past, and have put together a range of services and guidance to help and support individuals and communities during these difficult times. These include interventions designed to reduce the harm associated with alcohol, increase the proportion of the population moving towards a healthy weight and reducing the number of children admitted to hospital by improving oral health. The first part of this report focuses on programmes and interventions that are aimed at mitigating the effects of the recession on the population of Lothian and that we are trying to design-in partnership with patients public and staff. We often know what works, but collaboration is essential if we are to learn how to make an intervention work most effectively - mutuality.

The second strand of my report concentrates on the use of research and evidence in public health. Effective and efficient care depends on the development and implementation of evidence, on shared, continually updated and carefully and critically recorded information, and on co-operation and trust between those who provide services to patients, and the wider public2. Traditionally, this has been based on treating patients who present for help. Anticipatory care approaches seek out problems, address previously unmet need, improve the quality and comprehensiveness of care for patients with chronic conditions, and increase patient engagement in the design and management of prevention and treatment.

[ Box 1 ] Alcohol

Alcohol requires specific mention because of it's prominence in our society. Tackling excessive use of alcohol in Scotland has been high on the agenda for both the NHS and government this year. As part of a broader programme of therapies aimed at reducing alcohol misuse we have introduced brief interventions. These help people reduce their alcohol intake from hazardous levels and provide tailored support that can help rebuild lives and families. Treating patients, however, is not enough. As a population, the amount of alcohol purchased is enough for every adult to exceed the recommended weekly limits. There must be effective strategies in place to reduce alcohol use across the population. These should include minimum pricing, tackling oversupply, and increasing the availability of smaller sized and lower strength drinks1. In my report this year, I explore our mutual response to the growing problem of excess alcohol use in Lothian.

Trust is a measure of the quality of relationships between people, organisations and what happens to them. It depends on a shared understanding and expectations of behaviour and action3. A health service built on these values recognises that risks to health, and the capacity to address them, are spread unevenly across the population.

Further evidence of trust and co-operation has been the response to the flu pandemic both by professionals from all agencies and by the general public, and this theme forms the third strand of the report. Trust and co-operation helped minimise the spread of the disease in the early stages and allowed an effective vaccine to be made available promptly to those who needed it most. We also explore immunisation - the need to vaccinate the population against diseases such as measles and Human Papilloma Virus (HPV) and the development of public health legislation to protect the population from old and new threats to their health.

A reliable health service builds on the technical competence, institutional openness and concern for others that underpins patient safety. It recognises the redistributive role of healthcare and allocates resources accordingly. Such a health service can build the long term relationships necessary to continue to sustain the trust in the future that is the mark of a mutual health service and a healthier society.

Dr Alison McCallum, Director of Public Health and Health Policy

Dr Alison McCallum
Director of Public Health and Health Policy