Sick man of Europe; home of the deep-fried Mars bar; beer, fags and hard drugs: the stereotype of Scotland as a nation of unhealthy Rab C Nesbitts has proven hard to shake off. Sadly the latest Scottish Government public health review will do little to change that.
The good news is that life expectancy has been improving in Scotland over the last 60 years but the bad news is that people in Scotland die younger on average than in any other Western European nation. Why? Partly because unhealthy lifestyle choices remain stubbornly widespread in spite of a bombardment of health messages, and partly, it would appear, because of Scotland’s infamous “excess” mortality.
We have known about this phenomenon for a long time, but unpacking its causes, still less tackling them, has proven very difficult. It is not as simple as saying that Scotland, particularly west central Scotland, has high rates of deprivation. Other cities like Liverpool and Manchester do too, yet their life expectancy rates are less bleak.
Of course, deprivation does go hand in hand with a number of red alert disease risk factors, such as smoking, high levels of alcohol consumption, poor diet, obesity, inactivity and poor mental health, but even this toxic cocktail does not explain away all the excess deaths.
Scotland’s former chief medical officer Harry Burns, who devoted much of his time to this conundrum, believes the breakdown of families and communities following the decline of heavy industry is implicated in Glasgow’s low life expectancy.
Research into its causes must continue, but ministers are right to push ahead with a new integrated national public health strategy that focuses on what works. In public health, simplicity and clarity of messaging is key. It does not help, of course, that messages about diet in the wider media are prone to change but if those involved with public health within Scotland are all working to the same agenda, then that could have a powerful positive effect.
It should be possible to change, even transform, Scotland’s health profile. The proof is in the improvements that have already been made. A concerted national push has apparently been lacking until now, so this report implies; putting that right is the essential next step.
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