UK annual report On the State of the Public Health
UK annual report On the State of the Public HealthKeywords: Improvements in health care,Government, NHS
In December, the Chief Medical Officer, Professor Liam Donaldson, published his annual report, On the State of the Public Health. It provides an assessment of important issues where significant improvements in health can be achieved by sustained action. Over the last 150 years, the Chief Medical Officer has published annual reports, in most years. These reports provided an important record of the nation's health and the major challenges faced by government in tackling the main problems. In the last 20 years or so, the annual report has also provided detailed accounts of a wide range of initiatives taken by the Government on public health and in the National Health Service.
Professor Donaldson's report offers a new perspective on five subject areas. It analyses the effectiveness of current treatments and services, describes government action in these areas and identifies action necessary to bring about improvement. The report focuses on five key areas of health: health inequalities and the North-South divide; untreated high blood pressure; liver cirrhosis and increased alcohol consumption by younger people; the threat from E. coli 0157;and Epilepsy Services.
According to Professor Donaldson, the report reveals that certain small communities in the North and Midlands of England have a death rate equivalent to the national average in the 1950s. Men in professional occupations have rates of death that are much the same wherever they live, whereas rates for unskilled workers vary greatly between the North and the South. This suggests that professional people seem to be able to transcend the North-South divide in health.
However, he said that a worrying trend is developing in the number of younger people who are being diagnosed with cirrhosis of the liver, which appears to be linked to alcohol and binge drinking in particular. There is a need for greater awareness of the long-term damage that alcohol taken in single large amounts can cause.
Professor Donaldson said that the section of the report dealing with high blood pressure posed a different sort of challenge. Untreated or inadequately treated, high blood pressure leaves the person concerned at increased risk of dying before their time from a heart attack or a stroke. Too many people are in this position. He said that new estimates suggest that over a third of the adult population are now considered to have high blood pressure. In 1998, based on the definition then used, only about half of those with high blood pressure were receiving treatment and blood pressure was not adequately controlled in over one-third of these. High blood pressure is being recognised earlier, and new standards, in the National Service Frameworks, are being implemented to improve the care of older people and those with heart disease, including standards for the control of high blood pressure. Despite this, there is still much to do. He said that better organisation, rigorous implementation of clinical policies,more public awareness and greater compliance by patients with their medication would all save lives, as would action by the food and catering industry to reduce the salt content of processed food.
Referring to the Lanarkshire E. coli 0157 outbreak in 1996, in which 17 people died and 496 were made ill, he said that the public and the media saw that food poisoning was not just something that caused the occasional tummy upset; it could kill. The report shows that there have been some improvements but the problem is not yet under control; people are still falling victim to E. coli 0157. Professor Donaldson called for renewed commitment to turn the tide on this disease.
The final section of the report deals with epilepsy. It says that five earlier reports have remained largely unimplemented, negative attitudes to epilepsy still persist, and the disease remains an unglamorous area of clinical practice. It is time for a real breakthrough in our approach to epilepsy, one that is modern, enlightened, transforming the lives of the 380,000 or so people in England who have epilepsy. The report spells out how this could be done through the National Service Framework for people with long-term conditions,which the Government is planning.
A copy of the Chief Medical Officer's annual report On the State of the Public Health can be accessed on the Department of Health's Web site at www.doh.gov.uk/cmo/annualreport2001
