Steps towards prevention: Scotland and non-communicable diseases

By Joshua Bird

In 2011, Scotland’s Christie Commission on the Future Delivery of Public Services found that “focussing resources on preventative measures must be a key objective of public service reform.” They called for a fundamental overhaul of those institutions responsible for designing and delivering public services, and implored the Scottish Government to shed the myopia and “short-termism” that so often hampers attempts at creating a legitimate preventative agenda.

The National Health Service faces mounting pressure to meet the ballooning demand for public services. Societal shifts such as ageing populations, rapid urbanisation, and the globalisation of unhealthy lifestyles, as well as the UK’s increasingly constrained public spending environment, pose serious threats to the NHS’s continued ability to deliver free health and social care.

A preventative agenda, such as the one outlined in Christie, would substantially ameliorate these issues. Per the World Health Organisation, preventable disease causes 89 per cent of all deaths in the UK. These include cardiovascular disease, coronary heart disease, cancers, stroke, respiratory illnesses, diabetes, and others, all of which result from a combination of lifestyle choices and societal forces. These chronic medical conditions, which are non-transmissible, slow progressing, and long lasting, are collectively known as noncommunicable diseases (NCDs).

NCDs are the world’s leading cause of mortality. In 2013, over 36 million people, including over 40,000 Scots, died from one (or a combination) of the aforementioned illnesses. To combat the global burden of NCDs, the international community came together in 2012 to develop the WHO’s Global Action Plan for the Prevention and Control of Noncommunicable Diseases.

Prevention is the crux of this action plan. First, it provides a myriad of policy options for national governments that will reduce premature mortality (deaths occurring before age 75) from NCDs by 25 per cent globally by the year 2025. It also contains voluntary reduction targets for a variety of lifestyle choices aimed at reducing the risk of NCDs. These targets address smoking, alcohol consumption, physical inactivity, salt intake, obesity, diabetes, and high blood pressure (hypertension).

Adopting this framework is critical for Scotland. Known as the “sick man of Europe,” Scotland’s health outcomes are among the worst in the developed world. Further, NCDs are Scotland’s biggest killer. By achieving these targets, we could prevent as many as 3,800 premature deaths, and save billions of pounds annually. So where is prevention on Scotland’s policy agenda?

Despite the oft-cited Christie report (now four years old), little has been done to move prevention to the fore. While this can be partially attributed to outside influences such as Westminster’s austerity policies, Holyrood has nevertheless fallen short of moving toward “a healthy balance between prevention and reaction.”

Granted, the Scottish Government has, in recent years, put forward a series of strategies and frameworks focussed on the individual risk factors, including alcohol abuse, tobacco, and others. In fact, the Scottish Government’s 2025 tobacco reduction target is actually more ambitious than the WHO’s target. The government has also begun addressing prevention for particularly deadly afflictions like cancer and heart disease.

However, the approach so far has been largely piecemeal, with efforts chiefly addressing risk factors themselves rather than NCD prevention as a single public health issue. The associated human and economic costs of this approach are unsustainable. Thus, the time has come for the Scottish Government to begin integrating prevention, much as it has recently done with health and social care delivery. This underlies the need for a national NCD prevention strategy that includes targets commensurate with, or exceeding, those outlined by the WHO.

While setting goals is important, the interrelated nature of NCDs means we must ensure that targets are evidence-based and comprehensive. For example, achieving a target for increased physical activity will be largely ineffective at reducing obesity and hypertension without simultaneously addressing poor dietary habits and alcohol abuse. The risk factors must be closely evaluated when developing targets to ensure they don’t ‘miss the mark.’

To paraphrase the Parable of the River, it is time to stop fishing bodies out of the water and start considering who or what is pushing them in. Sporadic and isolated approaches to NCD prevention have thus far only produced sporadic and isolated successes. Moreover, the Christie Commission’s work has set out a framework to make prevention a local and national priority. Scotland has a unique opportunity to not only lead the UK, but also the world, by adopting the WHO’s framework. Doing so will help tackle the biggest cause of premature death in Scotland, and ensure that Scots live longer, healthier lives.

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Joshua Bird is currently completing a Master of Public Policy at the University of Edinburgh. During the course of his studies he has worked on public policy issues with the British Heart Foundation (Scotland) and the Scottish Council for Voluntary Organisations.

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