The final item of business tonight is a members’ business debate on motion S4M-13677, in the name of Dennis Robertson, on the World Health Organization’s 25 by 2025 framework. The debate will be concluded without any questions being put.
Motion debated,
That the Parliament welcomes the World Health Organization’s (WHO) 25 by 2025 framework for preventing global non-communicable diseases (NCDs); believes that NCDs account for nearly 75% of all premature deaths in Scotland, including in Aberdeenshire West; understands that NCDs share common risk factors as detailed by WHO in its framework; notes the view that Scotland should adopt the 25 by 2025 recommendations, and believes that 3,805 lives could be saved per year if Scotland achieves the target reductions recommended by WHO.
17:02
I thank all the members who signed the motion to enable the debate to take place.
In your introduction to the debate, Presiding Officer, you probably said it better than I am going to: we are debating the 25 by 2025 framework, which is a World Health Organization initiative to reduce the number of deaths from non-communicable diseases, which are generally known as NCDs. What are they? They are diseases including cardiovascular disease, chronic respiratory disease, diabetes and cancers.
Many deaths from such diseases are preventable. Some deaths occur because of our lifestyle. We have known for many years—especially in Scotland—that our lifestyle is often not in keeping with good health, despite the fact that the Scottish Government and the previous Scottish Executive, back in 2003, have undertaken initiatives to ensure our wellbeing. Despite all the messages and advice that are coming out, it appears that we are not listening. What would be achieved if we did listen? What would be achieved if the Scots decided to be healthier? We would probably reduce the number of deaths by 3,805 per year.
Is it a simple message? Well, yes and no. I say that because when I became the convener of the cross-party group on heart disease and stroke, it became evident to me that although some conditions are preventable, many require the intervention of our health professionals. Screening for bowel cancer, breast cancer and cervical cancer is very commendable and is leading to healthier lives, but high blood pressure is something that many of us suffer from. Just over a year ago, some testing for high blood pressure was done in Parliament. Along with many colleagues, I went along and had my blood pressure tested. I found out that I had high blood pressure. It was news to me—I did not know that I had high blood pressure. I am sure that many other people out there in the community need to have more regular checks.
Are we doing enough? Well, yes and no. We are doing enough in terms of some of the Government’s initiatives—for example, the walking to work initiative. If we walked 1 mile at a moderate pace every day, us men could reduce our chance of dying from prostate cancer by 30 per cent. If women became more physically active, that could reduce the number of cases of breast cancer in the UK by 9,000 a year. We have a responsibility for our own health and wellbeing.
Because of some aspects of our food intake and the fact that we enjoy many foods that are generally quite bad for us, we are asking our food manufacturers to help us a little bit by reducing the amount of salt in our processed foods and the amount of sugar in some of our fizzy drinks, because it appears that we are finding it very difficult to say no.
When should such work start? It must start at an early age. That is where the Scottish Government has got it right. We are starting in the early years—we are getting into the schools and we are looking at trying to achieve a healthy weight for everyone. That starts in the early years. That way, our young people will learn more than we did about healthy lifestyles, wellbeing and the way to a healthy life. That means becoming more physically active and doing the things that some of us do not do at the moment. Many of our children will still sit at a computer rather than go outside to play.
We need to get the education right. There have been recent initiatives to get people on their bikes and to get them to take more exercise in our rural areas. In my constituency of Aberdeenshire West, we have some fantastic outdoor initiatives to encourage people to have a healthy weight and to improve their wellbeing. However, it is necessary to say yes to that lifestyle—we must embrace it. If we do, we will meet some of the targets.
Our anti-smoking target is far more adventurous than the WHO’s, because we aim to reduce the level of smoking to 5 per cent by 2034. It would be fantastic if it were reduced to nil, but we must find measures to help those who are still smoking, because there are still far too many deaths in Scotland as a result of lung cancer and smoking. With the introduction of e-cigarettes, more people are finding a route to giving up tobacco. We are not entirely sure of the long-term impact of e-cigarettes, but we are very sure that they are having an impact in reducing smoking.
Is the Government doing enough? I think that we are heading in the right direction. We hope that, through awareness and education, people will listen. I am listening, but I am not sure whether my lifestyle is following suit; I sincerely hope that it is.
17:09
I congratulate Dennis Robertson on securing this important debate. Our concern is highlighted in the line in the motion that points out that
“nearly 75% of all premature deaths in Scotland”
are caused by non-communicable diseases. That is a big challenge for us all.
Of course, we can point to improvements. For example, from 1994 to 2013, age-standardised death rates for under 75s fell by 38 per cent overall. The figure was 71 per cent for coronary heart disease, 69 per cent for stroke and 28 per cent for cancer. There has been progress throughout the years of the Scottish Parliament: we should not forget that. However, when it comes to premature mortality we are still worse than the other countries in the United Kingdom and than many other countries in Europe. Of most concern is that the problem is skewed very much towards our most disadvantaged areas.
Of course, it is not just a Scottish problem, which is why the debate is set within the context of the World Health Organization. The WHO said something rather alarming last week, which was that 59 per cent of people in Europe are overweight or obese. Following on from that, it said something even more frightening, which was that young people nowadays may not live as long as their grandparents. I was pleased to hear quite recently that half the girl babies who are born today will live to be 100, but now the WHO is warning us that there is a risk, particularly because of obesity, that young people may live less long than their grandparents.
There is a major European and global problem. The WHO’s “Global status report on non-communicable diseases 2010” highlighted four risk factors: tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets. Those are exactly the four issues that we have been highlighting throughout the years of the Scottish Parliament. That report says something interesting, which is that while we emphasise the dimension of health inequalities, we should also have strategies that impact on those who are at moderate risk.
We need a twin-track approach. If we want to embody it in one phrase, we could call it “progressive universalism”, which is what Michael Marmot, the great guru on health inequalities, has called it. We must have not only messages that go to the whole population but targeted initiatives to deal with health inequalities. Let us give clear messages. For example, Dennis Robertson talked about e-cigarettes. Tobacco is the greatest preventable risk factor for all the non-communicable diseases that we are talking about today. E-cigarettes are already weaning a lot of people off cigarettes—they are massively less harmful than traditional cigarettes—but doctors squabble about how much less harmful they are. It is better if we can give a clear message on e-cigarettes. It is also better if we can give a clear message on diet, because sometimes the public are a bit confused by the mixed messages that they get about what is healthy and what is not.
On physical exercise, two things are absolutely clear. The first is that it cannot erase the effects of a bad diet. However, the second is something that we are being told repeatedly now, which is that if a person can do one single thing to improve their health—particularly at my age, but at any age—it is to take regular exercise. That is a message that Sir Harry Burns repeated strongly—certainly in the latter years of his time as chief medical officer.
We need the general messages, but we also need the health service, and the work that general practitioners do to measure blood pressure and so on. The quality and outcomes framework that is now being discussed in relation to the GP contract will help with that. During the years of the Scottish Parliament we have seen massive improvements in the treatment of coronary heart disease, stroke and cancer. We need targeted initiatives, too, which is why we need to give extra resources to GPs who work in the most deprived areas, such as the deep-end GPs.
Most of all, when we are talking about health inequalities, we have to address the issues of life circumstances. We will never solve health inequalities just by lifestyle actions; wider social changes are absolutely necessary if we are going to deal with that.
The problem has many parts to it. However, an important part of the action is highlighted in the motion and by the WHO targets. I think that the Scottish Government is signed up to those targets, so I hope that we will all do everything that we can to ensure that the targets are delivered.
17:14
I thank Dennis Robertson for securing the debate. Non-communicable diseases—or NCDs—are multifaceted. However, one thing that they have in common is that they can be prevented. That becomes evident if we have a closer look at the common risk factors, which include excessive alcohol and tobacco consumption, high blood pressure and cholesterol, physical inactivity, being overweight, obesity and unhealthy diet. According to the World Health Organization, those risk factors lead to cardiovascular diseases, cancer, respiratory diseases and diabetes, which together account for over 30 million deaths worldwide.
I want to talk about how we can significantly reduce the premature deaths that are caused by NCDs in Scotland. In aiming for that goal, we can create a healthier and ultimately more flourishing society.
NCDs are also referred to as chronic diseases. They are neither infectious nor transmittable from person to person, although it is each individual’s responsibility to lower their risk of NCDs by avoiding risk factors. In that context, I strongly welcome the WHO’s 25 by 2025 framework. It calls for a comprehensive approach involving a range of stakeholders from the health, education, agriculture and finance sectors.
For reasons of time, I will take a closer look at two of the nine targets, which are to reduce physical inactivity and harmful drinking by 10 per cent. First, physical inactivity has been singled out as the fourth leading risk factor for global mortality. Statistics indicate that annually 3 million deaths can be attributed to insufficient physical inactivity. Furthermore, the World Health Organization estimates that lack of physical activity is the cause of up to 25 per cent of breast and colon cancers, 27 per cent of diabetes and approximately 30 per cent of heart disease.
Having a closer look at Scotland, we can see that there is major room for improvement. In 2012, only 39 per cent of adults met physical activity guidelines, which require a minimum of 30 minutes of moderate activity on at least five days a week. In order to counteract those figures, the Scottish Government and NHS Scotland have started several initiatives encouraging people to get active. Exemplary, therefore, is active Scotland, which assists people to find opportunities to exercise in their local area.
I commend Scouts Scotland and all its members for their work in this regard. As a long-standing member of the Scout Association, I have no doubt that the organisation plays an invaluable role in promoting physical activity and a healthy lifestyle among children and young adults. I am positive that the nearly 45,000 scouts across Scotland have a great impact on their community while encouraging others to live healthier lives.
I turn to alcohol consumption and its relationship with NCDs. The WHO estimates that 3.3 million deaths annually are a result of harmful drinking. In speaking about excessive alcohol consumption, I believe that it is crucial to mention not only its role in causing a large number of diseases but the social and economic burden that it puts on society.
We need to acknowledge that alcohol abuse is a major public health concern. Studies imply that nearly 20 per cent more alcohol per head is sold in Scotland than in England and Wales. In addition, the number of alcohol-related deaths is significantly higher in Scotland than in other parts of the UK. All in all, excessive alcohol consumption costs Scots £3.6 billion annually.
Cognisant of those statistics, we as a country are challenged to counteract them. The Scottish Government has already taken many measures to tackle alcohol abuse. Most notable of those measures is, “Changing Scotland’s Relationship with Alcohol: A Framework for Action”, which aims to facilitate the cultural shift required to transform our relationship with alcohol.
To achieve that goal, strategic and comprehensive solutions are necessary. They include educational measures, as well as diversionary activity, support for families and communities and preventative measures. Exemplary among the latter is the Alcohol (Minimum Pricing) (Scotland) Act 2012.
In conclusion, I return to my original statement: NCDs can be prevented. As I have indicated in the cases of physical inactivity and alcohol abuse, we are taking the first steps in the right direction. However, more can be done to fight NCDs and ultimately save lives.
17:18
I thank Dennis Robertson for sponsoring this debate, which covers not only international issues but issues that are relevant to Scotland and indeed my region of North East Scotland. As a medic, I am familiar with the work of the World Health Organization, which was established as part of the creation of the United Nations and makes an invaluable contribution to both the developed world and the third world.
Many people will be unfamiliar with the term “non-communicable diseases”, as referred to in the motion, as it perhaps does not easily describe the conditions with which they are associated. The WHO has identified the most common of those conditions as cardiovascular disease, cancer, chronic lung diseases such as chronic obstructive pulmonary disease and diabetes. However, it does not limit NCDs to those, as is shown by its work on childhood obesity, alcohol and drug abuse and encouraging and raising awareness of the dangers of smoking.
The WHO’s 25 by 2025 campaign to reduce the mortality rate will be welcomed by people across the globe, and I hope that the aim will be achieved even sooner than expected.
In our country, some of the statistics are, frankly, not just alarming but frightening. As the motion states, non-communicable diseases account for nearly 75 per cent of all premature deaths in Scotland. When we look more closely at specific conditions, it is clear that more needs to be done. We cannot ignore the fact that one in five people in Scotland has or is at risk of having diabetes and that 276,000 of our population have it. Diabetes Scotland points out that 80 per cent of type 2 diabetes cases could have been prevented via healthy living. I am a co-convener of the cross-party group in the Scottish Parliament on diabetes and, no doubt, such figures will come up this evening when I host a round-table discussion that will focus on the future of care delivery for people with diabetes, in the context of the new and emerging health and social care integration bodies.
Time prevents me from going into detail regarding every disease or condition that the WHO has identified, but it is clear that the issue of smoking needs to be tackled throughout every nation. Again, the statistics for Scotland alone are staggering. Tobacco use is the single greatest preventable cause of non-communicable diseases and is the only risk factor that is common to the four main NCD categories, as was mentioned earlier. Globally, tobacco causes one in six of all NCD deaths but, in Scotland, it causes about one in four of those deaths. Action on Smoking and Health (Scotland), a well-respected charity, is committed to supporting the objectives of the WHO’s campaign, particularly when it comes to supporting Scots who want to quit the habit, who amount to 67 per cent of smokers.
I will touch briefly on childhood obesity and the need for physical activity and healthier diets, which of course are all interrelated. Childhood obesity is an increasing problem and one that did not exist to any significant extent when I was a child during and after the second world war. As the WHO has stated, if we do not combat childhood obesity, it will clearly lead to heart disease, diabetes and other serious illnesses. Indeed, the odd case of type 2 diabetes has been diagnosed in childhood. I will not go into all the facts and figures but, worryingly, we have seen a rise in obesity among girls in Scotland from 14 to 18 per cent from 1998 to just last year. Sadly, the problem is more acute in deprived areas.
Increased physical activity is an obvious factor in overturning the problem. I am sure that all members would like more children to take up running or swimming rather than spend too much time on computer games. Similarly, a healthy diet, as recommended by the WHO, encourages concentrating on fruit and vegetables and seeking to achieve the recommended five a day. I have been told anecdotally that the British diet was at its healthiest during the second world war and, as a war baby, I remember consuming the Government-provided orange juice, which I loved.
The debate has been constructive. I commend the work of the WHO in its efforts to combat these diseases and conditions. Let us hope that we see a significant improvement by 2025, if not before then. I again thank Dennis Robertson for bringing the debate to the chamber.
17:23
I thank Dennis Robertson for securing the debate, especially on this day, which is world heart day. The World Health Organization’s goal to reduce premature cardiovascular disease deaths by 25 per cent by 2025 is an ambitious goal whose time has come to be taken seriously. The goal sets parameters, including a 25 per cent reduction in high blood pressure, a 10 per cent increase in physical activity and a 30 per cent reduction in tobacco use. We know that all those factors contribute to diseases and conditions with the highest mortality rates in Scotland. In my region of South Scotland alone, the number of heart-related deaths every day is 1.2 in South Lanarkshire, 1.1 in the Borders and 1.5 in Dumfries and Galloway.
It is not enough to look at non-communicable diseases in isolation. We have to recognise that they often exist as comorbidities and we have to recognise the singular concern of NCDs. We know that diabetes needs a treatment other than smoking cessation, but we now have information that active and passive smoking increase the risk of type 2 diabetes. It is of course up to each person to decide whether they want to stop smoking, but we have a duty to protect children, and to support those smokers who want to stop.
The Smoking Prohibition (Children in Motor Vehicles) (Scotland) Bill, which I introduced and which we will discuss in Parliament next week, addresses the very duty that I have just mentioned. Banning smoking in cars when children are present will raise awareness among adults, and will protect children from the 60,000 journeys per week during which they are currently exposed to toxic second-hand smoke.
However, we know that diseases such as diabetes need more than legislative measures to bring about a reduction in the harm that they cause. Education in the most deprived areas in Scotland must be more active and robust. The British Heart Foundation tells us that there needs to be a focus on prevention, and that a national strategy should be developed to achieve that, and I agree.
I note the Scottish Government’s action on initiatives such as the Scottish diabetes improvement plan and on its tobacco control strategy work, both of which address individual problems. However, we have in reality seen some funding cuts, with services that work to prevent NCDs being slashed.
Scotland’s most deprived areas have benefited from the keep well check-up service in recent years. It is vital that the service is kept going, but it seems from the answers that I have received to my parliamentary questions that funding is to be slashed. The preventative check-up for heart disease and diabetes is best practice: it must be rolled out to those hard-to-help communities across Scotland and not deleted.
Diabetes Scotland says that there are approximately 45,000 people living with undiagnosed type 2 diabetes. The keep well programme helps in the early diagnosis of that condition and other NCDs, and it must be retained, especially if we want to tackle inequality in care for people with diabetes.
When we discuss the 25 by 2025 framework we need to look at the issues based on the needs of our population. We know that Scotland is facing the growth of an ageing population and that we already have a shortage of GPs, with a further shortage forecast. It is therefore critical that the Scottish Government takes the World Health Organization’s framework seriously and works to place the focus on prevention. The spend-to-save tactic must apply in combating NCDs.
It is our responsibility not only to care for people when they are ill, but to do everything that we can to ensure that every person leads a healthy life—no matter where they live in Scotland, or who they are—in order to reduce their risk of developing an NCD later in life.
17:27
I thank Dennis Robertson for bringing the debate to the chamber, and I thank members for their contributions. Some members present may recall that in June this year we discussed the potential for a non-communicable disease prevention strategy for Scotland at a joint meeting of the cross-party group on heart disease and stroke and the cross-party group on diabetes.
The aims of the 25 by 2025 framework focus on the right things. As with many reports that are addressed to a global audience, some of the detail relates to the challenge in Scotland, whereas in other areas we are already more ambitious. I will set out some of the overarching policies and strategies in Scotland that will help to address many of the wider areas in which the World Health Organization’s framework expects to achieve progress.
We know, as members have mentioned, that alcohol is one of the top risk factors for non-communicable disease. In order to tackle the scale of alcohol-related harm in Scotland, we have taken sustained and effective action since 2009 through our comprehensive alcohol framework.
The framework is in line with the WHO’s 10 priority measures on alcohol, which include action on pricing, availability and marketing as well as drink-driving policies, community action and health service programmes such as alcohol brief interventions. A key element of the framework—which is endorsed by WHO—is minimum unit pricing. The opinion from the European Court of Justice advocate general earlier this month very much left the door open for that policy. We remain certain that it is the right measure for Scotland and that it will make a real impact in tackling alcohol-related harm.
As all members mentioned, we know that a poor diet and excessive consumption of food and drink contributes directly to the high rates of the main causes of death and poor health in Scotland. We are committed to improving the nation’s diet through our work with a range of stakeholders, including retailers and caterers.
We have introduced a range of measures to improve diet and are spending more than £10 million in the four-year period between 2012 and 2016 on projects to encourage healthy eating. They include the healthy living award, the healthy living programme, the healthier Scotland cooking bus and Community Food and Health Scotland.
Last year, we launched the supporting health choices voluntary framework after a period of consultation with the food industry. The framework sets out voluntary action for the food industry, including manufacturers, retailers and caterers, to encourage and support consumers to make healthier choices.
Scotland is among the first countries in the world to have introduced an ambitious target for reducing smoking prevalence. Our ambitious target is to reduce it to 5 per cent of our population by 2034. We want to create a generation of young people and young adults who do not smoke, to create a Scotland in which young people and young adults turn away from tobacco use, and to get the health, social and economic benefits that will come from that approach. As a Government, we recognise we are taking an ambitious approach to tobacco control, but we believe that we need to take bold and decisive action to reduce smoking prevalence in Scotland to create a tobacco-free generation.
The 5 per cent target is certainly challenging. Achieving it will require a determined effort on the part of the Government and the other agencies that have a role to play in helping to reduce smoking prevalence. The target can help to ensure that we fundamentally change the whole culture of smoking in Scotland and get the health benefits that will come from that.
We will take forward a range of measures in the five-year tobacco strategy to ensure that we take action. The strategy includes: the national campaign that was launched last year to raise awareness of the dangers that are associated with smoking in enclosed spaces; the introduction of a new target to achieve a substantial reduction in children’s exposure to second-hand smoke by 2020; continued support for parents to create smoke-free homes for children; and the aim of all our NHS boards having smoke-free grounds during 2015.
Members know that a bill is undergoing stage 1 consideration that looks to build on efforts to reach our goal and that we saw a fall from 23 to 20 per cent in the rates of tobacco prevalence in Scotland from 2013-14.
Implementing all our strategies will be vitally important in addressing the risk factors that can lead to a range of long-term, cancer and cardiovascular conditions. Cancer, heart disease, stroke and diabetes remain priorities for the Scottish Government. Our substantial investment in those areas, along with our wider public health strategies, has contributed to a reduction in mortality rates for heart disease of more than 43 per cent in the past 10 years, a reduction for stroke of 34 per cent since 2007, and an overall reduction in the rate of cancer-related mortality of 11.4 per cent.
The minister will welcome the forthcoming report from the British Heart Foundation and Richmond that will come out by March next year. It will look at all the figures in the 25 by 2025 framework that are pertinent to Scotland. That will help to shape the Government’s objectives and forward-looking strategies.
We will continue to look at any evidence that will help frame and form our strategies in the coming years. Given the figures that I mentioned, I do not think that it is all doom and gloom: people are generally living longer and healthier lives. However, we must be conscious that more can be done.
Our condition-specific improvement plans, including heart disease, stroke and diabetes, which were published last year, set out priority areas for action to improve healthcare services and ensure that people who are living with such conditions receive the best care possible. The immunisation programmes are not necessarily related to the diseases that we are talking about tonight but their uptakes are also encouraging.
It is clear that these challenges are not for the NHS or indeed Scottish Government to solve alone. Any solution requires the engagement of the whole of Scottish society. We are working to encourage people to make lifestyle changes such as adopting a healthy diet and a healthy approach to alcohol, managing their weight, increasing their physical activity and stopping smoking.
Early intervention does seem to be working. Many schools are adopting extra activity over and above the two hours of physical education, which has greatly increased under this Government.
Although a focused effort to improve people’s health is essential, we also recognise that to achieve our aims for a healthier, fairer Scotland we need to focus effort towards the wider challenges of tackling health inequalities. It is not easy, but we will continue to work hard to do that.
Meeting closed at 17:35.Previous
Decision Time