Environmental Health in A New Era: A Scottish Response

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Environmental Health in A New Era A Scottish
Response

• George Morris
• Scientific Policy Adviser
• CMO Directorate
• Scottish Government

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- drivers -
opportunity - mechanism
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drivers Why is Scotland thinking afresh about
Environment and Health?

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• A clear challenge on health and wellbeing

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• Scotland longer the Sick Man of Europe
• Reducing rates of many chronic diseases improving
  life expectancy but still much to do
• Concerns over alcohol, drugs, obesity, wellbeing
  etc.
• Rising inequalities

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Glasgow slums in 1990
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Comparison of lung cancer mortality in West of
Scotland and 3 major cohorts
West of Scotland
Average annual death rate /100,000
American Cancer Society volunteers
UK doctors
US veterans
Source Dr Harry Burns
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A 21st Century Scottish Environmental Health
agenda

• An Environment Not only -
• Free from physical, toxic, infectious and
  allergic hazard
• But also-
• Nurturing of positive health, wellbeing and
  resilience
• Consistent with and promoting of healthy
  behaviour
• Consistent with the development and maintenance
  of social capital
• Consistent with greater equity in health
• and none of this will be delivered by
  compartmentalising issues in environmental
  health or indeed across the wider spectrum of
  public health.

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The traditional approach to environment is

• Narrow
• Compartmentalised
• Hazard-Based
• and hitherto undeniably powerful and effective.
  but

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Can we truthfully say that what we do actually
reflects our current understanding of how health
is created and destroyed?
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Eras in Epidemiology
after Susser Susser
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(No Transcript)
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Has there ever been a greater mismatch between
paradigm policy and action?
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Failure to deal effectively with complexity
carries a cost for Scotland in terms of

• Understanding the true contribution of
  environment to health, safety and wellbeing
• Defining the right research agenda
• Recognising the convergence, synergies and
  antagonisms in the big cross-cutting agendas of
  government
• Realising the potential of Community Planning
• Tackling Inequalities

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opportunity Why might this be the time to take
a significant step?

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There is acceptance that complex challenges
demand a smarter but also a more strategic
approach.people are listening
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• announcement (in 2005) of intention to develop
  a Strategic Framework for Environment and
  Health in Scotland

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• themes of Scottish Government
• Wealthier and Fairer
• Healthier
• Safer and Stronger
• Smarter
• Greener

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mechanism What would a modern strategic
environment and health approach look like?

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It would frame the problems in health, safety and
wellbeing with reference to all the factors which
bear upon them
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The DPSEEA model
DRIVING FORCES Economic, social, political
ACTIONS
PRESSURES
STATE
EXPOSURE
EFFECT
WHO(2004)
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DRIVING FORCES Economic, social, political
Modified DPSEEA
ACTIONS
PRESSURES
STATE
CONTEXT Social, Cultural, Demographic, Economic,
Behavioural Includes perception of environment
EXPOSURE
EFFECT
Morris et al (2006)
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It would be assembled by creating and
co-ordinating systems
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The three cornerstones of strategy

• Intelligence System
• Evaluation System
• Levers of Change System

Morris et al, 2006 (in press) Publication in
Public Health Oct 2006
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systems would be built incrementally to target
agreed priorities
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the strategy will have inclusive, coherent
structures for governance
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How far have we got?
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• There is convergence between pubic health and
  sustainability, but also other crosscutting
  policy objectives but if we can get to grips with
  the problem interconnectivity introduces real
  opportunity
• MANY OF THE BIG CROSSCUTTING ISSUES FOR
  GOVERNMENT
• RELATE TO PLACE

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In Conclusion
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• If we continue to do more of the same we are very
  likely to get more of the same!