1. AGM Slides

2. Sir
Harry
Burns
Chief
Medical
Officer

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03 01
-2
00
5
Life expectancy trends
Life expectancy: Scotland & other Western European Countries, 1851-2005
Source: Human Mortality Database
90.0
80.0
70.0
Portugal
60.0
Scotland
50.0
40.0
30.0
20.0

4. U
Li kra
th in
G ua e
er ni
m a
Es an
C
ze S to y
ch lo ni
Re ven a
pu ia
b
R
La lic
us
Fi tvi
sia
H nla a
n u n
Fe n d
de gar
ra y
Au tio
Be
n
lg
Fr stri
iu
a a
m
Sw P nce
-F
itz ol a
le
er nd
m
Be
la
is
lg
h S nd
iu
sp pa
m
ea in
-F N
U
k
ni
re et Cro ing
te
nc he a
d
h rla t ia
Ki
sp n
ng
ea ds
do
ki
m
n
- E It g
ng aly
Ire lan
d
N lan
or d
U
Po w
ni
a
te
D rt u y
en ga
U dK
m l
ni in
te g
a
do
d
Is rk
Ki m
r
ng - M ael
M do Sc al
ac m ot ta
ed - la
on Wa nd
ia l e
, s
G FY
r R
Sw eec
ed e
en
% regular smokers
Prevalence of smoking by country,
in 15 year olds by sex, 2000/01, Europe
50
45
Boys
40
Girls
35
30
25
20
15
10
5
0
World Health Organization (1997 and 2003)
www.heartstats.org

5. Smoking prevalence - Males
Males

6. Smoking prevalence - Females
Females

7. Coronary heart disease mortality
Men aged 15-74 years
Denmark
Finland
Norway
Sweden
Scotland
Age-standardised mortality per 100,000
600
500
400
300
200
100
1950
1960
1970
1980
1990

8. Chronic liver disease, including cirrhosis
Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012

9. Chronic liver disease, including cirrhosis
Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012

10. Comparison to WE Mean
Males

11. Standardised mortality rates by cause, all ages:
Glasgow relative to Liverpool & Manchester
All ages, both sexes: cause-specific standardised mortality ratios 2003-07, Glasgow relative
to Liverpool & Manchester, standardised by age, sex and deprivation decile
Calculated from various sources
350
300
248.5
229.5
Standardised mortality ratio
250
200
168.0
150
126.7
112.2
111.9
All cancers
(malignant
neoplasms)
Circulatory system
131.7
100
50
0
Lung cancer
External causes
Suicide (inc.
undetermined intent)
Alcohol
Source: Walsh D, Bendel N., Jones R, Hanlon P. It‟s not „just deprivation‟: why do equally deprived UK cities experience different health outcomes? Public Health, 2010
Drugs-related
poisonings

12. Workers in the 1950s

13. More liveable housing?

15. Man’s search for meaning
• “Those who have a 'why' to live, can bear with
almost any 'how'.”
Viktor Frankl 1902-97

16. Aaron Antonovsky 1923-1994

17. Sense of coherence....
“.....expresses the extent to which one has a
feeling of confidence that the stimuli deriving
from one's internal and external environments
in the course of living are structured,
predictable and explicable, that one has the
internal resources to meet the demands posed
by these stimuli and, finally, that these
demands are seen as challenges, worthy of
investment and engagement."

18. For the creation of health....
....the social and physical environment
must be:
u Comprehensible
u Manageable
u Meaningful
u ......or the individual would experience
chronic stress

19. 00-046
The Founders’ Network
Evening Cortisol Levels Increase with
Months of Orphanage Rearing *
-0.2
-0.4
-0.6
-0.8
*linear trendline
-1
-1.2
0
10
20
30
40
Months of Orphanage Rearing
50

20. STRESS AND GRADE OF
EMPLOYMENT: MEN
Salivary Cortisol
20
18
16
nmol/l
14
12
Higher Grade
Lower Grade
10
8
6
4
2
Time of Day
Steptoe et al. 2003, Psychosomatic Medicine, 65, 461-470
22-22.30
20-20.30
18-18.30
16-16.30
14-14.30
12-12.30
10-10.30
08-8.30
0

26. Attachment theory


Ainsworth
 Deep emotional connection that infant develops with
primary caregiver
 Reflects an “internal working model”expressing the
infant‟s expectations of parental behaviour in
meaningful situations
 Basis for development of later relationships
Increasingly recognised as determinant of later emotional,
cognitive and social outcomes

27. Adverse childhood events study
Physical/sexual/emotional
abuse
Neglect (physical/emotional)
Domestic substance abuse
Domestic violence
Parental mental illness
Parental criminality

28. Adverse childhood events risk of alcoholism
Hillis et al 2011

29. Adverse childhood events
risk of perpetrating violence
Boys experiencing physical abuse
Duke et al 2010

30. The molecular biology of a cuddle

31. Creating wellness
Resources which
enhance resilience
Family
Nurture
Intelligence
Work
Material resource
Identity
Cultural stability
Stable set of answers
Optimism
Sense of coherence
Seeing the world as:
Structured
Predictable
Feeling that it is:
Manageable
Meaningful
Events
Stress
Tension
Resolution
Wanting to engage
Wellbeing

32. Management of complex
systems
importance of instability – “never
waste a good crisis”
Order generating rules – develop a
common vision of what you want the
future to be
Emergence of solutions – accept that the
outcome may not be exactly what you
anticipate
The

33. Implementing improvement at scale….
can it be done?

34. NHSScotland Surgical Safety Briefings

35. Healthcare Associated Infection

36. NHSScotland Surgical Mortality
23% reduction from median

37. Implementing improvement at scale….
can it be done?

40. Social connectedness
148
studies comprising 308,849
participants, high levels of social
integration conferred a 50% increased
likelihood of survival.
Complex patterns of social integration
conferred a 90% increase in survival.
Simple indicators such as living alone
versus living with others conferred a
survival benefit of only 19%.

41. Transforming society in Scotland
years collaborative – “Make Scotland
the best place in the world to grow up”
 Reduce offending and reoffending – “How
soon can we close a prison?
 Reduce dependency in the elderly –“Make
60 the new forty!”
 Early

42. The Early Years Collaborative Ambition
To make Scotland the best place in the world to
grow up in by improving outcomes, and
reducing inequalities, for all babies, children,
mothers, fathers and families across Scotland
to ensure that all children have the best start in
life and are ready to succeed.

43. Workstream 1
Aim
Primary Drivers
Societal
Issues
Reduce Infant
Mortality
A reduction of 15% in
the rates of stillbirths
and infant mortality by
2015
Post-birth
actions
Pre-birth
actions
Secondary Drivers

44. Workstream 2
Aim
Primary Drivers
Societal Issues
85% of all children
have all the
developmental
skills and abilities
expected of a 27-30
month old by the
end of 2016
Child’s
physical &
mental health
and
emotional
development
Carer’s
physical &
mental health
and skills
Secondary Drivers

45. Workstream 3
Aim
Primary Drivers
Societal Issues
90% of all children
have all the
developmental
skills and abilities
expected at the
start of primary
school by the end
of 2017
Child’s
physical &
mental health
and
emotional
development
Carer’s
physical &
mental health
and skills
Secondary Drivers

46. Workstream 4
Aim
Primary Drivers
EYC is a strategic
priority & underpins
all policy planning
and operational
activity
Provide the
Leadership System
to support quality
improvement
across the Early
Years Collaborative
EYC values, culture
and behaviours are
modelled by all
leaders at all levels
Infrastructure to
support delivery of
EYC
Secondary Drivers

47. 90% of children at Grassmarket nursery
school will receive a bedtime story

48. Alfie
‘I like my
bedtime story
because it helps
me to dream‟

49. Reducing offending/reoffending
Management
of stressful situations?
– Mindfullness?
Management
of normal daily life?
– OT project at Craiginches
Access
to external resources of support?
– Who helps with navigation?
A
sense of meaning and purpose in life?
– A job?

52. Jimmy Reid 1971

53. Rectorial Address

“Let me right at the outset define what I mean by
alienation. It is the cry of men who feel
themselves the victims of blind economic forces
beyond their control. It's the frustration of
ordinary people excluded from the processes of
decision making. The feeling of despair and
hopelessness that pervades people who feel with
justification that they have no real say in shaping
or determining their own destinies....”

54. Do something brave today –and don‟t
forget the hugs!

55. AGM Slides