NHS HDL(2000) 26

Health Department

Dear Colleague

THE SCOTTISH HEALTH SURVEY

Summary

1 . This letter notifies Health Boards and NHS Trusts of the publication today of the Scottish Health Survey 1998. It is the second in a series of surveys designed to make a major contribution to monitoring health in Scotland. The first survey took place in 1995 and the next will take place in around another 3 years.

2. The 1998 Survey provides robust data covering key areas of Scotland's health and the conditions and lifestyle behaviours which contribute to it. It examines differences between regions and social classes, trends over time and comparisons with England. Background information is at Annex A.

3. A copy of the Survey Report is enclosed. Health Boards will also be provided with the anonymised detailed survey dataset, to supplement local data already available, to assist them in targeting action where health need is greatest.

Action

4. Board General Managers/Chief Executives are invited to make copies available to those with a responsibility for public health and health promotion.

Yours sincerely

GODFREY ROBSON
Director of Policy

4 December 2000

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ANNEX A

Background

1 . People living in Scotland experience relatively high rates of mortality from major diseases compared with the populations of England and many other western countries. Deaths and ill-health from coronary heart disease, cancer and stroke are higher than elsewhere. However, statistics on the numbers and causes of death do not provide explanations for these differences. Other statistics, such as hospital admissions, are derived from people's contacts with the National Health Service, so tend to be concerned with limited, albeit more serious, manifestations of ill-health. Before the Scottish Health Survey there was no comprehensive picture of the health of the whole population, its biological characteristics or health-related behaviour. Nor, therefore, was reliable information available on trends in health and related behaviour.

2. The Scottish Health Survey was designed to overcome this lack of knowledge. The specific aims of the survey are:

• to estimate the prevalence of particular health conditions in Scotland.
  
  
• to estimate the prevalence of certain risk factors associated with these health conditions and to document the pattern of related health behaviours.
  
  
• to look at differences between regions and between subgroups of the population in the extent of their having these particular health conditions or risk factors, and to enable comparisons with other national statistics and with people in England.
  
  
• to monitor trends in the population's health over time.
  
  
• to make a major contribution to monitoring progress towards the Scottish health and dietary targets.

3. The main focus of the 1998 Survey was the same as that in 1995 - cardiovascular disease and its associated risk factors such as smoking, eating habits, physical activity and alcohol consumption. However, important additions have been the extension of the sample to include both the 2-15 and 65-74 age groups (thus increasing the total sample size to around 13,000) and the inclusion of the new topics of asthma and bladder problems. Future surveys will, nevertheless, retain the flexibility to take account of changing circumstances and priorities.

4. One of the most important aspects of the Survey programme is the ability to monitor changes in the population's health over time. Given that changes to lifestyle behaviours cannot be accomplished overnight, there have been no major changes between 1995 and 1998. However, some encouraging signs appear to be emerging. For example, there has been a very welcome increase in fruit consumption, an increase in the consumption of potatoes, pasta or rice and a fall in the numbers of those who usually or generally add salt to food at the table. This would seem to confirm that the Scottish Executive's drive to improve Scotland's diet is now beginning to deliver some positive results.

5. On the other hand, there are concerns on a number of fronts. The prevalence of obesity continues to increase. There has been no significant change in adult smoking prevalence, and, contained within this, a slight increase in young women smoking. The proportion of men drinking in excess of 21 units of alcohol a week is unchanged and there has been a slight increase in the proportion of women exceeding 14 units a week. Particularly discouraging are the reported drinking habits of girls and boys. Among ages 13-15, some 9% of girls and 12% of boys reported having drunk alcohol in the past week. Moreover, these percentages may be conservative given the potential for under-reporting on the issue of alcohol consumption by this particular age group. Our levels of physical activity also remain inadequate. Thus the Survey is giving us the very clear message that we must continue to take vigorous and concerted action across all four fronts of smoking, diet, alcohol consumption and physical exercise if we are to achieve the overall improvement we seek in these lifestyle behaviours and a resultant reduction in the prevalence of Scotland's 3 main killer diseases of coronary heart disease, cancer and stroke.

6. Given the substantial nature of the Report, a summary document containing the main findings of the Survey has been produced, for ease of reference, and a supply of these is also enclosed. Further copies of the summary document are available, free of charge, from the Scottish Executive Health Department. Additional copies of the main Report, price £30, can also be purchased from The Stationery Office. The main Report and the summary will also be made available on the Web at www.show.scot.nhs.uk/scottishhealthsurvey.