On the state of public health: Annual report of the Chief Medical Officer 2009

Sir Liam Donaldson, the Chief Medical Officer, today published his 2009 Annual Report, in which he states that the harm caused by inactivity is very substantial. Up to 70% of adults in England do not do the recommended minimum amount of physical activity and child fitness is falling by up to 9 percent every decade.

In his report, On the State of Public Health, England’s Chief Medical Officer calls for action to help reverse the nation’s trend towards physical inactivity, including recommending that the Government undertakes a pilot of fitness assessments for every secondary school pupil. Sir Liam is calling for a major change to get the population active, whatever their age.

Sir Liam said:

'Inactivity pervades the country. It affects more people in England than the combined total of those who smoke, misuse alcohol or are obese. Being physically active is crucial to good health. If a medication existed that had a similar effect on preventing disease, it would be hailed as a miracle cure.

'Studies indicate that approximately 61 per cent of men and 71 per cent of women over the age of 16 years failed to meet the minimum adult recommendation for physical activity. Inactivity increases the risk of more than six chronic diseases. This is of grave concern. Improving physical fitness in children helps build a lifelong habit of participation in physical activity. We must get our children moving to improve their future health.'

In addition to a pilot of comprehensive physical fitness testing in secondary schools, Sir Liam also called for:

  • New recommendations on the minimum physical activity requirements to be built into public health programmes.
  • Recommendations for minimum physical activity requirements to be consistent across the United Kingdom.
  • Further research to be undertaken to establish the most effective interventions to increase physical activity within specific age groups.

Sir Liam’s Annual Report also addressed four other key areas of public health.

Winter kills

Typically mortality rises 18 per cent during the winter months in England. Each one degree Celsius decrease in average winter temperature results in 8,000 additional winter deaths in England. Many of these deaths are amongst older people, especially women, and those with underlying health problems. Most are due to increased cardiac death, strokes and respiratory problems.

Cold weather has a number of predictable health impacts. It causes blood pressure to rise, weakens the lung’s resistance to infection and makes blood thicker, increasing the risk of thrombosis. The annual cost to the NHS of treating winter-related disease due to cold private housing is over £850 million.

To address the issue of excess winter mortality, Sir Liam calls for:

  • A national cold weather plan to be developed.
  • Healthcare providers to identify those who are vulnerable to harm from cold weather and refer them for appropriate help.
  • Supermarkets and local shops to consider offering free home deliveries to vulnerable people during periods of cold weather.
  • Warm clothing technology appropriate for older people to be developed and promoted.
  • Further research into the risk factors for winter mortality and how it might be prevented.

Sir Liam said:

'England’s annual winter death toll averages over 30,000 people. Though this has gradually fallen over the last half century, it is still too high. Finland - a colder country than ours – has a 45 per cent lower winter death rate. We have a comprehensive and effective national heatwave plan that is put into place during excessively hot weather. If a comparable national cold weather plan were to be developed, it could save thousands of lives each year.'

Rare is common

A disease is considered rare when it affects fewer than five in every 10,000 people. There are more than 6,000 rare diseases, affecting around three million people in England. Rare diseases are an important cause of illness and death, but do not receive the attention they need and deserve.

As rare diseases can affect many different body systems, misdiagnosis is common. In one study, over a third of people with a rare disease were initially misdiagnosed - some experiencing a delay of up to 30 years from first symptoms to the correct diagnosis being made. Whilst there have been significant improvements in diagnosing and treating children with rare diseases, the same is not true for adults. People with rare diseases are now living longer, but the transition from children’s care to adult services is often difficult.

Sir Liam calls for:

  • The appointment of a National Clinical Director for rare diseases.
  • The network of reference centres for rare diseases to be strengthened to enable better coordination of specialist services, including the transition from paediatric to adult services.
  • Adequate numbers of specialists to be recruited and trained so that future service needs can be met.
  • Strengthened research to develop and market medicines for the ‘orphaned’ rare diseases.
  • Increased public and professional awareness of this neglected group of diseases.

Sir Liam said:

'While many excellent services are provided for those with rare diseases, this is not the norm and services are inconsistent across the country. Improved coordination and management is needed to ensure that excellence becomes the standard, no matter where a patient lives.'

Grandparenting for health

There are currently over 11 million grandparents in England and this number is rising. Today, grandparents are living longer and, with family sizes becoming smaller than in previous decades, they have more time to spend with each of their grandchildren. Grandparents could be a great asset to a child’s health and development, but are usually overlooked in discussions about building healthy childhoods.

Almost 61 per cent of grandparents visit their grandchildren weekly, and 92 percent of grandparents find their grandchildren very rewarding. Grandparents undertake a wide range of activities with young grandchildren. Many of these help a child’s general social and educational development, but few activities focus on health. More health related activities would be beneficial for both grandchildren and grandparents. Studies show that for many the relationship remains strong and influential into adolescence. Adolescents reported better emotional health and were better adjusted if their closest grandparent was involved in their life.

To capitalise on this relationship, Sir Liam recommends:

  • The important contribution of grandparents to children’s health and well-being should be recognised and valued.
  • Evidence-based tools and advice for grandparents to promote the health of their grandchildren should be produced.
  • Policy initiatives aimed at improving children’s health should consider the potential role and impact of grandparents.
  • Children should be encouraged to maintain their relationships with their grandparents and support them throughout life.

Sir Liam says:

'Childhood is a vital time for health. Grandparents are a great asset in a child’s development. When policy on children’s health is being developed the role of grandparents should form part of the thinking. Developing the role of grandparents as educators and mentors of their grandchildren’s health could add an important new dimension, as well as benefitting their own health.'

Climate change and health

Climate change and health are inextricably linked. Climate change damages global health in many ways. For example, drought caused by climate change harms crop growth, and therefore causes malnutrition. Drought also threatens the improvements in clean water supply that are being made in many less developed countries. Worldwide, 5.5 million years of healthy life are already lost annually because of climate change.

There are a number of fortuitous opportunities to slow climate change whilst also improving health. In his report, Sir Liam recommends that national targets should be set to double travel on foot and to increase travel by bicycle eight-fold. This will reduce obesity, diabetes and heart disease significantly, whilst also slowing climate change. The NHS also has an important role to play, as it has the greatest carbon footprint of any public sector organisation in Europe. It must take opportunities to reduce its carbon emissions whilst also enhancing service and efficiency.

Sir Liam also called for:

  • The synergies between improving health and slowing climate change to be championed by the Government and health leaders to drive bold lifestyle changes.
  • The health impacts of climate change to feature prominently in undergraduate and postgraduate health professional education curricula.
  • The NHS in England to make its facilities readily accessible by public transport, and to make services increasingly available online, using modern technology, to reduce travel.
  • The NHS in England should use its buying power and other means to drive rapid transition to a low-carbon economy; the aim should be to reduce its carbon footprint by 10 per cent from its 2007 level by 2015.

Sir Liam said:

'Climate change and health are inextricably linked. A problem that is everybody’s is too easily treated as a problem that is nobody’s.'

Notes to editors

1. Professor Sir Liam Donaldson is the Chief Medical Officer for England. His 2009 Annual Report can be found at link below.

2. This is Sir Liam’s ninth Annual Report on the state of the nation’s health. His previous Annual Reports have called for action on key public health issues, including smoke-free enclosed public places (2002 and 2003 report), the obesity ‘time bomb (2002 report), an opt-out system for organ donation (2006 report) and a minimum unit pricing on alcohol to curb binge drinking (2008 report).
3. For further information or requests for interviews, please contact the Department of Health newsdesk on 020 7210 5221.

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