AGM Slides
Sir
Harry
Burns
Chief
Medical
Officer
18
51
18 -18
55 53
18 -18
59 57
18 -18
63 61
18 -18
67 65
18 -18
71 69
18 -18
75 73
18 -18
79 77
18 -18
83 81
18 -18
87 85...
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...
Smoking prevalence - Males

Males
Smoking prevalence - Females

Females
Coronary heart disease mortality
Men aged 15-74 years
Denmark
Finland
Norway
Sweden
Scotland

Age-standardised mortality p...
Chronic liver disease, including cirrhosis

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

Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012
Comparison to WE Mean
Males
Standardised mortality rates by cause, all ages:
Glasgow relative to Liverpool & Manchester
All ages, both sexes: cause-sp...
Workers in the 1950s
More liveable housing?
Man’s search for meaning
• “Those who have a 'why' to live, can bear with
almost any 'how'.”

Viktor Frankl 1902-97
Aaron Antonovsky 1923-1994
Sense of coherence....
“.....expresses the extent to which one has a
feeling of confidence that the stimuli deriving
from ...
For the creation of health....
....the social and physical environment
must be:
u Comprehensible
u Manageable
u Meaningful...
00-046

The Founders’ Network

Evening Cortisol Levels Increase with
Months of Orphanage Rearing *
-0.2

-0.4
-0.6
-0.8

*...
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...
Attachment theory




Ainsworth
 Deep emotional connection that infant develops with
primary caregiver
 Reflects an “i...
Adverse childhood events study
Physical/sexual/emotional

abuse
Neglect (physical/emotional)
Domestic substance abuse
...
Adverse childhood events risk of alcoholism

Hillis et al 2011
Adverse childhood events
risk of perpetrating violence
Boys experiencing physical abuse

Duke et al 2010
The molecular biology of a cuddle
Creating wellness
Resources which
enhance resilience

Family
Nurture
Intelligence
Work
Material resource
Identity
Cultural...
Management of complex
systems
importance of instability – “never
waste a good crisis”
Order generating rules – develop a
...
Implementing improvement at scale….
can it be done?
NHSScotland Surgical Safety Briefings
Healthcare Associated Infection
NHSScotland Surgical Mortality

23% reduction from median
Implementing improvement at scale….
can it be done?
Social connectedness
148

studies comprising 308,849
participants, high levels of social
integration conferred a 50% incr...
Transforming society in Scotland
years collaborative – “Make Scotland
the best place in the world to grow up”
 Reduce off...
The Early Years Collaborative Ambition
To make Scotland the best place in the world to
grow up in by improving outcomes, a...
Workstream 1
Aim

Primary Drivers
Societal
Issues

Reduce Infant
Mortality
A reduction of 15% in
the rates of stillbirths
...
Workstream 2
Aim

Primary Drivers
Societal Issues

85% of all children
have all the
developmental
skills and abilities
exp...
Workstream 3
Aim

Primary Drivers
Societal Issues

90% of all children
have all the
developmental
skills and abilities
exp...
Workstream 4
Aim

Primary Drivers
EYC is a strategic
priority & underpins
all policy planning
and operational
activity

Pr...
90% of children at Grassmarket nursery
school will receive a bedtime story
Alfie
‘I like my
bedtime story
because it helps
me to dream‟
Reducing offending/reoffending
Management

of stressful situations?

– Mindfullness?
Management

of normal daily life?

...
Jimmy Reid 1971
Rectorial Address


“Let me right at the outset define what I mean by
alienation. It is the cry of men who feel
themselve...
Do something brave today –and don‟t
forget the hugs!
AGM Slides
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
AHDS 2013 KN1 Harry Burns
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AHDS 2013 KN1 Harry Burns

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  • The man who first understood what was happening was this chap who was an /American sociologist who finished his career working in Istrael where he studied adults who, as children were in concentration camps
  • Antonovsky described the sense of coherence, something children developed if the parenting they experienced allowed them to understand that the world was predictable and explicable, that they had the resilience to cope with what the world threw at them and that the effort of coping was worthwhile expending
  • Failure of see the world as..........would be extremely stressful
  • Even at a national level, you can see the relationship between control and mortality. In former Soviet countries, those with lowest control (Russia) have highest mortality and Czech Rep and Poland have high control and low mortality
  • Dr Bruce McEwen, with whom we are collaborating has studied the brains of these monkeys. He finds that they do not develop in the same way as monkeys not exposed to stress. The PF cortex gets less cell growth, as does the hippocampus but the amygdala sees more dense connections develop between cells. The significance of that is that the hip[pocampus suppresses the stress response while the amygdala upregulates it. If they get out of balance a potentially permanent resetting of the stress response results. Also, the hippocampus is important in memory development so any reduction in cell growth could affect learning. The amygdala is associated with emotion so enlargement here will cause aggression, anxiety etcLoss of PF cortex will reduce executive functioning
  • MRI scan of hippocampus. We’re measuring HC volume in affluent/deprived glaswegians
  • This slide is a more complete rendition of Antonovsky’s hypothesis than I usually show. The two elements which interact to create wellbeing are the sense of coherence - which the EYC will help develop – and the GRRs which are the more conventionally understood socioeconomic determinants of health. Fixing one without the other is wasteful andllkely to fail but fixing the sense of coherence is the more important because without it, bad things happen. SoC and GRRs interact throughout life with GRRs helping us when SoC is tested beyond normal bounds. We need to develop both but EYC, in producing young people with astrong sense of control and aspiration with help build GRRs in society.
  • Data from at least 9 out of 10 Boards with Data available on Extranet. Each month has an average sample size of 2949 procedures
  • AHDS 2013 KN1 Harry Burns

    1. 1. AGM Slides
    2. 2. Sir Harry Burns Chief Medical Officer
    3. 3. 18 51 18 -18 55 53 18 -18 59 57 18 -18 63 61 18 -18 67 65 18 -18 71 69 18 -18 75 73 18 -18 79 77 18 -18 83 81 18 -18 87 85 18 -18 91 89 18 -18 95 93 18 -18 99 97 19 -19 03 01 19 -19 07 05 19 -19 11 09 19 -19 15 13 19 -19 19 17 19 -19 23 21 19 -19 27 25 19 -19 31 29 19 -19 35 33 19 -19 39 37 19 -19 43 41 19 -19 47 45 19 -19 51 49 19 -19 55 53 19 -19 59 57 19 -19 63 61 19 -19 67 65 19 -19 71 69 19 -19 75 73 19 -19 79 77 19 -19 83 81 19 -19 87 85 19 -19 91 89 19 -19 95 93 19 -19 99 97 20 -20 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. 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. 5. Smoking prevalence - Males Males
    6. 6. Smoking prevalence - Females Females
    7. 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. 8. Chronic liver disease, including cirrhosis Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012
    9. 9. Chronic liver disease, including cirrhosis Source: Whyte B., Ajetunmobi T. Still “the sick man of Europe”? GCPH, 2012
    10. 10. Comparison to WE Mean Males
    11. 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. 12. Workers in the 1950s
    13. 13. More liveable housing?
    14. 14. Man’s search for meaning • “Those who have a 'why' to live, can bear with almost any 'how'.” Viktor Frankl 1902-97
    15. 15. Aaron Antonovsky 1923-1994
    16. 16. 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."
    17. 17. 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
    18. 18. 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
    19. 19. 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
    20. 20. 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
    21. 21. Adverse childhood events study Physical/sexual/emotional abuse Neglect (physical/emotional) Domestic substance abuse Domestic violence Parental mental illness Parental criminality
    22. 22. Adverse childhood events risk of alcoholism Hillis et al 2011
    23. 23. Adverse childhood events risk of perpetrating violence Boys experiencing physical abuse Duke et al 2010
    24. 24. The molecular biology of a cuddle
    25. 25. 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
    26. 26. 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
    27. 27. Implementing improvement at scale…. can it be done?
    28. 28. NHSScotland Surgical Safety Briefings
    29. 29. Healthcare Associated Infection
    30. 30. NHSScotland Surgical Mortality 23% reduction from median
    31. 31. Implementing improvement at scale…. can it be done?
    32. 32. 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%.
    33. 33. 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
    34. 34. 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.
    35. 35. 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
    36. 36. 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
    37. 37. 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
    38. 38. 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
    39. 39. 90% of children at Grassmarket nursery school will receive a bedtime story
    40. 40. Alfie ‘I like my bedtime story because it helps me to dream‟
    41. 41. 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?
    42. 42. Jimmy Reid 1971
    43. 43. 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....”
    44. 44. Do something brave today –and don‟t forget the hugs!
    45. 45. AGM Slides

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