A report by the Scottish Collaboration for Public Health Research and Policy (SCPHRP), a public health consortium funded by the Medical Research Council (MRC) and Scottish Chief Scientist Office, has found that schemes aimed at young children and their parents in particular could help Scotland to fling its ‘sick man of Europe’ image into the North Sea.
Four reviews of 30,000 studies of public health interventions provide an evidence-based starting point for SCPHRP to develop new strategies that, if adopted, could improve Scotland’s poor historic health record and reduce steep health inequalities in the long term.
SCPHRP researchers have begun the challenge by looking to the rest of the world to see what existing international policies and practices can tell Scotland about how to reduce its health problems. The four reviews focused on four life stages: early life, adolescence and young adulthood, early to mid-working life and later life. The team hope the conclusions of the four studies will prove useful to policy makers in developing future health intervention strategies.
Dr Rosemary Geddes from the SCPHRP leads on work on early childhood, and stresses that the research has demonstrated early intervention is crucial to future success:
‘‘There are major inequalities between the most and least deprived children living in Scotland. Early childhood experiences literally sculpt the brain to help develop skills in vision, hearing, reading, writing, communication and emotional control. The study of existing programmes has found that early childhood intervention programmes really can reduce disadvantages that would normally follow children all their lives.‘The most successful programmes are those that involve children and parents. There is evidence from other countries that early investment in a preventative approach outweighs cost in the long term.’’
In adolescence and early adulthood, Dr Caroline Jackson from Fife has found that some strategies can simultaneously reduce substance use and sexual risk behaviour, but that intervening early, during the pre-adolescent period, may give the greatest impact.
“The most promising approaches to reducing substance use and sexual risk behaviour in young people address the common underlying risk and protective factors for these behaviours. Many of these factors are related to early life and especially the nurturing which young children receive in the family and wider neighbourhood community. Interventions may have the greatest impact if they are delivered early, for example in primary school years, and promote strong networks between young people, their school and family.”
John Mooney from Glasgow has been looking at what might influence people to adopt healthier eating and activity habits as they move through their working lives; for example, to maintain a healthy weight. From a review of the international evidence, he summarises the main findings:
‘‘To have the greatest chance of cutting the number of people who are overweight or obese in Scotland, the Government ideally ought to consider many aspects of modern living that currently make the problem worse. For example, policies to restrict the availability of high fat or high sugar food and drink, either by pricing or supply, should reduce excess consumption particularly in those most at risk of developing obesity. Reducing our dependence on private car transport by improving the safety of cycling and walking would have substantial health benefits that would more than offset the investment required. In the review of obesity prevention measures we present the evidence for a series of policy proposals and outline a process by which decision makers in Government could prioritise their actions and identify those options which would be most likely to work well in Scotland.’’
The population of Scotland, like many other developed countries, is steadily growing older as people live longer and birth rates decline. Dr Helen Frost from Edinburgh has conducted a scan of interventions that can be applied in primary care or community settings that aim to prevent or delay physical and mental decline in later life.
Talking about the findings, Dr Frost said:
‘‘Internationally, there are some promising interventions for older people, for example that show exercise can be beneficial for preventing falls. But, overall, evidence of success is limited and few studies focus on people from low socio-economic groups, so any potential benefits might not work for people living in deprivation in Scotland. This opens the door for new Scottish research to find approaches for maintaining health and wellbeing in older people that are tailored to our society.’’
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The reports on the four life stages are available to download from the SCPHRP website: https://www.scphrp.ac.uk/
SCPHRP was formed in 2008 in response to the Scottish population’s history of poor health and the current epidemics of substance abuse and violence related ill health in youth and young adults, as well as chronic diseases caused by smoking, heavy drinking, unhealthy nutrition and lack of physical activity. Researchers working in the collaboration aim to design strategies to tackle these and other causes of health inequalities specifically for Scotland.
The titles of the four published scans are:
Interventions for Promoting Early Child Development for Health: an Environmental Scan with special reference to Scotland
Environmental Scan of Adolescence and Young Adulthood Health in Scotland: Interventions that address multiple risk behaviours or take a generic approach to risk in youth
Environmental Scan of Potential Policy Interventions to Tackle Obesogenic Aspects of the Built Environment
Promoting Health and Wellbeing in Later Life: Interventions in Primary Care and Community Settings.
Funding for the Scottish Collaboration for Public Health Research and Policy is provided by the Medical Research Council and the Chief Scientist Office of the Scottish Government Health Directorates. It has a budget of £3.5 million for the first five years (2008 – 2013).