Harry Burns and Andrew MurrayScotland`s Health – Lessons learned from running to

the Sahara

Evolution and exercise

• “Every morning in Africa an antelope wakes up knowing that it must outrun the fastest lion or it will be killed. Every morning in Africa, a lion wakes up knowing it must run faster than the fastest antelope or it will starve. It doesn’t matter if you’re a lion or an antelope. When the sun comes up – you’d better be running.”

Bernd Heinrich

Persistence hunting

Man v horse race

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

Trends in male life expectancy: Scotland

Richest 20%

Poorest 20%

Sizing the problem: alcohol-related deaths

Male (45-64) liver cirrhosis mortality rates:

Mo

rta

lity r

ate

pe

r 1

00

,00

0

Obesity trends in Scotland

Fat and Fit Blair BJSM 2009

SMOKADIABESITY

Risk Factors- mortality Blair et al BJSM 2009

Risk reduction associated with physical activity

Chronic condition Risk reduction

All cause mortality 30% risk reduction

CVD, stroke 20-35% reduction

Diabetes 30-40% reduction

Hip fractures 36-68% reduction

Colon cancer 30% reduction

Breast cancer 20% reduction

Loss of function 30% reduction

Depression/dementia 20-30% reduction

Changing the culture

• Drink driving

• Seatbelts

• Smoking

• Alcohol

• Mobiles while driving?

Proud History of Innovation and Quality in Medicine

Improvement science

• W Edwards Deming (1900-1993)

– “In God we trust, all others must bring data”

– “By what method? Only the method counts.”

• Don Berwick

– “Some is not a number. Soon is not a time.”

• Scottish Patient Safety Programme

– “By how much and by what method?”

Central line infection rate (per thousand line days)

0

0.5

1

1.5

2

2.5

3

3.5

4

Jan-0

8

Mar-

08

May-0

8

Jul-08

Sep-0

8

Nov-0

8

Jan-0

9

Mar-

09

May-0

9

Jul-09

Sep-0

9

Nov-0

9

Jan-1

0

Mar-

10

May-1

0

Jul-10

Sep-1

0

Nov-1

0

Jan-1

1

Mar-

11

May-1

1

Jul-11

Sep-1

1

Nov-1

1

2.8

0.84

70% reduction

% ICU mortality

10

12

14

16

18

20

22

24

26

28

30

Jan-

08

Apr

-08

Jul-0

8

Oct-0

8

Jan-

09

Apr

-09

Jul-0

9

Oct-0

9

Jan-

10

Apr

-10

Jul-1

0

Oct-1

0

Jan-

11

Apr

-11

Jul-1

1

Oct-1

1

18.2%

13.9%

24% improvement

Active Travel

Runs on MONEY and makes you FAT

Runs on FAT and saves you MONEY

Getting others involved

Managing my health

• Self management

• Creating and maintaining health

• Using the assets I had

A few Facts

• 563000 calories

• 1300 runners

• Injuries 73/78 days

• 34.4 miles per day av.

• Christmas Day the same

• Became anaemic

Time for action is now

• Health Creation

• Use exisiting assets to best advantage

• Physical activity

Health Creation

• SAFE

• EFFECTIVE

• EVIDENCE BASED

• COST SAVING (preventative spend)

Simple, clear message

• Major, major benefits

• Recommend 30 mins 5x per week adults

• 60 mins daily for children

• Best present you can give children

• Myth Busting

• Physical activity and or sport is for everyone

• Improved quality of life

• Preventative spend

MYTHBUSTING

• Too old to exercise

• Too Fat to exercise

• I’m diabetic, have OA, COPD, high BP, etc etc

• Regular physical activity actually helps treat these conditions

• Often patients are grateful

Physical Activity

• Let’s embed it into the NHS.

• VITAL SIGN- part of any history. check smoking status, alcohol, physical activity and diet

• ASK THE QUESTION

The Question

• How many days a week do you do physical activity?

• How long on each of those days?

• Everything counts

• See hand-out for pathway

Making it easier- NHS HS/ RCGPS

• Assessment

• Script for advice

• Brief intervention format

• Embed into KEEP WELL

• PAHA conference 12th

September

Brief Advice and Brief Intervention• Per QALY, primary

prevention

-Statin up to £17000

• Physical Activity £20-£440

Education- Change the Culture

• Make health creation, and treatment of risk factors part of education

• Physical activity- 40% of Scottish Medical Schools teach guidelines

• 14% of GP’s knew guidelines.(2004)

• Must change this systematically

New arrival

• http://elearning.healthscotland.com/course/view.php?id=315

• Health behaviour change modules

• Suitable for all health providers

• Do and pass on the link and 23 and a half hours

Allied Health Professionals DG’s

• Outstanding example

• Pledge to make an assessment PA part of each consultation

• NHS opportunities to get active- coming soon

Active Ageing

• World Congress in Active Ageing August

• Healthy Active Ageing group

• The elderly have much to gain

Sports and Exercise Medicine

• Cost effective

• Improved health outcomes

• Preventative spend

• Public health role

• Exercise prescription

• MSK medicine

Investments that work1. Whole of school programmes

2. Transport policies and systems that prioritise walking, cycling and public transport

3. Urban design that provides for equitable and safe access for recreational physical activity

4. Physical activity and NCD prevention integrated into primary health care systems

5. Public education, including mass media to raise awareness and change social norms on physical activity

6. Community-wide programs that mobilize and integrate community engagement and resources

7. Sports systems and programs that promote ‘sport for all’ and encourage participation across the life span.

Lessons learned

• A fresh approach- HEALTH CREATION- do as we would be done by

• Assets approach to health

• Physical Inactivity is important- let’s sort it out

• Sand is the enemy of the feet

Call to action

• Each patient encounter is an opportunity to make a difference- build into practice

• Make a difference with your team, for your patients

• Promote key, simple messages.

• Send 23 and a half hours to 5 people tonight

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Outcome Aims

• Increase life expectancy in Scotland by 5 years over 10 years

• Mortality: 4% reduction per year in adults• Build a foundation of healthy early life in babies and

children• Reduce drug related and violent deaths in young adults• Reduce offending and improve educational attainment• Reduce alcohol related mortality across the population• Maintain improvements in CVD and cancer mortality• Keep everyone fit!

• Agree outcomes

– For pregnancy, early development and preparedness for school

• Agree interventions to achieve these outcomes

– Five or six evidence based interventions for each stage

• Apply interventions consistently across the whole population

• Measure progress and react to the data

An early years collaborative

So, what now? – A collaborative to increase Physical Activity, create health?

• Create the need and impetus for action

• Involve CEs of every Health Board, local authority and their top teams

• Involve practitioners and the public

• Involve the sports governing bodies

• Involve people!

Useful resources

• 23 and a half hours - spread the word

• www.takelifeon.co.uk / Active Scotland/ PAHA

• elearning- Health Behaviour Change Modules

• @docandrewmurray / @scotgovhealth twitter