Scotland's Health: Lessons from Running to the Sahara

1. Harry Burns and Andrew MurrayScotland`s Health – Lessons learned from running to the Sahara

3. 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

4. Persistence hunting

5. Man v horse race

6. Life expectancy trends Portugal Scotland

7. Trends in male life expectancy: Scotland Richest 20% Poorest 20%

8. Sizing the problem: alcohol-related deaths Male (45-64) liver cirrhosis mortality rates: Mortality rate per 100,000

9. Obesity trends in Scotland

10. Fat and Fit Blair BJSM 2009

11. SMOKADIABESITY

12. Risk Factors- mortality Blair et al BJSM 2009

13. Risk reduction associated with physical activity

15. Changing the culture • Drink driving • Seatbelts • Smoking • Alcohol • Mobiles while driving?

17. Proud History of Innovation and Quality in Medicine

18. 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?”

19. Central line infection rate (per thousand line days) 2.8 70% reduction 0.84

20. % ICU mortality 24% improvement 18.2% 13.9%

21. Active Travel Runs on MONEY and makes you FAT Runs on FAT and saves you MONEY

24. Getting others involved

25. Managing my health • Self management • Creating and maintaining health • Using the assets I had

26. A few Facts • 563000 calories • 1300 runners • Injuries 73/78 days • 34.4 miles per day av. • Christmas Day the same • Became anaemic

27. Time for action is now • Health Creation • Use exisiting assets to best advantage • Physical activity

28. Health Creation • SAFE • EFFECTIVE • EVIDENCE BASED • COST SAVING (preventative spend)

29. 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

30. 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

31. 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

32. 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

33. Making it easier- NHS HS/ RCGPS • Assessment • Script for advice • Brief intervention format • Embed into KEEP WELL • PAHA conference 12th September

34. Brief Advice and Brief Intervention • Per QALY, primary prevention -Statin up to £17000 • Physical Activity £20- £440

35. 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

36. 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

37. Allied Health Professionals DG’s • Outstanding example • Pledge to make an assessment PA part of each consultation • NHS opportunities to get active- coming soon

38. Active Ageing • World Congress in Active Ageing August • Healthy Active Ageing group • The elderly have much to gain

39. Sports and Exercise Medicine • Cost effective • Improved health outcomes • Preventative spend • Public health role • Exercise prescription • MSK medicine

41. Investments that work • Whole of school programmes • Transport policies and systems that prioritise walking, cycling and public transport • Urban design that provides for equitable and safe access for recreational physical activity • Physical activity and NCD prevention integrated into primary health care systems • Public education, including mass media to raise awareness and change social norms on physical activity • Community-wide programs that mobilize and integrate community engagement and resources • Sports systems and programs that promote ‘sport for all’ and encourage participation across the life span.

43. 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

44. 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

45. Life expectancy trends Portugal Scotland

46. Life expectancy trends

48. 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!

49. An early years collaborative • 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

50. 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!