“If you had all the money in the world and were in charge of the NHS, what would you invest in?” – a question asked at a medical school interview this week. Not an easy one to answer but perhaps timely given the increased investment in the NHS in Scotland announced in the budget yesterday.
I wonder what I would have answered as Chief Medical Officer for Scotland. Our population is aging – by 2035 we will have 82 per cent more people aged 75 and over. Increased life expectancy is a good thing – I do not agree with the portrayal of the aging population as a ‘burden’ – and it is a testament to improved healthcare, but we will need more and different health and social care to ensure people live longer healthier lives. On average, 80 per cent of a person’s lifetime NHS spend is in the last two years of life.
Cancer rates are increasing in part because we are living longer – we have improved rates of survival for many cancers, but there is more to be done in earlier detection, access to treatment and research.
What about preventing ill health? The first professor of transport and health in the UK, Adrian Davies, was recently appointed at Napier University, recognising the key links between active transport, improving health and the unhealthy environment which exists for many due to our traditional forms of transport.
What can be done to encourage people to exercise more? The recommended daily amount is 30 minutes of moderate activity or 150 minutes a week for adults. The good news is that many of us are doing this. However almost one in five do not walk for more than 20 minutes even once a month – yet it is a simple, free way of improving the risks of diabetes, hypertension, cancer, dementia and improving mood and sleep.
A bank in Ukraine is offering preferential interest rates to those who have an active lifestyle – as measured by step count – and in Singapore employees in high-rise blocks are given rewards at the end of the month if they use the stairs, not the lifts.
The decreasing stigma around mental health issues has led to a positive increase in those coming forward for help. Mental ill-health affects whole families, employment, finances and physical health and we know those with chronic ill-health suffer from more anxiety and depression. We still do not have parity of services for those with mental health issues.
Perhaps I can give a steer as to how an obstetrician would have answered that question. The importance of the first 1,000 days of life, including that important time before birth, is beginning to be recognised more widely. Good health of mothers and fathers leaves a lasting legacy for the baby and adult of the future. The knowledge that many adult diseases, such as those mentioned above, originate before we are born is more than 40 years old. The chances of an adult whose mother was obese during her pregnancy having a heart attack aged 50 is five times higher than if the mother was a normal weight.
Anxiety and depression in pregnancy and after birth can result in poor bonding and lead to the risk of mental ill-health for the child. Prevention of preterm birth would save millions of pounds in intensive care and longer term health needs. Investment in the early years of life, health, education, and good parenting, has been shown in studies to give a return of at least eight times what is invested, largely in future earning power for the child. The health of the nation in our hands ... what would you choose?
Catherine Calderwood is Scotland’s Chief Medical Officer and is on Twitter @CathCalderwood1