London School of Hygiene & Tropical Medicine

A leading epidemiologist and population health expert today called for urgent action to improve the health of Scots, after research revealed that death rates among Scots of working age (15-74 years) are the highest in Western Europe.

David Leon, Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, warned that unless there is commitment across Government to developing policies and interventions aimed at improving the Scots' diet and reducing consumption of and exposure to tobacco smoke, Scots will continue to die earlier, and suffer higher levels of serious disease than most of their European counterparts, even those living in countries with higher levels of poverty. He will also call for more Government support and funding for research and analysis into Scotland's poor health compared to other countries and for developing effective interventions to improve public health.

Although it is usually Scottish men who attract headlines for their poor health, Professor Leon's research1 has shown that it is actually Scottish women who have the worst comparative position. Since 1950 Scottish women of working age have had higher mortality than women in any of the other 16 Western European countries included in the analysis. This is partly driven by them having the highest rates of death from lung cancer in the world as well as the highest rates in Europe for coronary heart disease.

Several causes of death such as cancer of the oesophagus, liver cirrhosis and suicide in men have also been increasing in Scotland, in contrast to the downward trends seen in most other Western European countries. In addition, Scotland experiences the highest death rates in Europe from cardiovascular disease and lung cancer, although it performs relatively well in terms of external causes of death such as injuries and violence.

Scotland has not always performed so poorly. In the first half of the 20th Century life expectancy in Scotland was actually higher for both men and women than many Western European countries, such as France, Spain and Italy. However, in the middle of the 20th Century things began to go wrong and it began to slip down the European life expectancy table.

Professor Leon's comments come on the eve of the launch (tomorrow, Monday) in Edinburgh of the first ever concerted drive across Scottish government departments to tackle fundamental causes of ill health and promote wellbeing. The Scottish Executive's Health Improvement Challenge is backed by £250m over three years and sets a common agenda with local authorities and voluntary groups for a host of initiatives to improve diet, cut smoking rates and increase physical activity levels.

'Scotland is only now achieving levels of life expectancy seen in the best performing European countries in 1970', explains Professor Leon. 'But in terms of what the future holds, it is not all doom and gloom. To some extent, the script is already written, as many causes of death have their origins in circumstances earlier in life. Thus deaths from lung cancer, which serve as a good indicator of smoking-related mortality in general, have passed their peak and can be expected to fall further in coming years. But more must, and can be done. We need to place a high priority on policies that improve the Scottish diet and, in particular, increase consumption of fresh fruit and vegetables, and reduce exposure to tobacco smoke, both from active and passive smoking.

'We need to better understand what determines health behaviours and attitudes to risk in Scotland, and commission further research and analysis into the various factors that are at play here. There are European nations that are poorer than Scotland which enjoy comparatively better health and the position of Scots in early life is nowhere near as bad as it becomes later in life, particularly amongst middle-aged men and women. It is the prevailing attitude to health behaviours and risks in Scotland which is causing the problem, and it is an attitude we need to fundamentally challenge if we are to see any significant improvements in Scotland's health in relation to the rest of Europe'.

Professor David Leon is the author of 'Understanding the Health of Scotland's Population in an International Context' (December 2002), which was commissioned by the Public Health Institute of Scotland (PHIS), an NHS organisation created to serve the whole of the public health community in Scotland. A fully copy of the report is available on the PHIS website at www.phis.org.uk (under 'News').

If you would like to interview Professor Leon, please contact Lindsay Wright at the London School of Hygiene & Tropical Medicine on 07941 294885.

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