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? Sta+o ft «eG uesrns ey “== BOARD OF v5) HEALTH “elE NSA)N WORKING TOWARDS A BETTER HEALTHIER WAY OF LIFE 99th ANNUAL MOH REPORT and Fourth ANNUAL REPORT of the DIRECTOR OF PUBLIC HEALTH Special Theme: “The health of older Guernsey” REPORT FOR THE YEAR 1997/98 BOARD OF HEALTH MEMBERS 1997 Conseiller Mrs S M Plant President: Deputy B Russell Vice President: Mr G V F Birch (until November 1997) Senior Member: Other Members: Deputy O D Le Tissier Deputy Mrs J Beaugeard Deputy H R Allen Deputy M Barrett (until April 1997) Dr P W Richards (from May 1997) Mr H G Goodeve (from December 1997) STATES OF GUERNSEY BOARD OF HEALTH Objectives To maintain and improve the health of the people of Guernsey and Alderney as cost effectively as possible by within the resource constraints placed upon it by: Identifying health needs - now and in the future. Planning the future provision of health services to meet these needs. Commissioning the provision of these services. Ensuring that the quality of health services provided is high and standards are maintained through careful monitoring. Ensuring that only appropriate and effective care or treatment is given, by monitoring the outcome of such interventions. Listening to the customers in order to understand their needs and working with others so as to best meet these needs. Informing people on health matters, promoting a healthy lifestyle and environment. Acting as a ‘caring neighbour’ and considering the environment for future generations. Checking that all health services provided are as cost-efficient as possible. Promoting managerial and professional excellence within health services. Recruiting, training and developing sufficient health care staff to achieve these objectives and valuing the staff and helping them to meet their needs and objectives. INTRODUCTORY LETTER TO THE BOARD OF HEALTH October 1998 The President States of Guernsey Board of Health Sir, I have pleasure in submitting the 99th Annual Report of the Medical Officer of Health for Guernsey for 1997/1998. Iam, Sir Sra Your Obedient Servant Dr David Jeffs MEDICAL OFFICER OF HEALTH Director of Public Health CONTENTS CONTENTS Board of Health Members 1997 Board of Health Objectives Medical Officer of Health Introductory Letter Highlights from this Report “On the state of the Public Health”’’ Public Health on the Broader Front @ Public Health in the Regional Context @ Public Health in Britain @ The Minister for Public Health @® Green Paper ‘Our Healthier Nation’ @® White Paper ‘The New NHS. Modern, Dependable’ @® What is Clinical Governance? @ ‘Strengthening the Public Health Function’ @ What are the key themes for health policy? @ What is the significance for Guernsey? Avoiding the avoidable @ “New Epidemics” @ Tobaccos @ Alcohol and health @ Action on Drug Abuse @ Cancer in Guernsey @ Sexual Health Environmental Health @ Introduction @ Complaints/ Requests for Advice/ Enquiries @ Food Safety and Infection Control @ Control of the Physical Environment Health Promotion e Introduction Accident Prevention Alcohol Cancer Coronary Heart Disease Family Health Mental Health Resources Sexual Health Smoking Schools Conclusion 6. Sexual Health and Communicable Disease Control Contraception, Unplanned Pregnancy and Abortion Guernsey Family Planning Clinic The Abortion Law [Guernsey] 1997 Sexual Health Clinic Communicable Disease Control Te. Occupational Health and Fire, Health and Safety Occupational Health Fire Health and Safety Health & Safety Working Group 8. Health of Older Guernsey Ageing *‘ Baby Boomers’ Responding to an ageing population in Guernsey How real is the problem? Does more ageing mean more ill health Is there an ‘iceberg of hidden morbidity’ in the Guernsey population? The Guernsey ‘Health Screening in the Elderly’ Project Opportunities for prevention The impact of technology in old age Where will people live? Tackling the shortfall in sheltered housing The ‘single care’ home concept Transport links Can Guernsey afford an ageing population? Thoughts for the future Conclusions: “Twelve years to get it right!’ 9. Guernsey and Alderney - Vital Statistics 1997 10. Staff Providing Public Health Services 1997 HIGHLIGHTS FROM THIS REPORT HIGHLIGHTS FROM THIS REPORT An extended version of these ‘highlights’ will be found on the Board of Health ‘Home Page’, http.//gatekeeper. guernsey.org.uk An important function of the Annual MoH Report is to report ‘On the state of the Public Health *. This Report confirms that Guernsey as a whole remains in pretty good health. [p 1 ] However, a significant minority of our population are already middle- aged, and potential problems linked with ageing are likely to become an increasing consideration over the next 20 to 30 years. [p2] The ‘greying of Guernsey’ has implications for housing, healthcare, transport strategy. the provision of pensions, the size of the economically active workforce, and the prosperity and well-being of the island more generally. Providing a public health perspective on these important issues is the ‘special theme’ of this Report. [Chapter 8 pp 50- 78] Public health in Guernsey cannot be seen solely from an island perspective however. We need to be aware of, and where appropriate to be influenced by developments on the broader public health front. [p3] As well as important new initiatives in public health in Europe, the Blair government has also given public health a new prominence in Britain. This includes the appointment of a Minister for Public Health, the Green Paper ‘Our Healthier Nation’, the White Paper ‘The New NHS: Modern, Dependable’, the introduction of the need for ‘clinical governance’, and the Chief Medical Officer’s Working Party to advise how best to ‘strengthen the public health function’. [p4] Key themes, including the cost effectiveness of population approaches, the impact of poverty and relative poverty as important determinants of poor health, the need for more intersectoral working, the need to review the function and working together of several States Committees, the benefits of “evidence based’ healthcare, and most importantly the need for local structures of ‘clinical governance’ are all felt to have special relevance for Guernsey. [pp7/8] ‘Avoidable ill health’ is specifically considered in Chapter 3. Progress in implementing the Guernsey ‘tobacco package’, developments in addressing alcohol misuse, the Guernsey Drug Strategy, cancer control, a new research project on providing cancer treatment ‘far from home’ and the establishment of the Guernsey Sexual Health Forum are all detailed. [pp9-22] In environmental health, the States of Deliberation have approved significant amendments to existing public health legislation, and have agreed also the introduction of new ‘Control of Environmental Pollution’ laws. This proposes a legislative framework to control pollution in respect of waste, sea water, noise and air, permitting the introduction of separate Ordinances for each of these. [pp23] Food hygiene continues to be a very important aspect of the Environmental Health Department’s work. Implementation and education on the recommendations of the Pennington Report on Ecoli O157 highlights the need for continuing commitment in this area. [pp24/25] With the exception of food poisoning, which still remains a problem, most other notifications of infectious diseases have continued to decline, and again in 1997 are at an historical all time low. [p43] The Health Promotion Unit celebrated its 10th birthday in 1998. The past ten years have seen the growth and development of health promotion as a basis for healthier lifestyles into the next millennium. Within its limited resources, the Health Promotion Unit continues to be active and successful in further developing health promotional priorities in the key areas outlined in previous Reports. [p31] The need for a comprehensive approach to ‘Contraception, Unplanned Pregnancy and Abortion was outlined in the Policy Letter of that title [Billet d’Etat VIII 1996]. Implementation of the various recommendations approved by the States has led to the appointment of both a part-time co-ordinator, and a qualified counsellor for the Guernsey Family Planning Clinic, which is showing increasing success in meeting the contraceptive needs of its target age group, the young and sexually active. [pp35-37] Results are also published of abortions lawfully performed in Guernsey in the first nine months of the controversial Abortion [Guernsey] Law 1997 covering the period March-December 1997. These are further compared with abortions lawfully performed on known Guernsey residents in England and Wales during 1997. The total number of abortions performed during 1997 show no increase above the average number of lawful abortions performed on known Guernsey residents in Britain between 1990-1994. Contrary to fears expressed at the time of the ‘Abortion Debate’, legalisation of abortion in Guernsey has not yet led to any apparent increase in the total number of terminations performed. [pp38/39] Sexual health services are a further important area for future development. Plans are currently being considered regarding comprehensive and more integrated service development in these areas. [pp40/41 ] There have been continuing developments in the fields of Occupational Health, and Fire, Health and Safety with the opening of a specially designed, dedicated Occupational Health suite, and the appointment of a full-time Fire, Health and Safety Advisor. [pp45-49] The Report concludes that in relation to the challenge of an ageing population, that Guernsey has ‘twelve years to get it right’, and that this must include appropriate transport policy, and development of approximately 20-25 new or converted units of ‘sheltered housing’ annually over the next several years. Although presenting a political and planning challenge, this is felt to be achievable. [pp70-78] INTRODUCTION Chapter 1 ‘On the state of the Public Health...... ; Introduction England’s recently retired Chief Medical Officer, Sir Kenneth Calman, sometimes shows a picture of himself dressed in a white coat, a stethoscope to his ears, with its bell placed firmly on a map of England, somewhere around the East Midlands. He has a quizzical expression on his face, as if trying to make a difficult diagnosis. He calls the picture ‘GP to the Nation’. It perhaps symbolises the role of the Chief Medical Officer, as England’s senior public health physician, to be responsible for and to report On the state of the Public Health as the CMO’s Annual Report is called. The Annual Report of the Medical Officer of Health in Guernsey attempts on a lesser scale to fill a similar role. So if Guernsey were a patient, presenting at the doctor’s surgery for an annual check up, how would we report ‘the health of the Island’? reeT UY DELI TIL CONSIQEUTD crcgnwnndteonnas-c-5- fe @ Could lose a little weight around the middle ............... 2 : WUVCEHS 10 CXETGISE GilOLTNOTC ole ncnnc doces > : Such phrases from the consulting room seem equally applicable to the health of Guernsey’s population as a whole. Sociodemographically, the island would seem to have reached a generally comfortable and fairly prosperous middle-age and with this have come many of the problems which will be familiar to those already in their middle years. But just as in our own personal life, we can make healthier, but sometimes more difficult ‘lifestyle choices’, so we can as a community try and address some of the issues which evidence suggests are currently impacting adversely on our population’s health. These include diet, levels and opportunities for exercise, patterns and quantities of alcohol consumption, smoking, drugs misuse, sexual health, and necessary action on various environmental factors which may adversely affect human health, both locally and further afield. These several considerations form related themes which are explored in greater depth in Chapter 3. To continue to progress in these areas requires a number of parallel strategies. These must include: @ Ensuring people have adequate knowledge of factors likely to impact on their own health, sufficient to allow them to make their Own personal ‘healthy choices’ . @ Developing ‘healthy public policy’ to ensure that ‘healthy choices’ become ‘easy choices’ @ Making sure that ‘healthy choices’ are also ‘accessible choices’, and particularly that groups such as the less affluent, mothers with children, the elderly, etc do not find themselves excluded from doing what they know is best for their health. @ Making environmental considerations an integral part of both our personal lifestyle choices, and of our wider public health policy. But just as middle years must inevitably lead on to older age, there is now increasing evidence that the determinants of health in later life are often laid many years before. Action taken now at both a personal and public policy level can do much to ensure that Guernsey is better prepared for the inescapable ageing of our population, which will start to occur in the second and third decades of the next century. ‘The health of older Guernsey’ and the likely impact of an ageing population on healthcare form the major special theme of this Report. Various aspects of this are explored further in Chapter 8. To return to our ‘patient in the consulting room’ metaphor, this year’s ‘annual check up’ confirms that Guernsey as a whole still remains in pretty good health. However, a significant minority of our population is already middle-aged and potential problems linked with ageing are likely to become an increasing consideration over the next twenty to thirty years. Our best hopes of enjoying a healthier older age as a community will to a large extent depend on what investment we make now in taking those healthier personal lifestyle choices, and implementing the necessary public policies in areas such as healthcare, housing, transport, and planning, together with ensuring there is adequate and equitable funding to support these developments. Finally, whilst I have attempted whenever possible to acknowledge the many contributors to this Report, it has obviously not been possible, especially in Chapter 8, to recognise every contributor. To all these, and to the many others who have supported public health initiatives throughout the year, my appreciative thanks. I would also wish to specifically thank my personal assistant, Mrs Yvonne Kaill for her help in producing this Report, and to public health data officer, Mrs Jenny Elliott for the production of the several graphs. Dr David Jeffs Director of Public Health