----- Original Message -----
From: "Mcdaid,D" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, July 07, 2003 4:18 PM
Subject: English CMO's Annual Report ' On the State of Public Health'


Dear Colleagues

The Chief Medical Officer, Sir Liam Donaldson has published his annual
report 'On the state of Public Health'  Amongst other things the report sets
out progress that has been made regarding recommendations related to
tackling inequalities in health

The report can be found at www.doh.gov.uk/cmo/annualreport2002

An excerpt from press release below. Full press release available at

http://www.info.doh.gov.uk/doh/intpress.nsf/page/2003-0252?OpenDocument

Best wishes

David McDaid
LSE health and social care

The Chief Medical Officer, Sir Liam Donaldson, today publishes his annual
report 'On the State of Public Health'. It provides an assessment of a
number of important issues where significant improvements in health can be
achieved by sustained action.

Sir Liam's report offers a new perspective on five subject areas. It
analyses the effectiveness of current treatments and services, describes
Government action in these areas and identifies action necessary to bring
about improvement. The five chapters of the report examine:
*       The health risks of second-hand smoke (passive smoking)
*       West Nile virus
*       Obesity
*       Poor clinical performace
*       The safe administration of intrathecal chemotherapy

The report also highlights a specific issue which warrants local
investigation or action in each of the nine Government Office Regions (there
is a public health team in each office). In addition to drawing attention to
the particular concerns, this chapter is designed to generate local debate.

The 2002 report also charts the very substantial progress that has been made
on the recommendations in last year's report. These focused on health
inequalities, high blood pressure, E.coli O157, epilepsy, alcohol and liver
cirrhosis.

Sir Liam said:

"This is my second annual report and once again I have chosen to highlight
five key areas of health and healthcare. The issues may sound familiar, but
I have chosen them either because they herald potentially serious problems
in the future, or because action so far has failed to make the inroads that
are necessary.

"Smoking kills 120,000 people each year in the United Kingdom. Over the last
few years, the Government has put in place an unprecedented range of
measures to combat tobacco-related disease. Major action to clear the air of
cigarette smoke in workplaces and public places would be the final brick in
the wall. Inhaling second-hand smoke (passive smoking) is unpleasant and a
direct hazard to health. It can cause lung cancer (increasing the risk by
20-30% in people who live with smokers) and heart disease (increasing the
risk by around 25% in people who live with smokers), and is causally linked
to Sudden Infant Death Syndrome, lower respiratory illness, asthma and
middle ear disease. Second-hand smoke contains 50 known or suspected cancer
causing agents and 100 chemical poisons.

"It has been estimated that some three million people in this country become
passive smokers when they go to work, whilst a further one million are
exposed 75 per cent of the time. Particularly vulnerable are bar workers,
waiters and waitresses. Comprehensive workplace smoking bans would protect
these workers.

"The majority of people in England are non-smokers and object to others
smoking near them. International experience has shown that the way to
rapidly and successfully tackle the health risks from second-hand smoke is
to take action on smoking in public places. Moves to make public places and
workplaces smoke-free would create a climate in which "no smoking" is the
social norm, it would help smokers to give up, it would remove the risks of
passive smoking for millions of people (including children and babies), it
would reduce the risks of fire and cut the costs of cleaning.

"Together with the other action which has and is being taken, tough action
on second-hand smoke would represent a further major assault on tobacco's
long reign as the major killer in this country. It would put this country at
the forefront of international best practice in tobacco control as well as
being something that the majority of the public want to see happen.

"West Nile fever is an old virus that emerged in the new world in 1999 when
it struck New York City, resulting in seven deaths. Since then it has swept
across the United States. In 2002, 4161 people were infected and 277 died.
The risks of the disease coming to this country have been assessed as low.
However, if a number of factors conspired, namely bird migration, the size
of the mosquito population and change in climatic conditions - then it is
not impossible that West Nile virus could arrive in this country. It is
important that we have a contingency plan in place.

"Obesity levels have tripled in England over the past two decades and a
major cause for concern is the growth in the proportion of overweight and
obese children. Most worrying is evidence to show that children are starting
to present with late onset (Type 2) diabetes which has in the past occurred
in middle and older age. In addition to calling for continuing commitment to
preventive programmes, I recommend that action is taken by the food industry
to adopt a more responsible approach to marketing foods high in fat and
added sugars, particularly to children.

"The vast majority of NHS doctors practise to a very high standard. For the
few who give cause for concern, the NHS has had a great difficulty in the
past addressing the problem. A new approach was adopted in 2000 when the
National Clinical Assessment Authority (NCAA) was set up to deal with
concerns at the earliest possible opportunity and offer more doctors with
problems to be rehabilitated rather than suspended and disciplined. Progress
has been good and I present the most recent statistics on referrals to the
NCAA. Even more use needs to be made of the NCAA and NHS procedures amended
to facilitate this.

"Progress on the five topics I highlighted last year has, on the whole, been
very good (health inequalities, epilepsy, alchol and liver cirrhosis,
hypertension and E.coli 0157). I look forward to reporting progress made on
the issues in my 2002 report in a year's time."

Over the last 150 years, annual reports published by the Chief Medical
Officer have provided an important record of the nation's health and the
major challenges faced by Government. In the last 20 years the annual report
has also provided detailed accounts of a wide range of initiatives taken by
the Government on public health and the National Health Service.