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Chief Medical Officer publishes Annual Report

DEPARTMENT OF HEALTH News Release issued by The Government News Network on 14 July 2008

New focus on tackling the health of the teenage nation

The Chief Medical Officer, Sir Liam Donaldson, today published his 2007 Annual Report, in which he called for a new focus on teenage health. The report, which reviews key health problems and developments over the last year, highlighted the unique health needs of teenagers.

The teenage years are a risk taking period of life, closely tied to the rite of passage into adulthood. Although the majority of teenagers cope well, large numbers of teens take part in high risk behaviours such as binge drinking, drug taking and unsafe sex. There are also teenagers living with chronic illnesses.

Sir Liam's report urged health services to take better account of the specific health needs of young people and sets out Top Ten Tips for teenagers..

He also called for:

- A national summit to take stock of health programmes and services for teenagers.

- More involvement of teenagers in the design of health services for them.

- A young person's panel to be established to advise on national campaigns addressing risk taking in teenage years.

- The legal blood alcohol level limit for drivers aged between 17 and 20 years to be reduced to zero.

Speaking at the launch of his 2007 Annual Report, On the State of Public Health, Sir Liam said:

"Adolescence can be a challenging time. It is a period in which teenagers encounter risks and make hard choices. Young people are exposed to behaviours, opportunities and products that have the capacity to harm their health in the short and long term. In this Report I concentrate on the 'Big Six': smoking, alcohol and drugs, accidents and violence, diet, physical activity and sexual health.

"Habits adopted in the teenage years can form behaviour for a lifetime. For example, adolescent binge drinkers are twice as likely as their peers to be dependent on alcohol or taking illicit drugs by the time they reach 30 years, while someone who starts to smoke aged 15 years is three times more likely to die of smoking-related cancer than someone who starts smoking in their 20s. The effects of poor health in adolescence can last a lifetime, and even shorten it. Keeping teenagers well is a valuable investment for the health of the population in the future."

Sir Liam Donaldson is the Chief Medical Officer for England and the United Kingdom Government's principal medical adviser. He has held the post for nearly 10 years. His previous Annual Reports have called for action on key public health issues such as smoke-free public places (2002 and 2003 reports), the obesity 'time bomb' (2002 report) and an 'opt-out' system for organ donation (2006 report).

Understanding the rise in oesophageal cancer

This year's Report also draws attention to the rising levels of oesophageal cancer, which is the sixth most common cause of cancer deaths in England and Wales and kills 6,000 people a year. England has some of the highest rates of oesophageal cancer in Europe. Over the last 20 years, the rate of new cases in England has gone up by 86% for men and 40% for women, whereas the rate has sharply decreased in other European countries, such as France. The reasons for this are unknown.

In his Report Sir Liam calls for:

- A large scale national research study to investigate the risk factors associated with the rising rate of cancer of the oesophagus.

- Better educational programmes to improve public awareness of the symptoms.

- Research into better diagnostic techniques.

- The Chief Medical Officer to issue a public alert in circumstances where there is an unexplained increase of a serious disease.

Sir Liam said:

"As rates of many cancers in England are decreasing, oesophageal cancer is bucking the trend and going the wrong way. Levels of oesophageal cancer in England are amongst the worst in Europe, and whilst some other nations' rates are falling, ours are getting worse. Despite this worrying trend, not enough is known about why this is happening.

"If this disease is to be controlled and the trend reversed, it is vital that more is done to understand the complicated mix of factors that cause it, and the public are better informed about what to look out for."

Creating vaccines for the future

Vaccination has been a cornerstone of public health for the last 200 years. In this year's Annual Report, Sir Liam has highlighted work currently underway to develop new vaccines for a number of diseases, including C. difficile, MRSA and influenza. A vaccine for C. difficile is possible within three years, and a vaccine for MRSA within 10 years. A wider spectrum influenza vaccine could combat the threat of a pandemic of 'flu. The report also describes potential vaccines for chronic diseases, including type 1 diabetes.

Sir Liam said:

"Vaccination is arguably the most important public health development in the history of humankind. Over the last 200 years it has saved hundreds of millions of lives worldwide. The continuing work to develop new vaccines and potentially save more lives in the future is a testament to the work of Edward Jenner two centuries ago. New vaccines could not just prevent infectious diseases, but could also prevent or treat some cancers and other chronic conditions."

Making surgery safer

Surgery is generally very safe but has many inherent risks that are not always fully appreciated. The report highlights the nature of some of these risks and presents new data showing the National Patient Safety Agency received 129,416 reports of potential errors involving surgical procedures during 2007. Most errors do not result in harm or the risk is averted. Sir Liam also highlights 14 cases of burr holes being drilled on the wrong side of the head during brain surgery in the last three years.

He argues that more attention needs to be given to reducing the impact of errors in surgery and suggests a number of measures including:

- The establishment of a clinical board for surgical safety.

- Routine use of the World Health Organization's Surgical Safety Checklist before, during and after the operation.

- More use of risk scores to estimate the risk to patients before the operation.

- Regular collection and analysis of death rates 30 days after operations, which should be made available to the public.

Sir Liam said:

"Surgery for patients in this country is generally very safe, but we can and should make it even safer. Errors do still occur. Further improvements will need a more detailed understanding of how often errors occur, a change in culture and the use of innovative new tools, such as surgical checklists."

Achieving racial equality in medicine

Also examined is the issue of racism in medicine. Historically, ethnic minority doctors have suffered notable discrimination when applying to medical school and throughout their careers. The report uses data from a number of sources to examine the current situation. In recent years there has been improvement, but concerns remain. The report presents evidence that doctors born outside the United Kingdom (particularly in Africa) but working here have higher mortality rates than their United-Kingdom born counterparts. It also shows evidence that doctors from ethnic minorities are living in the more deprived areas of the country.

Sir Liam calls for a series of measures to combat these remaining concerns, including:

- The establishment of a mentoring scheme for ethnic minority doctors.

- Better training on equality and race awareness issues for selection panels.

- More support for doctors raising concerns about racial discrimination.

Sir Liam said:

Examining the relationship between ethnicity and doctors is complex. Whilst many institutional barriers have been removed and much has improved, there are still areas that cause concern. Addressing these issues will require cultural and behavioural change."

Notes to editors

1. Professor Sir Liam Donaldson is the Chief Medical Officer for England. His 2007 Annual Report can be found at http://www.dh.gov.uk/cmo