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Chief medical officer Liam Donaldson today published his ...
Chief medical officer Liam Donaldson today published his

third 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


- Smoking and skin ageing

- Economic benefits of smoke-free public places

- Better blood transfusion

- A focus on academic medicine

- Earlier detection of HIV infection

The report also highlights a specific issue which warrants local

investigation or action in each of the nine public health regions. In

addition to drawing attention to the particular concerns, this

chapter is designed to generate local debate.

This report reviews progress on previous two years' five topics

including second-hand smoke, epilepsy, West Nile virus, obesity,

E.coli 0157, intrathecal chemotherapy, health inequalities and poor

medical performance and also on the problems spotlighted in each of

the regions.

Sir Liam said:

'In my third annual report, I have selected five new topics for


'Firstly, I have reviewed evidence on the damaging effect that

smoking has on people's skin. Many people are aware that smoking

causes premature death and serious diseases like heart disease and

cancer. Few know that smoking prematurely ages the skin. Smokers

tend to look older than non-smokers of the same age (possibly 10-20

years older) and they are more likely to more wrinkles, crow's feet

and a sallow grey colouring. Those in their teens and early twenties

tend to be image conscious and, therefore, by highlighting the

harmful effects of smoking on skin I hope to encourage more young

people to give up smoking. Also, young people working in bars and

restaurants need to be aware that even second-hand smoke may damage

their skin. The use of smoking in the modelling, fashion and film

industries is totally at odds with one of its principal aims - to

promote glamour and good looks. The medical and scientific facts tell

a different story - beauty is only skin deep and the smoke and

chemicals in cigarette smoke can damage the architecture of the skin

for good.

'Secondly, I return to the subject of second-hand smoke. When last

year I recommended creating smoke-free public places and workplaces,

one of the key arguments against such a policy was that businesses in

the hospitality and leisure sectors would suffer financial hardship.

This year's report considers these arguments further. Not trusting

the evidence of my own eyes when on my visits to the `smoke-free'

cities and countries of Ireland, California and New York City, I

found bars and restaurants thronging with people, I commissioned a

formal economic analysis. In this Annual Report, I take a probing

look at the economic implications of our country following the lead

of others around the world and going `smoke-free'. The evidence and

analysis shows that concern about falling profits is unfounded. In

other parts of the world where legislation to create smoke-free

public places and workplaces has been introduced, profits in the

hospitality and leisure industries actually rise. A major plank in

the argument against smoke-free public places and workplaces is thus

removed. The only remaining reason not to do it in the face of

majority public opinion in favour is on grounds of defending the

smoker's rights, but as one young woman bar worker in San Francisco

put it to me rather pithily: 'your freedom ends where my nose


'Thirdly, early detection and diagnosis is important in preventing

the spread of HIV, but estimates show that a third of those infected

with HIV are unaware of their infection. Opportunities are not being

taken to test people who attend genitourinary medicine clinics.

Waiting times for such clinics around the country are too long. Worst

of all, people who are eventually diagnosed as HIV positive have had

their disease for an average of six years. More needs to be done to

ensure that people who are infected with HIV are detected at an

earlier stage so that they do not then infect other people, and so

that their own health care treatment can commence earlier to reduce

progression of the disease. Testing in genito-urinary medicine

clinics is the key.

'Fourthly, whilst clinical research and medical student intake have

recently received a major boost through extra investment, the

successful delivery of a programme of continued excellence in

teaching and research depends on a strong academic base. The numbers

of posts in academic medicine is falling and there is no proper

career structure for young doctors wanting to go into research.

Indeed, there are some disincentives. A number of influential reports

in recent years have drawn attention to the gathering crisis in

academic medicine but no satisfactory solution has yet been found. It

is important that one is. In this Annual Report, I highlight the main

issues and say that the time has come for focused attention on this

problem, using the welcome new opportunity of increased government

investment in research and development.

'Finally, I draw attention to the need for improvements in the way we

use blood. Blood transfusion can be, and is, life-saving. It is a

precious resource given by voluntary donation as a `gift' from one

person to another. Overall, blood is much safer in this country than

many others. But like a lot of other medical procedures it is not

free of risk. My assessment is that risks of transfusion could be

reduced still further if all hospital and clinical teams adopted the

procedures of the safest. Moreover, the `gift' of blood is too often

squandered by its unnecessary and inappropriate use. Improvements are

being made too slowly. I make recommendations for action in this


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 few

years the annual report has provided an opportunity to highlight some

of the main health challenges of the day and focus attention on

initiatives that can be taken by the government, and others, on

public health and the National Health Service to address them.

* Copies of 'On the State of Public Health' are available here.

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