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The annual report of the chief medical officer, Kenneth Calman, was published today. The report, On the State of Pu...
The annual report of the chief medical officer, Kenneth Calman, was published today. The report, On the State of Public Health 1996, contains a special chapter on the health of disabled people, a section on the potential for health, and raises issues on consent, domestic violence, and air quality and health.

Sir Kenneth said:

'The special chapter on the health of disabled people notes that much progress has yet to be made, not just in the provision of appropriate facilities in people's homes and local environments, but also in achieving further changes in the general perception of disability - not just among policy-makers and employers, but in the public as a whole - and in identifying the challenges that disabled people face.

'More specifically, people with disabilities pose challenges to health, social, educational and employment services, and to the interface between these services and between government departments and agencies, local authorities, voluntary agencies, relatives and other carers, and the private sector; these challenges should be met to ensure that individuals with disability can meet their own, more personal and more demanding, challenges.

'Examples of work to alleviate the consequences of disability include: initiatives to increase independence and autonomy; help for young people with disability to manage the transition to adulthood; and a programme to improve services for disabled people within the NHS, including workshops led by disabled people for health service managers.

'These initiatives will be led by health and social services in partnership with the voluntary sector - but for disabled people to play their full role in society, action will be needed on a broader front: employers, the education sector and the leisure industry all have a major part to play.

'Society must recognise the rights of disabled people, as embodied in the Disability Discrimination Act 1995. Disability should not prevent individuals benefiting from being members of society, nor from fulfilling their duties to that society. But for rhetoric to become reality, providers of services must view the world from the range of perspectives of disabled people; work with disabled people; and work across boundaries to alleviate the impact of disability and, where possible, prevent it.'

Sir Kenneth said that his annual reports and those of his predecessors over the past 139 years showed clearly that public health in England had changed for the better, with life expectancy, infant and maternal mortality all showing striking improvements. In 1996, the infant mortality rate reached its lowest ever level of 6.0 per 1,000 live births; perinatal mortality also fell. Nevertheless, a review of this year's report still showed some disturbing features.

He said: 'Mortality among males aged 15-44 years is still as high as it was in 1986 - a sad loss of young lives. Excess winter mortality still occurs in England, particularly among elderly people. Deaths related to drugmisuse and accidental poisoning increased almost six-fold among men aged 40-44 years since 1986, and cigarette smoking among children, particularly girls, continues to increase. Lung

cancer has now overtaken breast cancer as the predominant cause of cancer deaths among women in some parts of the country, and is

strongly associated with cigarette smoking.

'Death rates from heart disease and stroke, while falling, remain too high; obesity is increasing; the numbers of people taking regular exercise remain disappointingly low; and there is evidence indicating

increased alcohol consumption, particularly among teenagers.

'All of these require explanation and action to improve health. The contention is that, with existing knowledge, health can be improved - and that the potential is there if only it can be realised.

Nevertheless, the determinants are mainly social and economic, and solutions need to be found at personal, local and national levels.

'The concept of 'potential' for health is used deliberately, and should be more widely recognised: potential is associated with the concept of energy - the capacity to work and play; it implies an ability to transform, to change one form of energy into another; it suggests empowerment of individuals - a crucial factor in improving public health; it acknowledges a gap between what is now and what could be.

'Health cannot be narrowly defined; it is not just the absence of sickness, nor just about living longer, but about a better quality of life. Any strategy for public health must take into account these factors and be broadly based and holistic. Improving health is as much about employment, occupation, housing, transport, the environment, education and living standards - including poverty - as it is about treatment within the health service.'

The principle of consent has been a focus of public and professional concern in several areas of practice in recent years. In general, a

patient has the right under common law to give or withold consent to medical examination or treatment. This is a basic principle of health care.

Patients are entitled to receive sufficient information, in a way that they can understand, about proposed treatments, the possible alternatives and any substantial risk or risks which may be special in kind or magnitude or special to the patient, so that they can make a balanced judgment. Sir Kenneth stated that those seeking consent must ensure that they were adequately trained for this task, and

could supply the necessary information.

The report also focuses on domestic violence, which encompasses not just physical but also mental and emotional abuse. Sir Kenneth said domestic violence had considerable implications for the NHS,

particularly in A&E departments, primary care, and in specialist settings such as maternity services and child and adolescent mental health services.

He said: 'The department of health has responsibility for health and social care aspects of domestic violence. Effective implementation

of Part IV of the Family Law Act 1996 will require improved recognition of domestic violence; further facilities to help, advise and support women who experience domestic violence; and an effective interface with other agencies, especially social services and the criminal justice system.'

Sir Kenneth also outlined the work being done on air quality and health. The department of health, together with the department of the environment, transport and regions will be reviewing the banding system used to describe air quality and will publish a handbook on

air pollution and health in order to provide the public with the best possible information on the subject.

The Chief Medical Officer also highlighted progress made on five key topics identified in last year's annual report:

-- Risk communication and the language of risk: within the Department an extensive work programme has concentrated primarily on risks to

public health, though it is relevant to communication with individual patients. The programme includes: general guidance on risk

communication; workshops focusing on the identification and management of risk communication issues; case study seminars; and

support for key risk communication decisions.

-- Mental health: following last year's special chapter on mental health, further progress has been made in this key area including: in January 1997, The Patient's Charter: Mental Health Services was launched; there are plans to spend over£1.4m nationally to increase knowledge and understanding of mental health and to combat the stigma of ill-health; there were over 500 responses to the Green Paper, Developing Partnerships in Mental Health, and 200 responses to last year's consultation on a revised version of the Mental Health Act 1983 Code of Practice are now being analysed; in May 1997 the Primary Mental Health Care Toolkit was published.

-- Antibiotic-resistant micro-organisms: during the past year many parts of the Department have been involved in discussions on how to reduce the prevalence of antibiotic-resistant micro-organisms. New guidelines on methicillin-resistant Staphylococcus aureus (MRSA) control in hospitals, and guidance on the management of tuberculosis which is drug resistant or associated with HIV infection, are being drawn up. The Advisory Committee on the Microbiological Safety of Food is preparing a report on food and antibiotic-resistant


-- Information technology: information technology and the use of computers has revolutionised the delivery of patient care. Rapid developments indicate that, over the next few years, the pace of change will become even faster, providing greater potential benefits to patients and the public, with likely improvements in public

health, health care, education, research and management effectiveness.

-- HIV infection and AIDS: clinical trial results of combination therapy are promising, although the long-term effects are unknown.

Evidence indicates that these treatments provide clinical benefit and may delay the onset of AIDS, prompting clinicians to produce guidelines for the antiretroviral treatment of HIV and AIDS.

Emerging epidemiological evidence of a recent decline in AIDS cases since the introduction of combination therapies is encouraging - but public health measures aimed at prevention of infection remain central to its containment.


On the State of Public Health 1996 is priced at£17.50, ISBN 0-11-322097-9, and is available from The Stationery Office.

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