The ugly truth about England’s health: the Chief Medical Officer reports

We’ve got something a bit different for you this week, as we stand back and take a look at how we’re doing as a nation in terms of our health and wellbeing and also, individually, at different stages of our lives. I’m kicking this off today by flagging up volume one of the first annual report from our Chief Medical Officer, Professor Dame Sally Davies, which was published last week. It’s a weighty document, as you might expect, which considers many aspects of health in England and highlights the good, the bad and the downright ugly.

Ugliest of all and given top billing is the shocking increase in liver disease, which is on the rise in England whilst it declines in the rest of Europe, with deaths from chronic liver disease and cirrhosis in the under 65s up by 20% between 2000 and 2009, but falling by a similar amount across the Channel. What’s going on? Unrivalled levels of harmful drinking, obesity and undiagnosed hepatitis infections, that’s what; major causes of liver disease and all preventable. I blogged about this in the summer, looking at a new’traffic light’ blood test giving an early warning of liver damage, a silent killer which can progress unnoticed for years.

The report contains many recommendations for the direction Public Health in England needs to take, emphasising the need to give greater emphasis to wellbeing and to address medical, environmental and lifestyle risk factors (for disability, disease and early death), through a range of evidence-based interventions by community providers such as GPs, pharmacies and local authorities. There is a reminder that people need to be treated holistically, considering the whole person not just single problems or risk factors. Recognising that people may well have a number of risk factors and the importance of tackling these together is something we’re hearing about more and more, and this report chimes with that published by The King’s Fund in the summer, which also recommended that public health initiatives should target clusters of unhealthy behaviours.

Nearly 70% of us have two or more habits or medical risk factors that are linked with life-limiting disease. Lifestyle and health behaviours get top billing in the list of risk factors presented in the report, which are given in order of impact:

  • tobacco use
  • harmful alcohol use
  • high blood pressure
  • high cholesterol
  • overweight and obesity
  • physical inactivity
  • illicit drug use
  • low fruit and vegetable intake
  • occupational risks
  • unsafe sex

The environment is considered too, with urban air pollution estimated to be among the top ten causes of mortality in the UK. This may all sound a bit depressing, and particularly on a wet and windy November morning, as it is in our neck of the woods, but it’s striking that many of the factors held up as so damaging to our health are ones we have the potential to change.


Department of Health: Chief Medical Officer publishes her first annual report. 21st November 2012. The full report can be downloaded here: CMO annual report: Volume One, 2011 ‘On the state of the public’s health’

The Lifestyle Elf: New ‘traffic light’ blood test gives warning signal to unsafe drinkers. 30th August 2012.

Buck D, Frosini F. Clustering of unhealthy behaviours over time. Implications for policy and practice. The King’s Fund. August 2012. The Lifestyle Elf blog on this report: England sees a drop in unhealthy lifestyle behaviours but a widening gap between different groups.

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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