Linda Bauld: While we’ve been dealing with one public health crisis, the others have been building up
BEFORE March 2020, part of my day job involved conducting research on some of the risk factors that can cause chronic conditions like cancer, heart disease, respiratory diseases and diabetes. Trying to find better ways to help people stop smoking, improve their diet and activity levels or reduce the harm caused to individuals and families by alcohol.
Many of the studies I was involved in were paused due to Covid-19 although others continued. Like thousands of my colleagues working in public health across Scotland, our focus shifted to dealing with the immediate threat to health and wellbeing caused by the virus.
But these public health issues haven’t gone away. In fact, just as there is an NHS backlog at the moment, with scores of patients across the country now waiting for delayed diagnoses or treatment for their conditions within the NHS, there is a public health backlog.
People have not been receiving support from health improvement services, and there are signs that measures to address the pandemic like closing businesses and schools have made these risk factors worse, particularly in our poorer communities.
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The latest evidence relates to deaths caused by alcohol, which National Records of Scotland reported this week increased by 17% in 2020. This is the highest number of alcohol deaths for a decade. A similar increase in 2020 was reported via preliminary figures for England and Wales.
Deaths from alcohol were four times higher in the most deprived compared to the least deprived areas in Scotland. Most of these deaths occurred in men in their 50s and 60s and two thirds were from liver disease. These preventable deaths will reflect long-standing patterns of drinking that got worse, including during lockdown periods last year.
Surveys suggest that while many people actually reduced their drinking during lockdown, this was not the case for those already drinking heavily. A survey conducted by Alcohol Focus Scotland and Alcohol Change UK reported in July 2020 that a third of those drinking at higher levels before lockdown increased their consumption when stay at home measures were introduced, and that more than half of those drinking more reported that it was to deal with stress and anxiety. Similar findings have been reported from studies in the Netherlands and Spain.
Evidence on diet and weight is also worrying. Obesity Action Scotland recently released a report from a survey conducted in March 2021 among a representative sample of adults that asked how health behaviours had changed since the pandemic began.
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Six in ten people reported that their mental wellbeing had deteriorated and just under half reported that they had put on weight and reduced their levels of physical activity. Some reported positive changes including being more likely to cook from scratch, eat together as a family or consume more fruit and vegetables, but the main findings were that things had got worse for many people not better. This is a problem because Scotland already has an obesity epidemic with the highest levels of weight in the UK and among the highest in the world.
The picture relating to smoking during the pandemic is more complex. Our national surveys in Scotland haven’t yet provided a reliable picture of how that has changed, although the long term trend is of very encouraging declines, with huge progress made to date.
My own research team began a monthly representative survey on this in the autumn of 2020, building on a long-running similar survey in England. Early signs are that concerns about Covid-19 may actually have encouraged more people to try and quit smoking, but not necessarily amongst less affluent groups. If that is the case, the pandemic could have widened inequalities in smoking.
The public health backlog is also about services. Within my own research I know it takes some time for people to decide to take up or be offered services that can help change behaviour and reduce their risks of chronic conditions, and even longer to persuade governments to adequately fund and organise such services. This includes things like weight management services, alcohol treatment or stop-smoking support.
But during the pandemic these services either haven’t been there or have been offered in a different form – for example online. I know many experienced public health practitioners in Scotland who have stepped up to organise Covid-19 vaccine programmes, deal with infection outbreaks and collect and report on data relating to the pandemic. That means they haven’t been available to plan or deliver health improvement services. Appointments were also paused due to infection controls and a general halt to a lot of face to face support. Just as in the wider NHS, these services are now restarting and that’s very welcome. But I’m worried that the risk factors that have made some Scots more vulnerable to Covid-19 (for example, being overweight or obese) have been getting worse not better during the pandemic.
We need to turn our attention back to these important elements of public health. That will be easier if we can continue with our vaccine rollout and do our part globally to support other countries to do the same. Addressing the pandemic is still the current priority. But as it fades we’ll be learning lessons about what to do if we are faced with something similar to Covid-19 again. One of those lessons must be that in dealing with one public health crisis we don’t neglect the others that are just as important but take decades to address.
Linda Bauld is Chair of Public Health at the University of Edinburgh.
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