Right from the Start

A determination to challenge and address Scotland’s stark health inequalities has been a constant throughout Sir Harry Burns’ career.

“It was why I gave up being a surgeon and went into public health because I’d been working in the Royal Infirmary in Glasgow and I’d seen huge disparities in outcomes depending on where people lived,” he explains.

“People in the East End of Glasgow were much sicker than they might have been if they lived somewhere else, so that’s what got me interested in moving into public health.”

Burns became director of public health for Greater Glasgow Health Board in 1993 where he continued to witness the extremes in outcomes between the city’s most affluent and most deprived. While it was a post that he “really enjoyed”, he came to the conclusion that achieving his ambition of making significant inroads into health inequalities would require greater involvement with government, and so he welcomed the opportunity to widen the discussion that came with his appointment as Chief Medical Officer for Scotland in 2005.

Health inequalities are “a manifestation of a set of underlying drivers in society”, which also cause things like inequality, educational outcome inequalities, off ending behaviour and employment probabilities, he explains, and will not be cured via the health service alone. It will also not be fixed overnight. Burns says he is often asked if politicians are only interested in the next election or if there is political will to do the right thing, no matter how long it takes.

“I am in no doubt that the longer I’m involved with politicians, the less cynical I become about them. Not that I ever was cynical, of course! But I am actually a fan in general of politicians. They are there because they want to improve society. So the Scottish Parliament is a terrific environment in which to work because politicians are much more accessible.”

Flagship legislation such as the ban on smoking in enclosed public places, the recently partially-implemented tobacco display ban and the long-awaited minimum price for alcohol have allowed the Scottish Parliament to be seen internationally as “a leading source of health legislation”, he says, adding that our direction with alcohol in particular is also recognised as world leading.

“Minimum pricing is a clever mechanism given that they can’t change absolute rates of tax and, therefore, it is a move that is being looked at internationally as being smart and is being viewed by other countries as something they may well want to try and do as well, I think.

“So, I think the devolution part of this has required some clever approaches to be evolved and that can only be a good thing.” However, legislation is not the only way to effect change. To change culture, we also need to “get on and do things,” he says.

“I think the science is well enough understood and I’m certainly doing my best – I’ll speak to anyone who will listen to this. I think most folk have heard it about five times! It’s about method. People say, ‘OK. That’s the explanation. What do we do?’ And the really interesting thing about the Early Years Collaborative is that there is a method.” 

The Early Years Collaborative is the first of its kind. It has learned from the collaborative work of the Scottish Patient Safety Programme and is a ‘bottom up’ way of changing the system, which aims to accelerate the conversion of the high level principles set out in GIRFEC and the Early Years Framework into practical action. And Burns has every confidence that it will work.

“To have Smart Alecs like me in a room saying, ‘You’ll do x, y, z,’ doesn’t work. People getting involved in testing things, trying things out and then sharing that learning is the fastest way to move the system.

“So that is what the Early Years Collaborative is doing. And it will transform things. There is no doubt about that.”

At the moment the Scottish infant mortality rate is the lowest of the four UK countries and Burns says the aspiration is to reduce it even further to a point where it is “in shouting distance” of Scandinavian countries.

“So it is ambitious but we know how to do that. It is just a question of applying evidence at scale.”

It’s early days for the Collaborative but Burns shares that some small but significant changes have already begun to trickle through.

For example, he says he was keen to ensure pregnant women get access to Healthy Start vitamins – an important combination of Vitamins C, D and Folic acid – and says we are now seeing health boards handing out many more than ever before. He also shares the example of East Ayrshire Council, which has seen positive results from handing out resources to parents to help ensure every child going to nursery is read a bedtime story every night.

“So it is all straws in the wind at the moment. But at least the wind is blowing in the right direction,” he says, adding that as such initiatives and others like it accumulate and expand, we should see a shift in infant mortality and stillbirth rates within a couple of years.

However, news of what Scotland is attempting has already begun to spread. A delegation from Denmark – which has already adapted the Scottish Patient Safety Programme – came to observe the second learning session and Burns says he has also been invited to go to Copenhagen later this year to talk about the Collaborative.

“So when the Scandinavians are beginning to look at what you are doing then you know you are doing something a bit unusual,” Burns jokes.

But it doesn’t stop there. Burns is also keen to explore whether the same change method could also be applied to improving educational attainment and reducing offending behaviour. He insists it is “perfectly possible” to make Scotland a “completely violence-free society,” and has been encouraged by engagement with front-line professionals from out with the traditional early years constituency.

“A key part of this is me not knowing the answers. They know the answers. They know what it is like on the ground to be working with a disaffected alienated group of young men. And I have to say that discussion with the police and prison officers and so on has been tremendously inspiring. They really understand this. And the notion that they can work with people to transform their lives is something that they are quite comfortable with. So I’m very optimistic about how we develop thinking around this, going forward.”

And this optimism is contagious. Burns jokes that “we’re changing the world” in Scotland and “starting to make a name for ourselves”, as he shares his belief that there is no problem too hard.

“I genuinely don’t think there is. We keep talking about the demography – what is going to happen when there is not enough young people to look after all the old people? Well, creating young people who are firing on all cylinders, who are educationally successful, who are not getting drunk and taking drugs and fighting and so on. That’s a good way to start.
Making full use of the intellect and ambition of young people, rather than just accepting that those at the lower end of the social scale are going to be a burden.”

So there is a will, as well as a way, to make that change happen in Scotland, I ask.

“I think so. I mean, why wouldn’t there be? Given what the Scottish Patient Safety Programme has achieved, given the start that the Early Years Collaborative has had, it seems to me that folk are saying this holds out significant possibilities,” he replies.

“So I’m detecting increasing interest in being aspirational and ambitious.”