Intended for healthcare professionals

Feature Interview

Harry Burns: the man who shifted Scotland’s thinking on health

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2262 (Published 21 March 2014) Cite this as: BMJ 2014;348:g2262
  1. Bryan Christie, freelance journalist
  1. 1Edinburgh, UK
  1. bryan.christie{at}virgin.net

Harry Burns, Scotland’s outgoing chief medical officer, tells Bryan Christie that social disintegration is at the root of ill health

The same techniques that led the Great Britain cycling squad to success at the 2012 Olympic Games are being applied to health improvement in Scotland. They are based on the idea that small gains across a range of interventions can add up to significant overall improvement.

The idea has worked in patient safety, which has seen a 12% fall in mortality in Scottish hospitals since 2007.1 It is now being applied to population health for the first time in a move that is attracting international interest.

The man at the centre of these developments is Scotland’s chief medical officer, Harry Burns, who is standing down at the end of March after eight years in the post. He says that one of his key contributions has been to create a new understanding around health improvement.

“I think I’ve helped Scotland to conceptualise health improvement differently. It’s not something you do to people; it’s something you do with people. We have got to quite an interesting place in terms of a positive view of wellbeing rather than a negative view of illness. The notion that people have assets and qualities within them that allow them to live a healthy life and make positive choices is something that we are much more comfortable talking about now in Scotland.”

This focus on building on people’s assets has led directly to the Early Years Collaborative, a Scotland-wide programme involving social and health services, education, and other services, that is designed to give all preschool children a good start in life.

A bedtime story for every child is just one of the small changes being used in the programme to help children reach development goals. Parents are encouraged to take part, and nurseries record how many children are benefiting. “Bedtime reading is an evidence based intervention that will produce small benefits,” said Burns. “A range of many different things being done at scale consistently across the whole piece begins to make a significant difference. What we are doing is very similar to the way the Olympic cycling squad characterised benefits. They paid attention to small gains.”

He has worked closely with the Institute for Healthcare Improvement in the United States to develop the changes in Scotland.

High levels of smoking and alcohol use have traditionally been blamed for Scotland’s poor health record, but Burns, who was a consultant surgeon before moving into public health 20 years ago, has examined the evidence and puts forward an alternative view. He says unhealthy habits are a consequence of people having little control over their lives and no stake in the future. Helping them to assert control is the key to making healthier choices.

Fresh approach

Burns’ period as chief medical officer has covered a time when Scotland became the first country in the UK to ban smoking in public places (2006) and to introduce legislation to set a minimum price for alcohol (2012). Although many others were involved, including politicians, Burns was an important figure in these developments. The biggest contribution, however, has been in getting Scotland to think afresh about the roots of ill health and how it can be tackled. Levels of illness in Scotland cannot be explained alone by smoking and diet—Liverpool and Manchester have similar levels of deprivation as Glasgow but not the same degree of ill health. Instead, Burns says we are seeing the biological consequences of sociological chaos.

One of his early influences was the Scottish trade union leader Jimmy Reid, whose speech when he was inaugurated as rector of Glasgow University in 1972 was printed verbatim in the New York Times. The newspaper compared it favourably with the Gettysburg address. In the speech Reid described the alienation from society of people buffeted by forces beyond their control.2

To the young Burns listening, it was powerful stuff and it shaped his professional career. He says poor educational attainment, criminality, and dependency all stem from social disintegration and must be addressed. “It’s about doing the right thing because it’s the right thing to do. I think it’s very important that this argument retains a strong moral basis. The world would be a lot better off if people did things because they were just and morally good rather than because it helps grow economies. That is something that I keep harping on about, and I think most folk recognise that. When I’m giving talks it’s the only time I’m interrupted by applause.”

He remains in much demand and is moving on to become professor of global public health at Strathclyde University. In that role he will work closely with the International Prevention Research Institute in Lyon, France, which aims to prevent disease through training, education, and research. He wants to move from theory to practice. “The critical thing is to find out what to do about (health inequality)—how to respond to it—and that is what I hope I will be spending most of my time on.”

Medical training is another issue that has occupied his time. He is not a fan of “super-specialisation” and would like to see more flexibility and greater depth in training to prepare the doctors of the future. He remains hopeful that this will be addressed in the current review of training across the UK being led by David Greenaway, professor of economics and vice chancellor of Nottingham University.

It is testament to the impact Burns has had as chief medical officer that there is concern that the progress made in the past few years may be more difficult to sustain after he has gone.

Burns has provided reassurance to someone on Twitter who regretted his decision to stand down. “For the avoidance of doubt,” he tweeted, “I’m not leaving the field. I’m just changing the position I play.”

Notes

Cite this as: BMJ 2014;348:g2262

Footnotes

  • Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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