 The final item of business today is a member's business debate on motion number 13677, in the name of Dennis Robertson, on the World Health Organization's 25x2025 framework. This debate will be concluded without any questions being put. I would be grateful if those members who wish to speak in the debate could press the request to speak buttons now, please. I call on Dennis Robertson to open the debate. Seven minutes, please, Mr Robertson. Thank you, Presiding Officer. First of all, I thank all those members who signed the motion to enable this debate to take place today. In your introduction to the debate, you probably said it better than I am going to. We are looking at the 25x2025. This is a World Health Organization reduction in deaths, possible deaths, deaths through non-communicable diseases, generally known as NCDSs. What are they? They are diseases such as cardiovascular disease, chronic respiratory disease, diabetes and cancers. Many of those deaths are indeed preventable. Preventable in terms of some are there because of our lifestyle. We have known for many years, especially in Scotland, that quite often our lifestyle is not in keeping with good health. Although the Scottish Government and even prior to the SNP Scottish Government, the previous executive back in 2003 took out initiatives in terms of our wellbeing. With all the messages that are coming out and all the advice that is coming out, it would appear that we are not listening. What would be achieved if we did listen? What would be achieved if the Scots decided to be healthier? We would probably reduce our deaths by 3,805 per year. That is 3,805 deaths every year. Is that a simple message? Yes and no. The reason I say that is because when I became the convener of the cross-party group in heart disease and stroke, it became evident to me that there were many conditions out there, although some are preventable, but many conditions out there that required the intervention of our health professionals as well. The screening that has been taking place in terms of bowel cancers for instance, breast cancer for instance, cervical cancer for instance, these are all very commendable and it is leading to healthier lives. However, high blood pressure is something that many of us suffer from. Indeed, Presiding Officer, just over a year ago in the Parliament here when we were doing high blood pressure testing, I, certainly along with many colleagues here in the chamber, went along and had my blood pressure tested just to find that I had high blood pressure. It was news to me. I did not know that I had high blood pressure and I am sure that many other people out there in the community in Scotland perhaps need to have more regular checks. Are we doing enough? Well, yes and no. We are doing enough in terms of, I think, some of the Government initiatives in terms of walking to work. For instance, men, if we walked one mile at a moderate pace every day, we could reduce the aspect of dying with prostate cancer by 30 per cent. Women, if they became more physically active, could reduce breast cancer by 9,000 in the UK. So we do have a responsibility for our own health and our own wellbeing. But in terms of that, because of some of the aspects of our food intake and the way we probably enjoy many of our foods that are generally quite bad for us, we are asking our food manufacturers to perhaps help us. Just help us that little bit. Reduce the salt intake in our processed foods. Reduce the sugar in some of our fizzy drinks, because it would appear that we are finding it very difficult to say no. But when does it start, Presiding Officer? Well, it has got to start at the early age and I think that this is where the Scottish Government has got it right. We are starting at the early ages. We are getting into the schools. We are looking at trying to have a healthy weight for everyone, everyone, Presiding Officer. That starts at the early years. Our young people are going to learn, perhaps more than we did, about healthy ways and healthy styles and the wellbeing to a healthy life. That means becoming more physically active. It means doing the things that some of us don't do at the moment, because many of us and many of our young children, too, will still sit at a computer apart from going outside to play. We need to get that education right. Recently, the initiatives in terms of getting on your bike, cycling, taking more activity within our rural areas, and certainly within my constituency in Aberdeenshire West, we have some fantastic outdoor initiatives these days to encourage healthy weight and healthy wellbeing. However, we have to say yes. We have to say yes to that lifestyle. We have to embrace that lifestyle and, if we do, we will meet some of the targets. Certainly, our anti-smoking target is far more advantageous than the World Health Organization one, because in Scotland, we are looking at reducing or smoking down to 5 per cent by 2034—5 per cent. It would be fantastic if it was nil, but in ways of doing that, we have to find measures of trying to help those who are still smoking, because far too many deaths in Scotland are still as a result of lung cancer and smoking. Certainly with the introduction of e-cigarettes, we are starting to find that more people are finding the route towards giving up tobacco. We are not entirely sure of the impact of e-cigarettes in the long term, but we are very sure that, at this moment in time, the e-cigarettes are certainly having an impact on people reducing smoking. Are the Government doing enough? I think that we are in the right direction. We are hoping through awareness and education that people will listen. I am listening. I am not sure if my lifestyle is following suit, but I sincerely hope so. Thank you, Presiding Officer. Many thanks. We now turn to the open debate speeches of four minutes or so, and I call Malcolm Chisholm to be followed by David Torrance. Presiding Officer, I congratulate Dennis Robertson on bringing forward this important debate. I think that the concern that we have is highlighted by the line in his motion that points out that 75 per cent of premature deaths in Scotland are caused by non-communicable diseases. That is really a very big challenge for us all. Of course, you can point to improvements if we look, for example, at the statistics from 1994 to 2013. Age-standardised death rates under 75 have fallen by 38 per cent overall, 71 per cent for coronary heart disease, 69 per cent for stroke and 28 per cent for cancer. There has been progress throughout all the years of the Scottish Parliament and we shouldn't forget that, but we are still worse for premature mortality than the other countries of the UK and many other countries in Europe. Of course, the most concern is that disadvantage is skewed very much to our most disadvantaged areas. However, it is not, of course, just a Scottish problem. That is why the debate is set within the context of the World Health Organization. It said something rather alarming last week. It said that 59 per cent of people in Europe are overweight or obese. Following on from that, it said something even more frightening, that young people nowadays may not live as long as their grandparents. That is a risk, because quite recently I was very pleased to hear that half the girl babies born today will live to be 100, but now the WHO is warning us that there is a risk, particularly because of obesity, that young people may live less long than their grandparents. There is a major European and indeed global problem, and that is why we have highlighted in the debate that the WHO's global status report from 2010, which highlighted four risk factors—tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets. Those are exactly the four issues that we have been highlighting throughout all the years of the Scottish Parliament. However, that report says something interesting as well. It says that we have to emphasise the dimension of health inequalities but also have strategies that impact on those modestly at risk. In a kind of way, we need to have a twin-track approach on that. If we want to embody it in one phrase, it can be called progressive universalism—that is what Michael Marmot, the great guru of health inequalities, has called it. We have to have messages that go to the whole population, but we have also to have targeted initiatives to deal with the health inequalities. Let us have clear messages. Dennis Robertson talked about e-cigarettes, for example. Tobacco is the greatest preventable cause and risk factor for all the non-communicable diseases that we are talking about today. E-cigarettes definitely have the R already, winning a lot of people off cigarettes. They are massively less harmful than traditional cigarettes, and yet we have the doctors squabbling about how much less harmful they are. It is better if we can have a clear message on e-cigarettes. It is better if we can have a clear message on diet, because sometimes the public is also a bit confused by the mixed messages that they get about what is healthy and what is not. What is absolutely clear is two things about physical exercise. One, that it cannot erase a bad diet. Secondly, and we are being told this repeatedly now, if you can do one single thing to improve your health, particularly if you are my age, but at any age it is to take regular exercise. That was a message that I know that Sir Harry Burns repeated very strongly in the latter years of his time as chief medical officer. We need the general messages, but we also need the health service, of course, blood pressure and so on, and all that by GPs and the quaff that is now being discussed in terms of the GP contract. Help with that. We have had massive improvements in the treatment of coronary heart disease, stroke and cancer again during the years of the Scottish Parliament. However, we need targeted initiatives, which is why we need to give extra resources to GPs in the most deprived areas such as the deep-end GPs. Of course, most of all, in my times nearly out, but when we are talking about health inequalities, we have to address the issues of life circumstances, because we will never solve health inequalities just by lifestyle actions, and that is why the wider social changes are absolutely necessary if we are going to deal with them. It is a problem with many parts, but I think that a very important part of the action is highlighted by the motion and by the WHO targets. I think that the Scottish Government has signed up for them, and I hope that we will all do everything that we can to make sure that the targets are delivered. Many thanks. I now call on David Torrance to be followed by Nanette Milne. Thank you, Presiding Officer. I would like to thank Dennis Robertson for securing this debate in Parliament today. Non-communicable diseases, or NCDs, are multifaceted. However, I believe that there is one thing that I do have in common that can be prevented. This becomes evident if you have a closer look at the common risk factors that include excess of alcohol and tobacco consumption, high levels of blood pressure and cholesterol, as well as physical inactivity, overweight obesity and unhealthy diet. According to a world health organisation, those risk factors lead to cardiovascular diseases, cancer, respiratory diseases and diabetes, which together account for over 30 million deaths worldwide. Today, I want to talk about how we can significantly reduce premature deaths caused by NCDs in Scotland. I believe that in aiming for this goal, we can create a healthier and ultimately more flourishing society. NCDs are also referred to as chronic diseases. They are neither infectious nor transmittable from person to person, though each individual has the responsibility to lower the risk of NCDs by avoiding risk factors. In that context, I strongly welcome the World Health Organization's 25x2025 framework. It calls for a comprehensive approach involving a range of stakeholders from health, education, agriculture and the financial sector. For reasons of time, we want to have a closer look at two of the nine targets, reduced physical inactivity and harmful drinking by 10%. First, let me say a little more about physical inactivity. In fact, physical inactivity has been a single doubt as a fourth leading risk factor for global mortality. Statistics indicate that annually 3.2 million deaths can be attributed to insufficient physical activity. Furthermore, the World Health Organization estimates that a lack of physical activity is a cause of up to 25 per cent of breast and colon cancers, 27 per cent of diabetes and approximately 30 per cent of heart disease. Having a closer look at Scotland, we can see that there is a major room for improvement. In 2012, only 39 per cent of adults met physical activity guidelines, which require a minimum of 30 minutes of moderate activity and at least five days per week. In order to counteract those numbers, the Scottish Government and NHS Scotland have started several initiatives that encourage people to get active, for example, in active Scotland, which assists people finding opportunities to exercise in their local area. However, I want to take this opportunity in the chamber to commend Scout Scotland and all its members for their work. As a long-standing member of the Scout Association, I have no doubt that the organisation plays an invaluable role in promoting physical activity and the healthy lifestyle among children and young adults. I am positive that the nearly 45,000 Scouts across Scotland have a great impact on their community by encouraging others to live healthier lives. Let me now turn to alcohol consumption and its relation with NCDs. The World Health Organization estimates that 3.3 million annual deaths are a result of harmful drinking. Both speaking about excessive alcohol consumption, I believe that it is not only crucial to mention its role in causing a large number of diseases but also its social and economical burden on society. We need to acknowledge that alcohol abuse is a major public health concern. Studies imply that nearly 20 per cent more alcohol is sold in Scotland than in England and Wales. Additionally, the number of alcohol-related deaths is significantly higher in Scotland compared with other parts of the UK. All in all, excess alcohol consumption costs Scotland £3.6 billion annually. On this, we are a country that is a challenge to counteract. I believe that the Scottish Government has already taken many measures towards tackling alcohol abuse. Most notably is the alcohol framework for action, which aims to facilitate a cultural shift that is required to transform our relationship with alcohol. To achieve its goals, strategic and comprehensive solutions are necessary. That has included educational measures as well as a diverse support for families and communities and preventive efforts. An example of that latter is the Alcohol Minimum Price Act. In conclusion, I would like to return to my original statement. NCDVs can be prevented. As I indicated in the case of physical and activity and alcohol abuse, we are already taking the first steps in the right direction. However, more can be done to fight NCDs and ultimately save lives. Thank you very much. I thank Dennis Robertson for sponsoring this debate, which not only covers international issues but also issues that are very relevant to Scotland and indeed my own region of north-east Scotland. As a medic, I am familiar with the work of a double-world health organisation, which was established as part of the creation of the United Nations and makes an invaluable contribution to both the developed world and to the third world. Many people will be unfamiliar with the term non-communicable diseases, as referred to in the motion, as it does not perhaps easily describe the conditions with which they are associated. The WHO has identified the most common of those as cardiovascular disease, cancer, chronic lung diseases such as COPD and diabetes. However, the WHO does not limit those, as is shown by its work on childhood obesity, alcohol and drug abuse, and encouraging and raising awareness of the dangers of smoking. WHO's 2025 campaign to reduce the mortality rate will be welcomed by people across the globe, and hopefully that will be achieved even sooner than expected. In our own country, some of the statistics are frankly not just alarming but frightening. As the motion states, non-communicable diseases account for nearly 75 per cent of all premature deaths in Scotland. When we look more closely at specific conditions, it is clear that more needs to be done. The fact that one in five people in Scotland has or is at risk of having diabetes equating to 276,000 of our population is something that cannot be ignored. Diabetes Scotland points out that 80 per cent of type 2 diabetes cases could have been prevented via healthy living. As a co-convener of the cross-party group on diabetes, no doubt those types of figures will come up this evening when I am hosting a round-table discussion that will focus on the future of care delivery for people with diabetes within the context of the new and emerging health and social care integration bodies. Time prevents me from going into detail regarding every single disease or condition that WHO has identified, but when it comes to smoking, it is clear that this is an area that needs to be tackled throughout every single nation. Again, the statistics for Scotland alone are staggering. Tobacco use is the single greatest preventable cause of NCDs and is the only risk factor common to the four main NCD categories, as I mentioned earlier. Globally, tobacco causes one in six of all NCD deaths, but in Scotland it is about one in four of those deaths. Ash Scotland, the well-respected charity, is committed to supporting the objective of the World Health Organization's campaign, particularly when it comes to supporting Scots who want to quit the habit and mounting to 67 per cent of smokers. I would also like briefly to touch on childhood obesity, the need for physical activity and healthier diets, which of course are all interrelated. Childhood obesity is an increasing problem and not something that existed to any significant extent when I was a child during and after World War II. However, as WHO has stated, if we do not combat this, then it clearly will lead to heart disease, diabetes and other serious illnesses. Indeed, the odd case of type 2 diabetes has been diagnosed in childhood. I will not go into all the facts and figures, but worryingly, among girls in Scotland, we have seen a rise in obesity from 14 to 18 per cent in the years from 1998 to just last year. Sadly, it is the case that this is a more acute problem in deprived areas. Increased physical activity is an obvious factor in overturning this problem. I am sure that all of us in the chamber would like to see more children taking up running or swimming rather than spending too much time on computer games. Similarly, a healthy diet, as recommended by WHO, encourages concentrating on fruit and vegetables and seeking to achieve the recommended five a day. As a war baby, I have been told anecdotally that the British diet was at its healthiest during the Second World War. When I do remember consuming the government that provided ordnod's juice, which I loved. This has been a very constructive debate, and I commend the work of WHO and its efforts to combat those diseases and conditions. Let us hope that we do see a significant improvement by 2025, if not before. Again, I thank Dennis Robertson for bringing this debate to the chamber. Thank you very much and our final open debate speaker is Jim Hume. Thank you, Presiding Officer. Of course, thanks to Dennis Robertson for securing this date, especially on this day, which is actually World Heart Day. The World Health Organization's goal to reduce premature cardiovascular disease deaths by 25 per cent by 2025 is, of course, an ambitious goal whose time has come to be taken, I think, very seriously. The goal sets parameters that include a 25 per cent reduction in high blood pressure, 10 per cent increase in physical activity and a 30 per cent reduction in tobacco use, of course, among others. We know that all those factors contribute to diseases and conditions, which cause the highest mortality rates in Scotland. Just in South Scotland alone, my region, there is an average of 1.2 heart-related deaths in South Lanarkshire, 1.1 in the Borders and 1.5 in Dumfries and Galloway every single day, but it is not enough to look at non-communicable diseases in isolation. We have to recognise that those often exist as co-morbidities and we have to recognise the singular concern of NCDs. While we know that diabetes needs a different treatment than smoking cessation, we now have information that active and passive smoking increases the risk of type 2 diabetes. It is up to each person to decide whether they want to stop smoking, of course, but, however, we have a duty to protect children and support those who want to stop them. The bill that I introduced and will be discussing next week aims to do exactly that, banning smoking in cars when children are present will raise awareness amongst adults and will protect children from those 60,000 journeys per week where they are exposed to toxic second-hand smoke. However, we know that diseases such as diabetes need more than just legislative measures for their reduction. Education in the most deprived areas in Scotland needs to be more active and robust. The British Heart Foundation tells us that there needs to be a focus on prevention and that a national strategy should be developed to achieve that, and I agree with that. I note the current Scottish Government's actions such as the Scottish Diabetes Improvement Plan and the Tobacco Control Strategy work, which individually address their respective problems. However, in reality, we have been seeing some funding cuts to prevent NCDs being slashed. Scotland's most deprived areas have benefited from the keep well service check-up in recent years. I think that it is vital that this service is kept, but yet, in answer to my PQs, funding is to be slashed. The preventative check-up for heart disease and diabetes is the best practice that needs to be rolled out to those hard-to-help communities across Scotland, not deletes. Diabetes Scotland says that there are approximately 45,000 people living with undiagnosed type 2 diabetes. Keep Well programme helps in the early diagnosis of that and other NCDs and I think must be retained, especially if we want to tackle inequality and care for people with diabetes. When we are discussing the 25x25 framework, we need to start looking at the issues based on the needs of our population. We know that Scotland is facing an ageing population and that we already have a shortage of GPs and a forecast further shortage. It is therefore critical that the Scottish Government takes the World Health Organization's framework seriously and works to place the focus on prevention. The spend-to-save tactic, I believe, must apply when combating NCDs. It is our responsibility not only to care for people when they are real but to do everything that they can to make sure that every person leads a healthy life to reduce the risks of NCDs later on. A healthy life, no matter where you live in Scotland or who you are. I now invite Maureen Watt to respond to the debate at 7 minute social please. Thank you very much, Presiding Officer. I would like to thank Dennis Robertson for securing this debate this evening and for members' contributions. Some members present may recall that, in June of this year, we discussed the potential for a non-communicable disease prevention strategy for Scotland at a joint meeting of the heart, disease and stroke cross-party group with the diabetes cross-party group. The 25 x 2025 aims focus on the right things. As with many reports addressed to a global audience, some of the detail relates to the challenge in Scotland in other areas that we are already more ambitious. I would like to set out some of the overarching policies and strategies here in Scotland that will help to address many of the wider themes that the World Health Organization's framework expects to achieve. We know, as members have mentioned, that alcohol is one of the top risk factors for non-communicable disease. In order to tackle the scale of alcohol-related harm that we see in Scotland, we have taken sustained and effective action since 2009 through our comprehensive alcohol framework. The framework is in line with the WHO's 10 priority measures on alcohol, which include action on pricing, availability, marketing and driving policies, community action and health service programmes such as alcohol brief interventions. Of course, a key element of the framework and one that is endorsed by WHO is minimum unit pricing. The opinion from the advocate general earlier this month very much left the door open for this policy. We remain certain that it is the right measure for Scotland and will make a real impact on alcohol-related harms. As all members mentioned, we know that a poor diet and excessive consumption of food and drink contributes directly to the high rates of the main causes of death and poor health in Scotland. We are committed to improving the nation's diet through work with a range of stakeholders, including retailers and caterers. We have introduced a range of measures to improve diet under spending over £10 million over a four-year period from 2012 to 2016 on projects to encourage healthy eating. Those include the Healthy Living Award and the Healthy Living programme, the Health Year Scotland cooking bus and Community Food and Health Scotland. Last year, we launched the supporting healthy choices voluntary framework following a period of consultation with the food industry. The framework sets out voluntary action for the food industry, including manufacturers, retailers and caterers, to encourage and support consumers to make healthier choices. We know that Scotland is among the first countries in the world to have introduced the ambitious target for reducing smoking prevalence. Our ambitious target is to reduce that to 5 per cent of our population by 2034. Creating a generation of young people and young adults who do not smoke to create a Scotland in which young people and young adults turn away from tobacco use and to get the health, social and economic benefits that will come from that approach. As a Government, we recognise that this is a very ambitious approach to take tobacco control, but we believe that we need to take bold, decisive action to reduce smoking prevalence in Scotland to further create a tobacco-free generation. The 5 per cent target is certainly challenging. Achieving it will require a determined effort on the part of the Government and other agencies that have a role to play in helping to reduce smoking prevalence. We believe that the target can help to ensure that we fundamentally change the whole culture of smoking in Scotland and get the health benefits that will come from that. We will take forward a range of measures in the five-year tobacco strategy to ensure that we take action. The strategy includes a national campaign launched last year to raise awareness of the dangers associated with smoking in enclosed spaces. The introduction of a new target to achieve a substantial reduction in children's exposure to second-hand smoke by 2020 continued support for parents to create smoke-free homes for children and the aim of all our NHS board having smoke-free grounds during 2015. Members will know that we have a bill currently undergoing stage 1 consideration that looks to build on efforts to reach our goal and that we saw a fall from 23 per cent to 20 per cent in the rates of tobacco prevalence in Scotland in the year 2013-14. Implementing all of those strategies are vitally important in addressing the risk factors that can lead to a range of long-term conditions, cancer and cardiovascular conditions. Cancer, heart disease, stroke and diabetes remain priorities for the Scottish Government. Our substantial investment in those areas, along with our wider public health strategies, has contributed to a reduction in mortality rates for heart disease of over 43 per cent in the last 10 years, for stroke 34 per cent since 2007 and an overall reduction in the rate of cancer-related mortality of 11.4 per cent, of course. The minister will welcome the report that will be coming from British Heart Foundation and Richmond by March of next year, when it is looking at all the figures pertaining to the framework, the 25x2025, as it is as pertinent to Scotland. That will help to continue to shape the objectives of the Government and the forward-looking strategies. Of course, we will continue to look at any of the evidence that will help to frame and form our strategies in the next years. Given those figures, I do not think that it is all doom and gloom. People are generally living longer healthier lives, but we have always got to be conscious that much more can be done. Our condition-specific improvement plans, including heart disease, stroke and diabetes, were published last year and set out priority areas for action to improve healthcare services and ensure that people living with those conditions receive the best care possible. We also have immunisation programmes that are not necessarily related to those diseases, but the uptakes for those programmes are also very encouraging. In conclusion, it is clear that those challenges are not for the NHS or the Scottish Government to solve alone. Any solution requires the engagement of the whole of the Scottish society. We are working to encourage people to make lifestyle changes, such as adopting a healthy diet and approach to alcohol, managing their weight and increasing their physical activity and stopping smoking. Early intervention seems to be working. Many schools now are adopting extra activity over and above the two hours of PE, which has greatly increased under this Government. Although a focused effort to improve people's health is essential, we also recognise that, to achieve our aims for a healthier, fairer Scotland, we need to focus effort towards the wider challenge of tackling health inequalities, which is not easy but we will continue to work hard to do that. Many thanks minister. That concludes Dennis Robertson's debate on World Health Organization's 25x2025 framework. I now close this meeting of Parliament.