Tag: chief medical officer

Visit by new Permanent Secretary and Chief Medical Officer

 

On the 19th July Scotland’s new permanent secretary Sir Peter Housden, accompanied by Dr Harry Burns, visited First Step in Musselburgh to speak to a range of people involved in using or providing early years services. 

After a tour of  First Steps facilities staff, volunteers and services users took part in a discussion facilitated by Susan Deacon about some of the challenges to, as well as the supports for, early years in East and Midlothian.

Many issues were brought up in the short period that was available for discussion – but what heartened me was the tremendous positive energy there was in the room ( no doubt contributed to by the wonderful home baking provided by First Step) This energy and enthusiasm for what a difference early intervention can make was there despite the awareness of the challenges faced by parents and children in some of our communities,  and of the funding issues faced by statutory and voluntary services. 

The other issue that chimed for me was the importance of services not stigmatising their users and the importance of the community seeing a service that is something anyone can access when the need is there. I was reminded of a  rather ugly phrase use by Sir Micheal Marmott – ‘proportionate universalism’ – services that are universal but provided in proportion to the need. The universalism of a service prevents it from being stigmatised, but it makes no sense to provide universal services equally, because need is not distributed equally. First Step is respected within its community because of the hard work and dedication of its staff – but also, I think, because it has that element of a universal service with additional support built in to address more complex or enhanced need.

Rationale For Support for the Start

brain-pic 

This picture was part of a presentation given by the Chief Medical officer Harry Burns at a conference on Equally Well. The pictures shows what happens to brain development in cases of extreme neglect. Neglect so extreme to cause such marked under development of a child’s brain is thankfully very rare but the picture does demonstrate that brain development is closely related to the environment a child finds itself in.
 
Dr Burns presentation described the determinants of early brain development with the following bullet points:- 
  • At birth, development shifts from genetic to environmental influences
  • There are 100 billion neurons but they are not part of functional networks
  • First few years are spent forming permanent neural networks -‘Neurons that fire together wire together’
  • Social interaction determines brain development

He went on to discuss attachment theory giving the following quote:

  “Infants develop the attachment behaviours that optimally enhance their survival in their own characteristic environments.”

Crittenden, 2000

 He described the development of attachment as ‘Serve & return’ meaning that the infant will respond to positive rewarding stimuli by developing an attachment which strengthens with each return. However, if the return is absent, negative or chaotic this will set up responses in the child that help it to cope with this environment but which will probably prove maladaptive in the longer term. He illustrated this with reference to a study called the Dunedin cohort which was 1000 children recruited in late 1972/3.  At age 3, “at risk” children were identified on the basis of chaotic circumstances, emotional behaviour, negativity and poor attentiveness

As adults, those “at risk” were more likely to : –

  • be unemployed
  • have criminal convictions (especially for violence)
  • been pregnant as a teenager
  • have a substance abuse problem
  • exhibit signs of insulin resistance and metabolic syndrome

The above means that the template for health can be set at a very young age, and though it is possible to change problems created by difficulties in the early years of life, a poor start can make it hard to catch up. This is the rationale for focusing on preventing health inequalities by focusing on the early years of life and support for parents. 

You can view the full presentation on the social circumstances of health at this link