What made you decide to train as a doctor?
I wanted to be a pilot, but I was slightly colour blind and I was told I could not do that. So medicine looked quite interesting.
Do you miss being a surgeon?
No. I was a surgeon for 15 years and found I was working very hard to make surgery as boring as possible, because if it was exciting it meant bad things for the patient, usually. And because I was working in the east end of Glasgow I became very interested in the determinants of health, or the determinants of ill-health that I saw there.
What do you think is the most important part of the work you do now?
It’s to try and stimulate insight and innovation into thinking around problems for which it is often very tempting to have over-simplistic responses.
You say people’s understanding of the state of Scottish health is often wrong. What do you mean?
It is this oversimplification of what is an intensely complex issue. We have been through an era where folk have assumed it was due to behaviours, and in fact many of those behaviours are caused by underlying problems rather than the cause themselves. What Michael Marmot (director of the UCL Institute of Health Equity) talks about is “the causes of the causes”. So what I have been trying to understand is the causes of the causes, and we are now working on the causes of the causes of the causes.
What is the most significant health issue facing Scotland?
I couldn’t honestly pull one out. They are all so inextricably interlinked. The challenge is to find ways to allow every individual to achieve his or her full potential - whether it would be the potential for health, for education, for creativity - that is the fundamental issue.
You chair the Standing Literacy Commission - as a non-teacher, what were you able to bring to the debate?
I don’t think I can answer that until it reports. But it seemed to me that people tend to keep coming up with the old explanation for problems and sometimes it is useful to have an external take on those challenges.
What did you learn from the process?
That it is more complicated than people think. I found some very interesting new insights into the difficulties people have with literacy. And that there are a lot of people trying hard to support literacy.
A lot of your recent work has looked at the impact of stress and adverse events on children - what has been your most significant finding?
That children whose lives are in crisis have almost always got an explanation for their behaviour and almost always that goes back to early months of life, even antenatally. Things such as alcohol during pregnancy - quite often women don’t even know they are pregnant and are still drinking, and at that time the brain is developing very rapidly and alcohol can cause key circuits to fail to develop. We haven’t appreciated the damage that all that can cause.
You talk a lot about salutogenesis. What is it?
It is the idea that health is not something that we are born with, but something we have to create - whereas doctors tend to talk about causes of disease, implying that we start off with a particular level of health that becomes eroded. The opposite is probably true. We start off with a potential for health we then have to build upon.
What is the link between deprivation and health?
We need appropriate conditions to allow us to create a sense of well-being and health. And if those necessary conditions aren’t there - things like consistent parenting - it becomes hard to create either physical or mental health.
We hear a lot about childhood obesity, but do you think malnutrition is receiving too little attention?
Absolutely. Obesity is a form of malnutrition. Poor nutrition is often the result of parents who do not understand what parenting is about. We know, for example, that low-birthweight babies are more likely to become obese children. Low birthweight is often caused by maternal smoking. We should be focusing on maternal smoking, and the other drivers. It is not helpful to go and tell people who do not feel in control of their lives they are bad parents as well. We should be looking at ways of building ability and control and sense of capacity from before pregnancy.
Do you think two hours of PE is enough?
Physical activity is important across the life course. Steven Blair, an American epidemiologist, has calculated that if we add the risk of premature death from diabetes, smoking and obesity together, it is less than the risk from not being physically fit. So get your running shoes on.
If you had a magic wand and three wishes, what would they be?
I would wish that every child in Scotland has the best possible start in life, however we define it as a society. I would wish that that start was carried forward into a society that was compassionate and supportive. And I would wish that my stumbling attempts to learn to play the bagpipes were successful.
PERSONAL PROFILE
Born: Barrhead, 1951
Education: St Aloysius’ College, Glasgow; University of Glasgow
Career: Consultant surgeon, medical director of the Royal Infirmary, Glasgow; director of public health for Greater Glasgow Health Board; chief medical officer for Scotland since 2005.
