Allostatic load is a multiple biomarker measure of physiological ‘wear and tear’ that has shown some promise as marker of overall physiological health, but its power as a risk predictor for mortality and morbidity is less well known. This study has used data from the 2003 Scottish Health Survey (SHeS) (nationally representative sample of Scottish population) linked to mortality records to assess how well allostatic load predicts all-cause and cause-specific mortality. From the sample, data from 4,488 men and women were available with mortality status at 5 and 9.5 (rounded to 10) years after sampling in 2003. Cox proportional hazard models estimated the risk of death (all-cause and the five major causes of death in the population) according to allostatic load score. Multiple imputation was used to address missing values in the dataset. Analyses were also adjusted for potential confounders (sex, age and deprivation). There were 258 and 618 deaths over the 5-year and 10-year follow-up period, respectively. In the fully-adjusted model, higher allostatic load (poorer physiological ‘health’) was not associated with an increased risk of all-cause mortality after 5 years (HR = 1.07, 95% CI 0.94 to 1.22; p = 0.269), but it was after 10 years (HR = 1.08, 95% CI 1.01 to 1.16; p = 0.026). Allostatic load was not associated with specific causes of death over the same follow-up period. In conclusions, greater physiological wear and tear across multiple physiological systems, as measured by allostatic load, is associated with an increased risk of death, but may not be as useful as a predictor for specific causes of death.

ObjectivesTo examine secular and socio-economic changes in cardiovascular disease risk factor prevalences in the Scottish population. This could contribute to a better understanding of why the decline in coronary heart disease mortality in Scotland has recently stalled along with a widening of socio-economic inequalities.DesignFour Scottish Health Surveys 1995, 1998, 2003 and 2008 (6190, 6656, 5497 and 4202 respondents, respectively, aged 25–64 years) were used to examine gender-stratified, age-standardised prevalences of smoking, alcohol consumption, physical activity, fruit and vegetable consumption, discretionary salt use and self-reported diabetes or hypertension. Prevalences were determined according to education and social class. Inequalities were assessed using the slope index of inequality, and time trends were determined using linear regression.ResultsThere were moderate secular declines in the prevalence of smoking, excess alcohol consumption and physical inactivity. Smoking prevalence declined between 1995 and 2008 from 33.4% (95% CI 31.8% to 35.0%) to 29.9% (27.9% to 31.8%) for men and from 36.1% (34.5% to 37.8%) to 27.4% (25.5% to 29.3%) for women. Adverse trends in prevalence were noted for self-reported diabetes and hypertension. Over the four surveys, the diabetes prevalence increased from 1.9% (1.4% to 2.4%) to 3.6% (2.8% to 4.4%) for men and from 1.7% (1.2% to 2.1%) to 3.0% (2.3% to 3.7%) for women. Socio-economic inequalities were evident for almost all risk factors, irrespective of the measure used. These social gradients appeared to be maintained over the four surveys. An exception was self-reported diabetes where, although inequalities were small, the gradient increased over time. Alcohol consumption was unique in consistently showing an inverse gradient, especially for women.ConclusionsThere has been only a moderate decline in behavioural cardiovascular risk factor prevalences since 1995, with increases in self-reported diabetes and hypertension. Adverse socio-economic gradients have remained unchanged. These findings could help explain the recent stagnation in coronary heart disease mortalities and persistence of related inequalities.

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Governments face pressures to improve services and (at the same time) to contain taxes and to ensure that their decisions are accountable to increasingly well-informed and challenging citizens. The dilemma of "squaring the welfare circle" confronts New Labour in a particularly acute form, since the party has set ambitious targets for improvements in the NHS, education and elsewhere, and is also committed to economic prudence and transparency. This article uses new data from a major national survey to investigate knowledge and beliefs in the main policy areas. It shows that most people are generally strikingly well-informed in some areas and ill-informed in others. A government which wishes to pursue a progressive direction in redistribution, increasing taxation of the better-off, or expanding provision for those on low incomes, faces real difficulties because many people hold inaccurate beliefs about policy impact and the policy context in these areas. However, NHS costs are more accurately perceived across the population, and the proposed expansion is likely to create less controversy. Current high-profile policies appear to follow the contours of public knowledge reasonably accurately, but further policy development will require positive efforts to lead debates and improve public knowledge. The Need to Explain Policy Choices to CitizensFor reasons beyond their control, to do with economic globalization, changes in labour markets and shifts in population structure, governments in welfare states face increasing pressure on public spending. These constraints are growing stricter at a time when commentators detect an increasingly querulous and challenging stance among citizens. The New Labour government in the UK faces particular problems. It comes from a political tradition that

BackgroundFood and drink purchasing habits of pupils out of school at lunchtime may be contributing to poor dietary intakes and overweight and obesity. The aim of this study was to identify the places from which purchases were made, types of food and drinks purchased and, the reasons for purchasing food or drinks out of school.MethodsA survey of the food and drinks purchasing habits of secondary school pupils (11-16 yrs) out of school at lunchtime was conducted in Scotland in 2010. A face-to-face interview and a self-completion questionnaire was designed to identify the food outlets used at lunchtime, types of food and drinks purchased and pupils’ reasons for purchasing food or drinks out of school. Height and weight were measured and BMI centiles used to classify pupils as normal weight, overweight or obese. Results were compared by age group, sex, BMI group and level of socio-economic deprivation.ResultsOf the 612 pupils who completed the survey, 97 % reported having access to places selling food or drinks out of school at lunchtime, and of these 63 % made purchases. A higher proportion of pupils from more deprived areas reported purchasing food or drinks out of school, but the proportion making purchases did not differ significantly by sex or BMI group. Supermarkets were the outlets from which pupils reported most often making purchases, with fewer purchasing food or drinks from fast food takeaways, and this did not differ significantly by socio-economic deprivation. Reasons for making purchases included availability of preferred food and drinks, some of which are restricted for sale in schools, and social reasons, such as wanting to be with friends. Sandwiches and non-diet soft drinks were items most commonly purchased, followed by confectionery and diet soft drinks. However, less than 10 % of all the secondary school pupils reported purchasing these foods every day.ConclusionsSupermarkets, not just fast food outlets, should be considered when developing strategies to improve the dietary habits of pupils at lunchtime. The importance of food preferences and social reasons for purchasing food and drinks need to be acknowledged and integrated in future interventions.