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Partnership for Care: Scotland's Health White
Paper
CHAPTER TWO HEALTH IMPROVEMENT
A new approach to improve health in
Scotland and to reduce health
inequalities
A sustained effort to tackle the
lifestyles and circumstances which damage
health
New actions focused on early years;
teenage transition; the workplace; and in
communities
Legislation to secure the place of
Health Improvement in Community
Planning
1. The challenge of improving health in
Scotland - both physical and mental - will not be easy. Our
approach links health with other areas of public policy,
recognising the central role of Community Planning and
focusing action in ways that are relevant to peoples'
everyday lives.
2. Scotland's health is improving but the
scale of the challenge is still daunting. Scotland's death
rates are among the highest in the world for cancer and
coronary heart disease. Life expectancy is consistently
lower than in other European Union countries. We have
rising rates of suicide, particularly among young men, and
rising numbers of young people, in particular girls in
their early teens, being treated for self-harm. This
reflects a complex interaction of different factors
relating to life choices, life styles and life
circumstances.
3. Our objective is to improve Scotland's
health and reduce the health inequalities within our
society. Poor health is strongly linked to deprivation and
inequality. Our commitment to improving health in Scotland
is integral to closing the opportunity gap and the
programmes which are described more fully in the Health
Improvement Challenge, which will be published to accompany
this White Paper, will be pursued with a particular focus
on the social groups most at risk. We will bring forward
legislation to back up this commitment and ensure that
Health Improvement is a priority for NHS Boards and
Community Planning partners.
4. NHS Boards will also step up their
efforts to reduce health inequalities, for example by
working with both statutory and voluntary sectors to
implement Health and Homelessness Action Plans. In addition
we are developing, for the first time, Health Inequality
Indicators and will work towards a target for reducing
health inequalities, which we will set in consultation with
Local Authorities and NHS partners.
5. Action to promote good mental health
will be an essential component of our approach to improving
health in Scotland. We will continue to work to remove the
stigma attached to mental illness, reduce the rate of
suicides and achieve greater public understanding of mental
wellbeing. A national group chaired by the Minister for
Health and Community Care will continue to take forward
this work which supports wider Scottish Executive plans on
mental health improvement and social justice.
6. Health improvement has often been seen
as a task for the Director of Public Health and health
promotion departments in the NHS. This is no longer
acceptable. Promoting Scotland's health needs support and
leadership from:
Ministers and Departments across the Scottish
Executive;
Local Authorities;
employers;
professionals in health, education and social
inclusion;
local community leaders;
Trade Unions; and
representative groups in the voluntary
sector.
7. The Executive's new, cross-government
approach to health improvement will help deliver this
leadership and support. It draws on a wide understanding of
the contributors to health improvement across the
Executive's portfolios - in education, housing, the
environment and in employment - to ensure a coherent
approach to tackling those life circumstances and life
choices that impact on our health as individuals. At a
local level we are committed to working with Community
Planning partners to ensure effective delivery in
communities. Only by putting health improvement onto
everyone's agenda can we join together the various
initiatives and achieve an impact which will be more than
the sum of its parts.
Making Progress
8. We have already made a start. For
example, we have three health improvement
Demonstration
Projects, an Active Primary School programme, 44
Healthy Living Centres focused on reducing health
inequalities, a Health Promoting Schools Unit, an
Eating for
Health programme including a telephone advice line, and
a range of projects funded from the
Health
Improvement Fund. We have established a direction of
travel. We intend now to raise the pace.
Changing Culture
9. Looking ahead, we still need to promote
fundamental change in public attitudes among individuals
and families, within businesses, in local communities, and
the NHS. There will be no quick fix. If we are to raise
standards of health, then the people of Scotland need to be
motivated and their interest sustained over the long term
to make a difference. Health improvement actions will need
to involve the public in all its diversity and that will
need highly effective and varied communications.
10. Clarity and consistency of message
must be sustained across a broad spectrum of actions and
settings. Communications on specific topics will be visibly
drawn into the health improvement programme by a
co-ordinated healthy living identity, to link activities in
diverse areas such as education, health and social justice
with initiatives on mental wellbeing, smoking, alcohol,
diet and physical activity.
'Focus on Four'
11. The integrated and focused approach,
set out more fully in the
Health Improvement Challenge, will incorporate
four broad areas of particular attention: Early years;
Teenage Transition; Workplace; and Communities.
12. There is clear evidence of the
importance of a child's
early years on their subsequent health and
standard of living. The Executive will develop an
integrated approach for Early Years, including an enhanced
focus on health improvement. Actions will include:
an integrated programme of measures by early
2003 to be reflected in plans developed by
Community Planning partnerships and
NHSScotland;
challenging professionals, health workers, local
organisations, and NHS Boards to ensure measures
for health improvement in a child's early years are
designed to benefit the most vulnerable and
disadvantaged families and children; and
linking with the education service in programmes
such as
Sure
Start to focus health resources on those
children and families who need the most
support.
13. The
teenage transition is a time of great
change, impressionability, and conflicting pressures on
young people. Across the Executive we will develop and
build on existing programmes that integrate topic specific
action (smoking, drugs, sexual health, alcohol, healthy
eating, physical activity and mental wellbeing) alongside
promoting personal skills and emotional intelligence. This
work will link with the Schools Improvement Framework under
the
National
Priorities in Education, but will also go beyond the
school environment. Actions will include:
active health service involvement and support
for the roll out of the
New Community
Schools programme across the whole of Scotland
by 2007;
implementation of an Executive-wide policy with
funding to improve the quality of school meals
including the adoption of nutritional
standards;
enabling all schools to become Health Promoting
Schools by 2007 through the Health Promoting
Schools Unit; and
refocusing the school nursing service to support
an integrated approach to improving the health and
potential of children and young people through a
new Scottish Framework for Nursing in Schools.
14. A broad view of 'health' in the
workplace takes us beyond the widespread
belief that this is principally about preventing accidents
and injuries. Employment and training opportunities bring
emotional and social benefits, quite apart from their
impact on a person's economic wellbeing, and so can have a
powerful impact on the way we feel and the choices we make.
Actions will include:
support for small and medium-sized enterprises
in dealing with drug and alcohol problems amongst
employees;
increasing the number of non-smoking workplaces
to protect employees from passive smoking;
expanding the coverage of
Scotland's
Health at Workscheme; and
encouraging employers to examine the business
case for offering their employees health-improving
opportunities such as smoking cessation services
and exercise facilities.
15. Communities which are active in
promoting good health can benefit all who live there.
Support for community-led health improvement initiatives
will be closely linked to the development of Joint Health
Improvement Plans (JHIPs) with Community Planning
partnerships, and will be targeted at disadvantaged groups
in both urban and rural settings. Actions will include:
optimising the potential of alcohol and drug
action teams, Healthy Living Centres and other
community-based initiatives;
building voluntary sector and community-based
capacity to deliver health improvement through
community action;
supporting local people to take a lead in
developing local solutions for local community
problems; and
integrating programmes on fuel poverty with
JHIPs to ensure a reduction in the number of
households in fuel poverty.
Accelerating the Pace of Reform and
Change
16. Ministers and the Scottish Executive
will work with the people of Scotland to achieve a decisive
difference in Scotland's health and wellbeing. We have
already moved to strengthen the national delivery and
support for health improvement by bringing together the
Health Education Board for Scotland and the Public Health
Institute of Scotland into a single organisation - NHS
Health Scotland.
17. In broad terms our proposed approach
to improve health throughout Scotland will involve close
collaboration with other agencies - Local Authorities,
voluntary bodies, employers and Trade Unions and will:
empower the people of Scotland by supporting
more people to care about their own health and that
of their families; and
help people to understand the issues, listen to
their needs and give them the kind of support they
need, underpinned by clear consistent messages.
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