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Improving Health in Scotland - THE CHALLENGE
SPECIAL FOCUS PROGRAMMES
PHYSICAL ACTIVITY
Action 26
Follow-up on the launch of the Ministerial response and the Scottish Executive commitment to the Physical Activity Taskforce consultation that took place in February 2003.
Continuing with defined elements of Physical Activity Taskforce strategy to make Scotland more active. This work is based upon the draft report of the Physical Activity Task Force, which reported in June 2002. The challenge is clear. The ideal is that:
every child accumulates at least 1 hour of quality physical activity per day
every child has quality physical education and the opportunity to be active
every adult accumulates 30 minutes of moderate physical activity (the equivalent of brisk walking) most days of the week.
in addition, each person over the age of 55 has a programme of strength and balance training that continues for the rest of their lives.
The evidence base and experience of implementing this type of strategy is relatively recent in developed industrialised countries. Yet Scotland, like all of these countries, faces an epidemic of obesity as well as continuing problems arising from heart disease, cancer, type 2 diabetes, musculo-skeletal problems and a range of other conditions which have low levels of physical activity as part of their underlying cause.
Scotland needs to take sustained action to achieve these longer-term aims. The actions that will be completed by March 2004 are:
completion of the consultation process set up by the Physical Activity Task Force and the setting out of a clear action plan arising from this
integration of Active Primary Schools, Class Moves, School Sport Co-ordinators and other more focused programmes into a comprehensive whole school approach to physical activity which, is also part of the target of making each school in Scotland a Health Promoting school by 2007
the development of plans to create and disseminate the concept of active communities, active schools, active homes and active workplaces. However, there are substantial barriers to be overcome and this is expected to feature more strongly in the second phase of the programme.
The main challenge for this programme in the next year is to negotiate the key early steps in this revolution and the identification of effective methodology and goals for taking this agenda forward.
HEALTHY EATING
Action 27
Implement the next phase of the Scottish Diet Action Plan to the extent that it has a measurable, incremental impact in Scotland each year to 2010.
The case for improving the Scottish diet has been made convincingly and has been operationalised through the Scottish Diet Action Plan (1996). In the next phase of implementation the key targets will be to reduce saturated fat consumption and to increase fruit and vegetable consumption. The key conceptual stages in the next phase of work will be to:
increase the demand for healthy food
supply that demand for healthy food
provide support, education and skill development to allow people to act on this information to make healthy choices.
There is a well-worked-out strategic plan for the implementation of these goals under the following headings:
1. promote the consumption of healthy diet and food choices;
2. promote the preparation and provision of meals which offer a balanced diet;
3. increase access to healthier food choices, particularly in low income and rural areas;
4. work with the food manufacturing, processing and retailing industries to further develop healthier food choices; and
5. ensure that Agriculture and Fisheries interests contribute fully to the achievement of the Scottish dietary targets.
Action 28
Support the integrated programme, launched January 2003, of communication and public education, in the context of the wider health improvement agenda, to increase demand for, confidence in, and skills for, healthy eating.
The components of this piece of work comprise:
1. A multi-media, multi-component approach to communicating information, positive messages and skills about healthy eating. This will include TV advertising, radio advertising, programming, written materials, information line.
2. Multi-setting approach (including public sector workforce) to providing opportunities for, and access to, healthy food choices. This will concentrate on settings like schools, workplaces and communities.
3. Action will also be taken to ensure that individuals who now have a motivation and some skills to make healthier food choices have these choices available to them. Again, action will be focused on settings like schools, workplaces and communities.
As an example, nutritional standards have now been developed for school meals and these will be enforced and monitored by performance management systems for schools. Crucially, this initiative will be integrated into a whole school approach and create a supportive environment for healthier living (of which healthy eating is a part) in schools. Children will be provided with healthier food choices, supportive environments and information and support for healthy food choices.
Public information and skills development will only be successful if all sectors of Scottish society have access to healthier food choices in the context of their day-to-day lives. Therefore, work in communities (particularly those characterised by social exclusion) will be essential to support the overall strategy.
Action 29
Measure food consumption between 2003 and 2010 to monitor progress towards the targets set out in the Scottish Diet Action Plan using the Scottish Health Survey.
The Diet Action Plan is one of Scotland's best developed and most mature health improvement programmes. It brings together excellent evidence-base with actions directed towards communications, creating supportive environments and policy change. It is now being implemented on a scale and with sufficient energy to have the realistic prospect of seeing measurable improvements over the next 5 to 10 years.
SMOKING
Action 30
The Scottish Executive Health Improvement Directorate will review national tobacco control policy in conjunction with key interests early in 2003 and set out a new plan for action which builds upon the achievements to date.
The UK White Paper
Smoking Kills, which was published in December 1998 and subsequently endorsed by the Scottish Executive, is being implemented in a Scottish context. The Health Improvement Directorate will take stock of progress and outline a plan for action that builds upon the established base of successful activity. Amongst other things, this plan will look to introduce:
Annual, negotiated targets for each NHS Board for the number of individuals who give up smoking.
Workplace programmes with clear targets for an expansion in the number of workplaces free from smoking.
Further targets for an expansion in the proportion of public places in Scotland which are tobacco-smoke free, which are agreed with the signatories to the Scottish Voluntary Charter on Smoking in Public Places (British Hospitality Sector, Scottish Beer and Pub Association, Scottish Licensed Trade Association and Scottish Tourism Forum).
Work with the key Scottish enforcement agencies to further improves enforcement of the law relating to the sale of tobacco to under 16s. This will complement the pilot test purchasing schemes which are scheduled to run from early 2003 through to 2004.
Action 31
The Scottish Executive to make subordinate legislation through the Scottish Parliament to complement the UK Tobacco Advertising and Promotion Bill.
The recently agreed UK Tobacco advertising and Promotion Bill received Royal Assent in early November 2002 and came into effect during February 2003.
It includes a ban on press, billboard and internet advertising of tobacco products and the promotion of smoking through the free distribution of tobacco products, coupons and mailshots. Some of the regulation-making powers will fall to Scottish Ministers.
ALCOHOL
Action 32
To ensure the progressive implementation of the Plan for Action on Alcohol Problems launched by the Executive in January 2002.
The Executive's Plan for Action on Alcohol will continue to be driven forward. Key actions include:
The development and publication by April 2003 of local action plans covering culture change, prevention and education, support and treatment services, protection and controls.
Implementation of the agreed plans by Local Action Teams.
The development of services to address the needs of those who experience problems with alcohol and those affected by others' alcohol problems. These are likely to include both specialist and mainstream services, which reflect the needs of individual clients and are integrated with other health and social care services.
Continuing discussion with the UK Government around the use of the levers of price, and regulation of availability to influence alcohol-related problems in a positive way.
Action 33
To ensure that national and local alcohol plans reflect the findings of the independent review on liquor licensing law.
The independent Committee set up to review the Licensing (Scotland) Act 1976 is expected to report early in 2003. National and local plans for alcohol problems will need to take account of the outcome of the review.
MENTAL HEALTH AND WELL-BEING
Action 34
Establish by March 2003 a 3-year action plan for the National Programme to Improve Mental Health and Well-being of Scotland's Population.
The National Programme to Improve the Mental Health and Well-being of Scotland's Population is a key, integrated part of the Scottish Executive's health improvement and social justice strategies. The 3-year action plan will develop a set of actions and interventions to achieve specific outcomes across the key themes for health improvement. A key set of indicators will also be developed to help monitor progress and trends in improving mental health.
Action 35
Support the implementation of 'choose life', a National Strategy and Action Plan to Prevent Suicide in Scotland.
Currently over 600 people in Scotland commit suicide each year and Scotland has one of the highest rising rates of completed suicide in Western Europe. 'Choose life' a
National Strategy and Action Plan to Prevent Suicide in Scotland aims to address the rising rate of suicide in Scotland and was launched in December 2002. The goal is to reduce the rate of suicide in Scotland by 20% by 2013. Seven objectives have been set for implementation at both national and local level and seven priority groups for action have been identified.
Action 36
Continue the development and implementation of 'See me', a national campaign to eliminate the stigma and discrimination that people with mental health problems face.
This national campaign was launched in October 2002 to tackle stigma and discrimination. The campaign will continue working towards eliminating stigma and discrimination over 2003-06 by a combination of local and national efforts.
Action 37
Provide support to ensure that health improvement activity across all four major themes and special focus programmes encompass the improvement of mental health and well-being as part of their core activities.
Mental health is a key component of the concept of health that informs this document. Positive mental health develops within the context of a good start in life, a healthy and physically active childhood, a positive adolescence and positive work, leisure and community relationships. Physical and mental health are indivisible and so the approach to positive mental health is seldom, if ever, free-standing. Our approach to mental health improvement needs to be integrated through all programmes set out in this document. In other words, the work of the National Programme will support, complement and add value to all areas of health improvement activity.
HEALTH AND HOMELESSNESS
Action 38
All NHS Boards have been required to produce and implement Health and Homelessness Action Plans outlining the activity planned at local level to meet the health and health care needs of homeless people by autumn 2003.
Homeless people are among the most excluded and disadvantaged in our communities. As a result the Scottish Executive has put in place a raft of measures intended to change the face of homelessness over the next 10 years. Legislative change has already been taken forward, and the Homelessness etc. (Scotland) Bill currently going through Parliament will herald a new era of enhanced rights and opportunities for homeless people.
Homelessness is a complex issue and homeless people themselves are not a homogenous group. However it is clear that health and homelessness are inextricably linked; ill health is both a cause and effect of homelessness. In response to this,
Our National Health committed to improving the health of homeless people, and reducing the barriers to care experienced by this group.
Health and Homelessness Action Plans for 2002-05 must deliver and include:
A demonstrable knowledge base on homelessness within each NHS Board, evidenced by:
The provision of a profile of homelessness within the Board area, using the definition outlined by the Homelessness Task Force.
A comprehensive assessment of homeless people's health and health-care needs. Clear links must be established with Local Authorities' needs assessments under the Housing (Scotland) Act 2001.
An understanding of the network of health care services within primary and secondary care currently supporting homeless people. Consideration must be given to what services are being used and which are not, together with their accessibility.
An evaluation of the strengths, weaknesses and gaps in current provision, including a plan for addressing weaknesses and gaps.
A plan for addressing service improvements together with an implementation programme. In so doing consideration must be given to the importance of continuity of care, including admission and discharge arrangements, to meet the needs of homeless people.
Arrangements to ensure that action on homelessness is linked with the social inclusion strategies of partners in the statutory and voluntary sectors.
Action 39
Deliver, by April 2003, joint research with HEBS, looking at national and international examples of good practice in the delivery of health care to homeless people. The research findings will be applicable in a Scottish context and there will be some emphasis on meeting the needs of hidden homeless populations in rural and remote areas.
The research findings will be used to shape training programmes for NHSScotland staff involved in the care of homeless people. In so doing we can ensure that health workers are fully equipped to bring about the best outcomes for homeless people. We will also ensure that the spirit of the partnership approach of Action Plans translates into this training to promote holistic approaches to the delivery of health care.
SEXUAL HEALTH
Action 40
A sexual health strategy including approaches to reducing sexually transmitted infections, reducing unwanted early pregnancies and increasing a sense of 'healthy respect' for sexual matters in Scotland will be published for consultation by autumn 2003.
Sexual health is an important aspect of peoples' lives.
In Scotland there is a high rate of teenage pregnancy and the incidence of sexually transmitted infections is beginning to show signs of increasing.
The Public Health Institute of Scotland is chairing a National Advisory Group on sexual health. A report for consultation will be published by autumn 2003.
A sexual health National Learning Network established by NHS Health Scotland will bring together and disseminate evidence and information about what works and examples of good practice and will include learning from Healthy Respect demonstration project.
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