Towards a Healthier Scotland :4

Towards a Healthier Scotland - A White Paper on Health

"Scotland's new Parliament will help turn vision into reality. The time is right, the commitment there. Now we need action."

Chapter 2 A Shared Vision for Action

7. It is clear from the reaction to the Green Paper that there is a shared vision of a healthier Scotland that can stand proudly alongside Europe's healthiest nations.

8. Getting there means a sustained attack on inequality, social exclusion and poverty. Living and working in better circumstances will lead directly - and through influences on lifestyle behaviour - to better health. Reducing, wherever we can, differences in opportunity and experience as measured by income, gender and environment, will be at the heart of work to improve Scotland's health.

9. This Government are pledged to invest in improved health and so deliver a fitter and healthier Scotland in the new millennium. While decisions on areas of public expenditure in this and later Chapters will be for the new Scottish Parliament and Executive to take, the Government's Comprehensive Spending Review has focused Ł1.8bn new investment over the next 3 years in direct health programmes. And a further Ł2.3bn has been allocated to other public services in Scotland; this too will promote better health. Improvements in the welfare system will reduce poverty, and its harm to health. Lottery funding, to support the introduction of healthy living centres targeting those who are deprived, will add another Ł34.5m. Scotland's new Parliament will help turn vision into reality. The time is right, the commitment is there. Now we need action.

Action Levels

10. The Green Paper recognised that many factors can influence health. Life circumstances, as reflected in a worthwhile job, decent housing, good education and a clean and pleasant environment, make for physical and mental well-being: the converse is also true. Lifestyles - as reflected in smoking and drinking patterns, diet and exercise - have a powerful effect on health but these factors are linked strongly to social class and underlying life circumstances. Similarly, conditions such as coronary heart disease, stroke, cancer, mental illness and unwanted teenage pregnancies, which make such significant contributions to Scotland's health deficit, also reflect our socio-economic inequalities - inequalities which the Government are determined to tackle head-on. The adverse outcomes which so often follow disadvantage and deprivation affect far more than people's health, just as poor health locks people into dependency and exclusion. Hope is stronger when social and economic prospects are bright. Inequality breeds despondency and pessimism, and health suffers. Action on life circumstances is the rock on which work to improve lifestyles and tackle disease will stand or fall.

11. The consultation process gave wide-ranging support for the Green Paper proposals that our drive towards better health should focus on 3 linked action levels - life circumstances, lifestyles and health topics, as set out in Table 1. Emphasis was placed on developing a coherent, co-ordinated and inter-sectoral strategy to attack the roots of ill-health, rather than just focusing on specific diseases or individual behaviours; but there was a clear perception, too, that we should confront, with renewed determination, the principal killing diseases - coronary heart disease and cancer.

The 3 Action Levels for Better Health

Life circumstances
Lifestyles
Health topics

12. In the consultation process, people thought that tackling health inequalities by reducing the gaps in health between socio-economic, geographical, ethnic, gender and other groups in Scotland was of overwhelming importance. The Government agree that tackling inequalities has such importance that it should be regarded as an overarching aim.

Overarching Aim

Tackling inequalities

13. The consultation also supported the proposed list of priority health topics. But, in addition, many people stressed the lifelong impact of ill-health and health-damaging lifestyles in childhood, citing evidence of improvements in pre-school child health and well-being through targeted interventions - particularly for low-income groups. There is also evidence that improved child health can reduce future delinquency. The Government accept this challenge with enthusiasm and now add child health to our list of priority health topics.

14. Work to improve Scotland's health needs common understanding and goals. Central and local government, the NHS, business, trades unions, voluntary and other organisations can all influence health at each action level, particularly when they work together and recognise the value of working across traditional boundaries. Demonstration projects - described in Chapter 7 - will point the way to integrated working.

15. As a focus for action, the Government propose a range of targets for several of the national priorities to help guide both national and local activity. Full details of these are given in Annex A to Chapter 8. For maximum impact, headline targets have been identified in relation to coronary heart disease, cancer, smoking, alcohol, unwanted teenage pregnancy and dental health.

Health Headline Targets for the period 1995 to 2010

Coronary Heart Disease

Reduce premature mortality by 50%

Cancer

Reduce premature mortality by 20%

Smoking

Reduce smoking among 12-15 year olds from 14% to 11%
Reduce the proportion of women smoking during pregnancy from 29% to 20%

Alcohol Misuse

Reduce incidence of men and women exceeding weekly limits from 33% to 29% and 13% to 11% respectively

Teenage Pregnancy

Reduce rate among 13-15 year olds by 20%

Dental Health

60% of 5 year old children with no experience of dental disease

16. For each of these targets, there is an inequalities gap which will be regularly measured to assess progress in reducing the disparity in health status between different socio-economic groups. Further work is also being done to develop a range of measures which reflect health and well-being within population groups; and the demonstration projects, described in Chapter 7, will each have an inequalites component, including targets and indicators of progress.

Action

A co-ordinated 3 level approach to better health with an overarching focus on tackling health inequalities. Improving life circumstances and attacking poverty will focus NHS and other resources where the need is greatest.
A specific concerted drive to improve child health.
A new sustained attack on the killing diseases _ coronary heart disease and cancer.
A cross-Departmental approach to health in The Scottish Office to help focus social and economic policy on positive health impact.
Demonstration projects to help local successes lead to national change.

Table 1

Scotland's Health: National Priorities

Tackling Inequalities
Improved Life Circumstances*	Lifestyles Less smoking, drug and alcohol misuse A healthier diet More physical activity	Health Topics Child health Dental and oral health Sexual health, including teenage pregnancies and sexually transmitted diseases Coronary heart disease (and stroke) Cancer Mental health Accidents and safety

*Life circumstances include, for example, unemployment, poverty, poor housing, limited educational achievement, the general environment and all other forms of social exclusion.