Towards a Healthier Scotland :5

Towards a Healthier Scotland - A White Paper on Health

"Work is the best route out of poverty and into a healthier life."

Chapter 3 Action: Life Circumstances

17. Improving life circumstances is the first action level of our strategy. A range of initiatives across Government is making a difference in the quality of our lives and so influencing health. The Government have targeted large additional resources on key areas like housing, employment, education, welfare benefits, childcare and community care as well as health. Taken together, and subject to decisions of the new Parliament, these investments will have real health benefits, with the greatest impact in deprived areas.

Social Inclusion

18. Crucial to our aim of good health for all is our drive to address the inequalities which can be borne by communities as a whole. Under the banner of social inclusion, the Government are introducing a range of measures which will increase choice and participation in Scottish life for people who are currently marginalised. This White Paper delivers a further part of the Government's commitment to reduce social exclusion by focusing on the need to overcome health inequalities.

19. Our aim is for everyone to be socially included. In addition to the New Deals, our Childcare Strategy, the introduction of the Working Families Tax Credit, Early Intervention Programmes, New Community Schools and New Housing Partnerships, all described elsewhere in this Chapter and each with an important part to play in tackling social exclusion, we:

are introducing new Social Inclusion Partnerships, supported by funding of Ł48m over the next 3 years to promote inclusion and prevent exclusion in both urban and rural areas
have established the New Deal for Communities programme, with Ł12.9m over the next 3 years, to help deprived communities articulate their needs better, and to make their public services more integrated and responsive
will shortly be publishing our Social Inclusion Strategy, which will provide the framework for further co-ordinated action to promote social inclusion.

20. Older people have a huge contribution to make to our national life. But their experience and attributes are not always fully appreciated. They can feel left out and excluded. This is unacceptable. So we launched The Better Government for Older People initiative in June, 1998. This initiative is being piloted throughout the UK in 28 local authorities; three pilots are in Scotland. Their general aim is to provide older people with clearer and more accessible information on their rights, give them a greater say in the type of services they can get, and simplify their access to them. We are currently considering how to network more widely the lessons from the pilots.

21. We have also introduced a Ł2.5bn package for all pensioners in the UK. This includes a guaranteed weekly pension of Ł75 for single pensioners and Ł116 for couples; help with winter fuel bills; and free eyesight tests and flu vaccinations. All this will contribute to better health among older people.

Families with Children

22. Many of our new policies and additional resources have been concentrated on children because we believe that supporting vulnerable families at an early stage and providing better education for children who are under-achieving will pay many dividends, including better health.

23. New help for families with young children over the next 3 years includes:

Expansion of Family Centres providing support to families with children aged 3 and under, resourced by an extra Ł42m and targeted at areas of greatest need
Part-time Pre-school Education, where desired, for all children from the term after their third birthday, supported by funding of Ł384m over the next 3 years.

24. Children aged 0-14 and their parents will benefit from:

an increase of Ł2.50 per week in Child Benefit, and a further Ł2.80 for every child under 11 years in the poorest families
a Childcare Strategy, to increase quality childcare that parents can access and afford.
In addition to Ł49m Scottish Office funding there will be:
National Lottery Funding of Ł25m to develop out-of-school childcare
a new Childcare Tax Credit - part of the Working Families Tax Credit - providing a further Ł25m to Ł30m per annum towards childcare for lower income families.

25. Further initiatives to improve the educational opportunities and life prospects for school-age children will include:

the Education White Paper, Targeting Excellence: Modernising Scotland's Schools, which sets out a radical plan for improvement across the board, including expansion of pre-school learning, curriculum supporting children's learning, parental involvement and the contribution of schools, education authorities and central Government to a culture of continuous improvement
60 New Community Schools, with resources of Ł26m throughout Scotland, which will offer children and their families integrated education, social work, family support, and health education and promotion services
an extra Ł52m, to reduce class sizes in Primary 1-3 to 30, or below, by August, 2001
Ł60m for Early Intervention Programmes to help improve the reading, writing and numeracy skills of young children
Ł27m, plus Ł23m Lottery funding, for out-of-school hours learning projects aimed at raising educational achievement
an extra Ł23m, to fund specific alternatives to exclusion of children from school
Ł36.7m, to help improve services for children looked after by local authorities, targeting in particular good health, positive social and emotional development and educational attainment
Children's Services Plans, involving local authorities, the NHS and the voluntary sector in the planning and delivery of a range of services specifically for children in need.

Housing

26. Good housing is a basic human need. Seen from a health perspective, improved housing offers the prospect of better mental health, less sickness linked to damp and cold and fewer accidents. A Green Paper, which will be published shortly, will review the state of housing and housing policy in Scotland and seek views on a wide range of proposals for tackling current issues and problems. But the action we have already taken includes:

the New Housing Partnerships initiative which has been introduced, with over Ł300m, to promote community ownership of public sector housing and achieve major improvements in housing conditions
the Warm Deal Initiative which provides a Ł6m package each year to improve the insulation of the homes of low income families. Up to 50,000 homes will be insulated by April, 1999. Job and training opportunities - under the New Deal - will be created for 300 long-term unemployed people who will be undertaking this work
the Care and Repair Scheme, a shared priority with the Convention of Scottish Local Authorities (COSLA) to enable more older and disabled owner-occupiers to get help with repair and improvement works, and thereby stay in their own homes
legislation to enable more effective action to be taken to deal with neighbour nuisance and anti-social behaviour which can cause health-threatening stress to other people
Ł14m made available for projects to tackle rough sleeping in 2000/2001 and 2001/2002 in addition to the Ł16m provided in the 3 years from 1997/1998
resources to enable Scottish Homes to support the development of 17,000 new and improved houses for social rent over the next 3 years. In 1999/2000, Scottish Homes will be investing Ł207m in new and improved housing which, in turn, should be matched by a further Ł120m of private finance.

Community Care

27. The Community Care Action Plan, Modernising Community Care Services, published in October, 1998, set out the way forward for improved delivery of services for older people, and people with physical and learning disabilities and mental ill-health living in the community. The emphasis is on:

providing the kind of services people need, and timeously
better and faster decision-making with delegation of budgets and responsibility within a clear strategic framework
flexible and imaginative packages of care for people in their own homes
genuine and effective partnership working at locality level between health, social work and housing.

Employment and Training

28. Work is the best route out of poverty and into a healthier life. The Government's Welfare to Work Initiatives (including the New Deal) are designed to give more effective help to more people than ever before to get and keep a job. They are aimed at people who face particular difficulties in doing this _ long-term unemployed people and their partners, lone parents and disabled people. Well over Ł300m is being invested by the Government to take these programmes forward.

29. In addition, we have set up our own Scottish New Futures Fund. This reaches out to our most disadvantaged young people and aims to give them the help they need to begin benefiting from the main Welfare to Work programmes.

30. To help those who are in work but are still caught in the poverty trap, we are introducing a National Minimum Wage of Ł3.60 per hour from April, 1999.

Environment

31. A clean environment is a prerequisite for health. The National Air Quality Strategy, launched in 1997, sets out health-based standards and objectives for reductions in the levels of 8 key pollutants. The Strategy recognises that poor air quality can have significant adverse effects on health, for example its aggravation of asthmatic or respiratory conditions. For this reason, the Report on the Review of the Strategy, published on 13 January, 1999, proposes tightening 5 of the 8 objectives. Clean water and efficient sewerage services are essential for the health of everyone, yet they are usually taken for granted. The Government are urging the water authorities to accelerate their investment in these services to ensure they meet the highest standards of safety for the public. Over the next 3 years, Ł1.5bn is being invested in the modernisation of Scotland's public water and sewerage systems. The Government are also looking closely at ways of improving the standards and safety of small private water and sewerage systems used by many people in rural areas. A review of Scottish bathing waters was concluded in 1998 and 37 additional waters were announced on 4 February, 1999. An existing programme of investment of Ł105m should ensure that most of these waters comply with the required standards. Additional investment of around Ł10m will ensure compliance of the others.

32. Sustainable development is a key contributor to the drive to better health, providing a context for a range of initiatives with benefits for health. Good environmentally friendly transport services can contribute significantly to good health, for example through reduced pollution and facilitating access to health and other services. Travel Choices for Scotland, the Scottish Integrated Transport White Paper, was published in July, 1998. Its aim is to deliver an integrated and effective transport policy that will produce a transport system for Scotland that is efficient, safe, clean and accessible to all. It will provide better transport choices for Scotland's people, including those in isolated rural communities and deprived communities to whom access issues are of particular concern. The Government's Rural Transport Funding Package is providing Ł4.5m annually for 3 years to improve transport links in rural areas.

33. These environmental measures will contribute to good health by reducing illness - especially infections and allergic disorders - by helping people to access, more readily, health and other key services, both in rural and urban areas, and by boosting physical fitness.

Crime

34. Crime can cause injury and, in extreme cases, death. The fear of crime generates anxiety which leads to distress and ill-health. The Government are committed to tackling crime and its causes energetically. Our policy is based on a number of key principles which include:

tackling the social causes of crime: low income, poor housing, limited school attainment, community disorganisation and neglect

taking action to protect the public. The Government's new community safety strategy, Safer Communities Through Partnership _ A Strategy for Action, will help people's confidence so that they can live without fear for their safety. Tackling crime effectively will benefit health by reducing, for example, the injuries from assaults and the trauma arising from burglary, easing levels of stress and cutting the supply of illegal drugs. Reducing violence against women and their children is especially relevant to health. In November, 1998, we published a consultation document, Preventing Violence Against Women: a Scottish Office Action Plan, seeking views on a wide range of action to tackle unacceptable behaviour towards women. A Scottish Partnership on Domestic Violence, including representatives from key organisations involved in dealing with the specific problem of domestic violence, has also been established. The Partnership remit will involve developing a national strategy on domestic violence, recommending minimum service standards and a framework for monitoring progress. The Partnership has been asked to report by 31 March, 1999, with a detailed work plan and timescale for discharging its remit in full

ensuring that all those involved in the criminal justice system are treated fairly and humanely. Victims of crime must be helped to overcome the trauma of their experience, which might otherwise affect their long-term well-being.

Impacting on Health

35. Together, pursued strongly, all these initiatives will reduce inequalities and help to change lives in ways that are conducive to good health. Fatalistic and defensive attitudes became embedded through the years. Many of Scotland's communities felt that their future and values were being eroded. We are determined to break down such negative attitudes and encourage the belief that good health is something well within the reach of everyone. Health promoting influences need to permeate our schools, universities and colleges, workplaces, health services and communities at large - wherever we live, work, learn, spend leisure time or seek help.

Action

A sustained programme of social and economic change, supported by new funding, is already underway to provide the conditions conducive to better health.

The Scottish Office will ensure that its economic and social policies have positive health impact in the drive to tackle inequality, improve educational participation and attainment, boost housing and employment and promote social inclusion.

All Scotland's local councils will be asked to follow the lead that some have already taken by making health improvement a corporate goal and using community planning, as discussed in Chapter 6, to improve the circumstances in which people live.

The Scottish Office and the Health Education Board for Scotland (HEBS) will work, in partnership, with health boards, COSLA, local councils, the voluntary sector, mass media and other interests to stimulate a "pro health" culture.