Towards a Healthier Scotland - A White Paper on Health

APPENDIX 1

Action List

This Appendix lists, by Chapter, all the action set out in the White Paper.

Chapter 2 A Shared Vision for Action

There will be 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 will be undertaken. A new sustained attack on the killing diseases - coronary heart disease and cancer - will be pursued. A cross-Departmental approach to health in The Scottish Office will be taken to help focus social and economic policy on positive health impact. Demonstration projects will be established to help local successes lead to national change.

Chapter 3 Action: Life Circumstances

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, 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, the Convention of Scottish Local Authorities (COSLA), local councils, the voluntary sector, mass media and other interests to stimulate a "pro health" culture.

Chapter 4 Action: Lifestyles

The Government will secure: new laws to ban tobacco advertising enhanced health promotion campaigns, targeting young people, pregnant women and low income smokers new NHS services to help smokers quit improved facilities in pubs and restaurants for non-smokers consultation on a better way to reduce passive smoking at work tougher enforcement of the law against sales of tobacco to children The Government will increase the funding of the Scottish Diet Action Plan initiatives to over £2m over the next 3 years, starting with an extra £0.3m for the Scottish Community Diet Project. The Government will appoint a national dietary co-ordinator to give impetus to implementation of the Scottish Diet Action Plan, with a special focus on developing the contribution of primary producers and major retailers, and encouraging mothers to breastfeed. The proposed new Food Standards Agency will improve access by people to information about nutrition and food safety. The Government will set up a Task Force to develop a National Physical Activity Strategy for Scotland. It will bring together key agencies in sport and leisure, education, health, fitness, exercise and play, in joint action to help people of all ages and walks of life to enjoy the benefits of physical activity. The Government will make available additional resources to take forward the work of the Task Force and implement its recommendations. New steps to cut alcohol misuse and improve services will be taken in the next 3 years, supported by £2.5m. Work in implementing the new strategy will be guided by a new national committee, bringing together experts from the health service, police, local authorities, licensing authorities and the voluntary and private sectors. The Government will publish shortly an enhanced strategic framework to co-ordinate and focus drug misuse measures in Scotland. New prevention and treatment services will be funded from 1 April, 1999, helping to discourage drug misuse, offer effective treatment and cut drug-linked crime.

Chapter 5 Action: Health Topics

The Government will make available a Scottish resource pack which will assist agencies to plan and implement co-ordinated programmes to support children and their families in fulfilling their potential. A demonstration project - "Starting Well" - will develop and disseminate best practice in supporting children's health from pre-conception through to school entry. Health boards should commission measures, including public opinion polls, to ensure full dissemination of their proposals and gauge the support for water fluoridation. Water authorities will be advised that, where local views firmly favour fluoridation, they should focus, thereafter, on issues of technical feasibility, not on the arguments for or against fluoridation. The Government will fund pilot schemes to provide fluoridated milk in rural areas where fluoridation of the public water supply is not feasible. The Government will commission, and fund, the development of a dental disease 'prevention from birth' programme, involving registration with a dentist, dental education for all new parents, toothbrushing with a fluoride toothpaste for infants and advice on how to reduce sugar in the diet of infants. The demonstration project - "Starting Well" - will include dental and oral health and hygiene within its remit and will link closely with the other initiatives to address dental and oral health. A demonstration project - "Healthy Respect"- will develop best practice in the promotion of sexual health and the prevention of unwanted teenage pregnancies. It will build on the principles of the Scottish Needs Assessment Programme's overview of teenage pregnancy in Scotland. Funding will be provided to enable the voluntary sector's expertise to be made available to many more schools in Scotland and so promote a more informed and responsible approach to sexual matters on the part of young people. Heart disease will be a leading priority for the NHS in Scotland. A demonstration project - "The Heart of Scotland" - will develop an inter-sectoral community-based approach to the prevention of heart disease, recognising that many of the measures will also help to avoid cancer and stroke. HEBS will step up its national media campaign to address the factors which contribute to coronary heart disease as one of Scotland's main killing diseases. Health promotion teams will stimulate, support and deliver local action. Accelerated action on smoking and diet will help drive down rates of heart disease. Cancer will be a leading priority for the NHS in Scotland. A demonstration screening project - "The Cancer Challenge" - will be established in Scotland to test the feasibility of a national programme to detect colorectal cancer. Linking with its work on coronary heart disease and stroke, HEBS will increase its national media activity to promote awareness of the factors which help to make cancer one of Scotland's main killing diseases. Accelerated action on smoking and diet will help drive down cancer rates. Mental health will be a leading priority for the NHS in Scotland. The demonstration project on child health will be used to promote mental health in both parents and children. HEBS and health boards will work in conjunction with the Health and Safety Executive and others to safeguard and promote mental health. Social inclusion initiatives will help improve well-being and so enhance mental health. The Information and Statistics Division of the NHS Common Services Agency will work with health boards and other interests to develop national criteria for data collection. Health boards will be encouraged to foster, and participate in, local inter-agency accident prevention work. The Government will commission and fund an initiative to deliver a web-site database of best practice in home safety for use by local authorities and others; and to help establish information networks to inform the development of co-ordinated local strategies. A new target for reducing road accident casualties will be set up for the period to 2010 and published, together with a strategy for its achievement.

Chapter 6 Putting the Jigsaw Together

A Public Health Strategy Group, led by the Minister for Health and drawn from all Scottish Office Departments, will ensure the integration of policies and initiatives with health implications within The Scottish Office, and encourage the use of Health Impact Assessment. Health boards will lead and promote health promotion and improvement throughout their services and are charged with demonstrating clear reductions in health inequalities. Scotland's Chief Nursing Officer will initiate a review of the contribution made by nurses to improving the public's health, focusing especially on the role of the health visitor, the school nurse and the practice nurse. Boards will support other agencies, such as councils, which are working to improve health and quality of life through focused initiatives that address life circumstances. A review of the public health function is being led by the Chief Medical Officer to establish a framework in which the contribution of public health medicine can be maximised. The review will report in 1999. The Government are proceeding to establish a public health post in COSLA. The Government will continue to support ways of making health and lifestyle information readily available, including the extension of the NHS helpline, at both national and local levels, and through the use of digital television to provide Internet facilities. The Government will offer a facility on Scottish Health on the Web to help local interests to make their material widely available. The Government will fund the Scottish Needs Assessment Programme to develop standard guidance on Health Impact Assessment using current work in pilot areas such as the urban regeneration partnerships and aspects of urban transport policy. The Public Health Strategy Group, led by the Minister for Health, will promote the widespread use of Health Impact Assessment when formulating Government policies. Policy development and analysis will be strengthened further by the creation of a Professorship in Health Promotion Policy, to be launched with funding from HEBS in 1999. A separate advisory panel for Scotland will help the Lottery New Opportunities Fund assess bids to establish Scottish healthy living centres. Working with COSLA and the Scottish Consultative Council on the Curriculum, HEBS will establish a specialist unit to develop further health education and health promotion in schools. Workplace health promotion and occupational health support, with particular emphasis on small and medium-sized businesses, will be stepped up by appropriate agencies, notably HEBS and the Health and Safety Executive. A long-term occupational health strategy is being prepared by the Health and Safety Executive, after consultation. A publicity drive will be launched to secure wider coverage for the Scotland's Health at Work Award initiative (SHAW), with a particular focus on small and medium-sized enterprises. The Scottish Office will join other employers in applying for SHAW accreditation, and will encourage others to do so. Public health legislation is now being reviewed to ensure a strong framework within which to tackle communicable disease. The review will clarify the role of Directors of Public Health and colleagues when dealing with outbreaks of communicable disease and other public health emergencies. The expert group set up by the Government to review HIV health promotion strategy will report in summer, 1999. Guidance on the control of outbreaks of food-borne and water-borne diseases has just been revised by an expert group, taking account of the response to consultation and the Determination following the Fatal Accident Inquiry into the Central Scotland outbreak of E coli 0157 food poisoning. This guidance will be published shortly.

Chapter 7 Health Demonstration Projects

The Government will set up 4 health demonstration projects "Starting Well"; "Healthy Respect"; "The Heart of Scotland"; and "The Cancer Challenge". A national group will oversee and co-ordinate the 4 health demonstration projects, drawing together lessons learned and optimising the national benefits of the initiative as a whole.

Chapter 8 Research, Evaluation, Targets & Monitoring

The Chief Scientist Office will work with key partners to develop the public health component of its research strategy. This will set clear priorities for collaborative research and dissemination involving the widest possible range of skills and expertise and drawing on the strength of the people of Scotland and their communities so that we can meet our public health challenges. Headline targets have been set for coronary heart disease, cancer, smoking, alcohol, unwanted teenage pregnancies and dental health. The inequalities gap which exists for each of the headline targets will be regularly measured to assess progress in reducing the disparity in health status between different socio-economic groups. Further work is being undertaken to develop measures which reflect health and well-being within population groups. The 4 health demonstration projects will each have our inequalities component, including targets and indicators of progress. A group drawn from the public, private, community and voluntary sectors, led by the Minister for Health, will be set up to monitor progress on the implementation of the White Paper and to help ensure that health remains high on the agenda at national and local levels.