Working Together for a Healthier Scotland

Chapter 1 - Introduction

1. Good health helps us each to live life to the full. It is worth investing in for that alone. But a healthy population is also crucial to our national prosperity and well-being. Our cultural attitudes and lifestyles have a vital bearing on our health. So, too, do the circumstances in which we live. Poverty, unemployment, housing and the environment around us are all inextricably linked with health. Only by tackling these vital issues will we achieve the sustained health improvement we need, in the spirit of the World Health Organisation’s vision of health, which was defined as long ago as 1948, as

"a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."

That is why the Government’s Scottish manifesto promised that -

"We will aim to improve public health in Scotland with new initiatives on preventative health care that recognise the impact that poverty, poor housing, unemployment and a polluted environment have on health.

The Government will join with local government in a concerted attack against the multiple causes of social and economic decline - unemployment, bad housing, crime, poor health and a degraded environment."

2. The 20th century has seen dramatic improvements in Scotland’s health as once common diseases like polio were conquered. As the century ends, there are positive trends. Men and women live longer than at any time in the past; premature deaths from the two main killer diseases -coronary heart disease and cancer - are decreasing; and the oral health of adults is improving. But deep-seated problems remain. Lifestyles that lead to poor health are common. Smoking, especially among young people, is unacceptably high. Many of us do not eat a balanced diet. Too few of us take adequate exercise. The dental health of children is poor. Alcohol misuse remains a serious problem. Drug misuse continues to grow. What is more, the progress that has been made is relatively modest in relation to advances in other developed Western nations and our position in the international health league is unenviable. Overall progress, nationally, also masks increasing health inequalities between social classes and wealthy and poor areas. Health inequalities also reflect gender and ethnicity. Environmental and social conditions in many areas of Scotland still fall below standards acceptable in a modern society and, where deprivation exists, health is much poorer.

3. A fresh approach is necessary - a public health strategy which addresses the root causes of our health problems. Improving lifestyles must continue to be rigorously tackled, but within a framework which recognises, and focuses on, the underlying social, economic and environmental circumstances which influence health. A worthwhile job, a decent home, a clean environment, are all key health determinants. A good education increases self esteem and enhances employment prospects. The Government’s policies are geared to creating a climate in which these basic social rights are brought within the reach of all. The need is to ensure that each strand of policy, and every new initiative, is taken forward within a coherent framework, so that health gain is maximised. Above all, we need to attack the inequalities which scar our health record.

4. True public health policies are imbedded in action to improve our quality of life and protect our environment, in improving housing and educational achievement, as well as in addressing poverty and unemployment and in the restructuring of the National Health Service as a public health organisation with health improvement as its main aim. Collaboration, involving all partners with an interest in health, is the key. A Scottish Parliament, with its wide-ranging powers, will facilitate the cohesive approach to health improvement we have hitherto lacked. This Green Paper offers suggestions on how co-ordination can be improved. It is not concerned with the structures of the National Health Service as such, though clearly the location and delivery of health services are vital to good health and health professionals have a crucial contribution to make to health improvement, as discussed in the Government’s White Paper Designed to Care: Renewing the NHS in Scotland, published in December 1997.

5. The Green Paper is a genuinely consultative document on which the Government would welcome comments - a strategy for all must be a strategy by all. It describes in Chapters 2 and 3 Scotland’s current health status, the associated life circumstances and lifestyles, and the remedial action which has so far been taken. Chapters 4 and 5 set out, for comment, the Government’s proposals and how the various interests can work together to improve Scotland’s health. Chapter 6 seeks views on indicators, targets and research. In the light of the responses received, the Government will develop a White Paper which will, in effect, be a blueprint for a healthier Scotland. It would be wrong to think that all the solutions lie at our fingertips. What we need are new ways of thinking, better ways of working together and a considered and measured approach to health promoting action.