Working Together for a Healthier Scotland

Chapter 4 - The Government's Approach

Purpose

82. This chapter builds from previous chapters a framework within which the action outlined in the remainder of this document might be pursued.

83. Our goal is a healthier Scotland, with less ill-health and higher levels of well-being and fitness across the nation and social spectrum. The Government view as unacceptable the inequalities in health which exist in Scotland. The challenge lies in reducing avoidable differences in health opportunities and experiences across socio-economic groups, and geographical localities. The strategy for a healthier Scotland must be a strategy for the whole population, but must at the same time tackle health inequalities through giving the highest priority to those who have the most disadvantaged lives and the greatest needs.

Action at 3 Levels: Life Circumstances, Lifestyle Topics and Health Topics

84. Our priority health topics, such as CHD and cancer, are the visible face of Scotland’s preventable health problems. Lifestyle topics are the obvious focus for health improvement action. However, we must also address underlying factors which influence health - the circumstances in communities and society as a whole which bear heavily on people’s lifestyles and health, and contribute so much to health inequalities. Many different health problems have common roots in the disadvantaged circumstances in which people live their lives.

85. Simply addressing disease and lifestyle cannot deliver what is needed. The first part of a cohesive strategy for a healthier, more equitable, Scotland must be to counter the life circumstances which can give rise to poor health, and foster those which generate good health. Strong foundations must be put in place. These include a job, a home, a good education and an attractive environment.

86. A key task is to help strengthen communities in need, promoting a sense of belonging, hope, self-esteem and confidence. This is fundamental to the well-being of families and individuals and their capacity to act on health education messages, taking fuller responsibility for safeguarding their own - and other people’s - health. Communities, families, groups and individuals need help to have more influence over their day-to-day lives and destinies, and to play their part as citizens and family members in looking after each other and building a better, more caring, more cohesive and healthier society. This is not just, or primarily, for health agencies to pursue, but will provide common cause with those working to prevent crime and social exclusion, and to improve children’s lives and education.

87. Action at this, first, level will not generally come under specific headings such as CHD, cancer, stroke, mental health, smoking, or even be labelled ‘health’. But it does hold the potential for a major, long-term and sustainable impact across a spectrum of health and lifestyle topics, on health inequalities, on related issues such as crime, on mental and social well-being, and on quality of life.

88. The Government will build on these foundations by ensuring that communities, families and individuals have the specific support and help they need in relation to particular lifestyle priorities, such as smoking, healthy eating and drug misuse.

89. Lifestyle topics are the second level, calling for strong and supportive health education, underpinned by appropriate policies including regulation.

90. At the third action level - health topics - we must bring home to everyone the importance and preventability of Scotland’s major causes of illness and death, and help people who have already developed particular health problems to reduce the risk that they will worsen or recur.

Action Dimensions

91. A range of measures is required, including: policies addressing life circumstances as well as specific lifestyle and health topics; broad-based strategies for the development and strengthening of communities; the provision of high quality, accessible services and facilities for the prevention of ill-health and the promotion of good health; and health education which influences culture, provides information, gives encouragement and helps people to acquire the skills needed to act on the advice given.

Arenas for Action

92. The Government are committed to ensuring that the people of Scotland have the benefit of healthy influences and access to health promoting resources wherever they live, learn, work, spend leisure time and seek help. To this end, it is important to encourage the continued development of health promoting strategies, policies, facilities and education in arenas such as the Health Service, schools and other educational institutions, the workplace and a range of other community settings, formal and informal. We need frameworks for a health promoting Health Service, the health promoting workplace, health promoting communities and so on, building on the pioneering concept of the health promoting school. This work needs to be supported and encouraged by giving health issues a high profile in the mass media.

Life Stages

93. Promoting health is a challenge at all stages of life, from first life (indeed, before conception and during pregnancy) to old age. The challenge is to young and old people alike, the community in which they live, and the organisations and policymakers who support them. Different stages in people’s lives bring different priorities and require different approaches. Much of the health promotion effort must continue to involve people in the middle years of life, but young people and people in later life have particular needs. Effective early intervention for children in high risk groups can yield great benefits later on. Personal responsibility must also be stressed. A matter of pressing concern is risk-taking behaviour among young people, manifest in smoking, drug and alcohol misuse and hazardous sexual behaviour. We must be ever more creative in our search for ways of bringing these problems to their attention, while listening to their views.

94. It will not be enough to treat the various life stages in isolation. The opportunity for the generations to learn from each other and to help each other should not be forgotten. Adults have important parts to play in helping young people to healthier habits, and old people need to have the benefit of respect and care from the younger generations. In recent years, evidence has been accumulating of links between particular aspects of parenting and a range of unhealthy and antisocial behaviours among young people. This is not to say that parents alone are responsible for young people’s problems. Rather it points to a need to explore carefully what can be done to identify the circumstances which will enable parents to give their children the best start in life and support in their formative years.

Partnerships for Health

95. The task of building a healthier Scotland is not for the Health Service alone. The National Health Service has the lead role in forming strong partnerships with local authorities, voluntary organisations and the private sector which are essential for success. Partnerships must reach out to their local communities and involve the public in their activities. The Scottish Office is committed to setting a good example by ensuring that there is adequate co-ordination across all its Departments and with other Government agencies which operate in Scotland, including the Health and Safety Executive, in the interests of better health and that policies, strategies and initiatives are sensitive to people’s needs and circumstances.

Views are invited on the various aspects of the Government’s suggested approach, including the 3 level strategy envisaged, ie life circumstances, lifestyle topics, and health topics through prevention of illness and premature death.