Partnership for Care: Scotland's Health White Paper
CHAPTER TWO HEALTH IMPROVEMENT
A new approach to improve health in Scotland and to reduce health inequalities
A sustained effort to tackle the lifestyles and circumstances which damage health
New actions focused on early years; teenage transition; the workplace; and in communities
Legislation to secure the place of Health Improvement in Community Planning
1. The challenge of improving health in Scotland - both physical and mental - will not be easy. Our approach links health with other areas of public policy, recognising the central role of Community Planning and focusing action in ways that are relevant to peoples' everyday lives.
2. Scotland's health is improving but the scale of the challenge is still daunting. Scotland's death rates are among the highest in the world for cancer and coronary heart disease. Life expectancy is consistently lower than in other European Union countries. We have rising rates of suicide, particularly among young men, and rising numbers of young people, in particular girls in their early teens, being treated for self-harm. This reflects a complex interaction of different factors relating to life choices, life styles and life circumstances.
3. Our objective is to improve Scotland's health and reduce the health inequalities within our society. Poor health is strongly linked to deprivation and inequality. Our commitment to improving health in Scotland is integral to closing the opportunity gap and the programmes which are described more fully in the Health Improvement Challenge, which will be published to accompany this White Paper, will be pursued with a particular focus on the social groups most at risk. We will bring forward legislation to back up this commitment and ensure that Health Improvement is a priority for NHS Boards and Community Planning partners.
4. NHS Boards will also step up their efforts to reduce health inequalities, for example by working with both statutory and voluntary sectors to implement Health and Homelessness Action Plans. In addition we are developing, for the first time, Health Inequality Indicators and will work towards a target for reducing health inequalities, which we will set in consultation with Local Authorities and NHS partners.
5. Action to promote good mental health will be an essential component of our approach to improving health in Scotland. We will continue to work to remove the stigma attached to mental illness, reduce the rate of suicides and achieve greater public understanding of mental wellbeing. A national group chaired by the Minister for Health and Community Care will continue to take forward this work which supports wider Scottish Executive plans on mental health improvement and social justice.
6. Health improvement has often been seen as a task for the Director of Public Health and health promotion departments in the NHS. This is no longer acceptable. Promoting Scotland's health needs support and leadership from:
Ministers and Departments across the Scottish Executive;
Local Authorities;
employers;
professionals in health, education and social inclusion;
local community leaders;
Trade Unions; and
representative groups in the voluntary sector.
7. The Executive's new, cross-government approach to health improvement will help deliver this leadership and support. It draws on a wide understanding of the contributors to health improvement across the Executive's portfolios - in education, housing, the environment and in employment - to ensure a coherent approach to tackling those life circumstances and life choices that impact on our health as individuals. At a local level we are committed to working with Community Planning partners to ensure effective delivery in communities. Only by putting health improvement onto everyone's agenda can we join together the various initiatives and achieve an impact which will be more than the sum of its parts.
Making Progress
8. We have already made a start. For example, we have three health improvement Demonstration Projects, an Active Primary School programme, 44 Healthy Living Centres focused on reducing health inequalities, a Health Promoting Schools Unit, an Eating for Health programme including a telephone advice line, and a range of projects funded from the Health Improvement Fund. We have established a direction of travel. We intend now to raise the pace.
Changing Culture
9. Looking ahead, we still need to promote fundamental change in public attitudes among individuals and families, within businesses, in local communities, and the NHS. There will be no quick fix. If we are to raise standards of health, then the people of Scotland need to be motivated and their interest sustained over the long term to make a difference. Health improvement actions will need to involve the public in all its diversity and that will need highly effective and varied communications.
10. Clarity and consistency of message must be sustained across a broad spectrum of actions and settings. Communications on specific topics will be visibly drawn into the health improvement programme by a co-ordinated healthy living identity, to link activities in diverse areas such as education, health and social justice with initiatives on mental wellbeing, smoking, alcohol, diet and physical activity.
'Focus on Four'
11. The integrated and focused approach, set out more fully in the Health Improvement Challenge, will incorporate four broad areas of particular attention: Early years; Teenage Transition; Workplace; and Communities.
12. There is clear evidence of the importance of a child's early years on their subsequent health and standard of living. The Executive will develop an integrated approach for Early Years, including an enhanced focus on health improvement. Actions will include:
an integrated programme of measures by early 2003 to be reflected in plans developed by Community Planning partnerships and NHSScotland;
challenging professionals, health workers, local organisations, and NHS Boards to ensure measures for health improvement in a child's early years are designed to benefit the most vulnerable and disadvantaged families and children; and
linking with the education service in programmes such as Sure Start to focus health resources on those children and families who need the most support.
13. The teenage transition is a time of great change, impressionability, and conflicting pressures on young people. Across the Executive we will develop and build on existing programmes that integrate topic specific action (smoking, drugs, sexual health, alcohol, healthy eating, physical activity and mental wellbeing) alongside promoting personal skills and emotional intelligence. This work will link with the Schools Improvement Framework under the National Priorities in Education, but will also go beyond the school environment. Actions will include:
active health service involvement and support for the roll out of the New Community Schools programme across the whole of Scotland by 2007;
implementation of an Executive-wide policy with funding to improve the quality of school meals including the adoption of nutritional standards;
enabling all schools to become Health Promoting Schools by 2007 through the Health Promoting Schools Unit; and
refocusing the school nursing service to support an integrated approach to improving the health and potential of children and young people through a new Scottish Framework for Nursing in Schools.
14. A broad view of 'health' in the workplace takes us beyond the widespread belief that this is principally about preventing accidents and injuries. Employment and training opportunities bring emotional and social benefits, quite apart from their impact on a person's economic wellbeing, and so can have a powerful impact on the way we feel and the choices we make. Actions will include:
support for small and medium-sized enterprises in dealing with drug and alcohol problems amongst employees;
increasing the number of non-smoking workplaces to protect employees from passive smoking;
expanding the coverage of Scotland's Health at Workscheme; and
encouraging employers to examine the business case for offering their employees health-improving opportunities such as smoking cessation services and exercise facilities.
15. Communities which are active in promoting good health can benefit all who live there. Support for community-led health improvement initiatives will be closely linked to the development of Joint Health Improvement Plans (JHIPs) with Community Planning partnerships, and will be targeted at disadvantaged groups in both urban and rural settings. Actions will include:
optimising the potential of alcohol and drug action teams, Healthy Living Centres and other community-based initiatives;
building voluntary sector and community-based capacity to deliver health improvement through community action;
supporting local people to take a lead in developing local solutions for local community problems; and
integrating programmes on fuel poverty with JHIPs to ensure a reduction in the number of households in fuel poverty.
Accelerating the Pace of Reform and Change
16. Ministers and the Scottish Executive will work with the people of Scotland to achieve a decisive difference in Scotland's health and wellbeing. We have already moved to strengthen the national delivery and support for health improvement by bringing together the Health Education Board for Scotland and the Public Health Institute of Scotland into a single organisation - NHS Health Scotland.
17. In broad terms our proposed approach to improve health throughout Scotland will involve close collaboration with other agencies - Local Authorities, voluntary bodies, employers and Trade Unions and will:
empower the people of Scotland by supporting more people to care about their own health and that of their families; and
help people to understand the issues, listen to their needs and give them the kind of support they need, underpinned by clear consistent messages.