We are testing a new beta website for gov.scot go to new site

Improving Health in Scotland - The Challenge


Improving Health in Scotland - THE CHALLENGE



There is both a need and the opportunity to boost the health (physical, social and mental) of the people of Scotland - something that is fundamental to the happiness and prosperity of individuals, families, communities and the whole country. Scotland faces a tougher challenge to improve health than most other countries in the Western world. The Scottish Executive, the Health Department, NHSScotland and a much wider group of stakeholders are all important to the delivery of health improvement. Part of this challenge is to ensure that Health Improvement is achieved with clarity of purpose, shared aims and commitment across Scottish life, and with leadership which instils vision and the confidence to change - and to improve.

Other countries have already succeeded.

  • Japan achieved a relatively rapid improvement in life expectancy through the 1960s, passing other countries like England and Wales in the process.

  • Finland achieved a relatively rapid reduction in the lives lost to heart disease, particularly in the late 1980s, passing Scotland in the process.

There is every reason to believe that Scotland can achieve similar success.


It is true that Scotland has a poor health record. It is also true that many aspects of health have improved: there are fewer premature deaths from heart disease and cancer and overall life expectancy has risen across Scotland. The next challenge is to build on that success and to accelerate the rate of improvement:

* to improve the health of all the people in Scotland; and

* to narrow the opportunity gap and improve the health of our most disadvantaged communities at a faster rate, thereby narrowing the health gap.

The issues for Scotland are similar to those facing many developed countries; a gap between the health and economic expectations of different elements of our society, an increase in sedentary behaviours, an increased consumption of what is commonly referred to as 'junk' food, and an increasing burden of mental ill health. Scotland has an opportunity to set its own direction. To use the many mechanisms to develop a healthy, inclusive society in Scotland and to enable the country and its people to be successful, healthy, active and with good mental health. One person in four will suffer from mental ill health at some time in their life (WHO 2002). Promoting positive mental health and taking action to prevent mental ill health are therefore essential components of all health improvement work.

This paper sets out a framework for action in the form of a Challenge. It includes work on all the determinants of health. However, for the first phase, our focus will be on 5 of the top 10 key risk factors affecting health and 4 specific areas.

Risk Factors



early years


teenage transition

low fruit and vegetable intake


physical activity levels




We want to move towards a position where everyone in Scotland enjoys the very best of health, on a par with the best in Europe. Our aim is to accelerate the rate of change therefore, more rapidly achieving health improvement. Increasing life expectancy and healthy life expectancy, because the quality of life in terms of freedom from debilitating ill health, can be as important as the duration of life.


Health improvement has traditionally been seen as the role and task of Director of Public Health and Health Promotion Departments in the NHS. However, the task of improving Scotland's health record, across all sectors of Scottish life, requires consistent, senior level leadership (both national and local).

  • All departments across the Scottish Executive

  • The Cabinet

  • Chief Executives and Senior Management from across the NHS, local government, voluntary and private sectors

Progress has already been made. Many organisations and individuals across Scotland are already making great efforts to build on that progress, efforts that recognise the need to focus on the key determinants of health: life circumstances, lifestyles and specific health topics, with an overarching aim of decreasing health inequalities. But progress needs to be faster. We need a clear, consistent, robust and focused effort in some key areas if we are to achieve the change we seek. To support this we are proposing a programme of work to put health improvement initiatives into the mainstream of action and onto everyone's agenda, build upon existing programmes, develop a nation-wide effort and a special focus on four areas of early years, the teenage transition, the workplace and community.


This document provides a strategic framework to support the processes required to deliver a more rapid rate of health improvement in Scotland and highlights further actions to improve the health of the people of Scotland. It builds on the foundation of Towards a Healthier Scotland1 and should be seen as the first in a series. This current document is aimed primarily at the period to mid 2004, at which point a second phase of the framework will be published.

There are three main objectives.

1 To set out the work programme of:

  • the Scottish Executive's actions to improve health

  • the strengthened Special Health Board formed by the integration of the Public Health Institute of Scotland (PHIS) with the Health Education Board for Scotland (HEBS)

  • health improvement activities within NHS Boards.

2 To relate work programmes and processes across Scotland that are central to health improvement including:

  • health improvement as a cross-cutting policy for the whole Programme for Government

  • Community Planning Partnerships

  • the health improvement work of COSLA and local authorities

  • the impact on health that arises from the work of the business sector, voluntary sector and other strands of Scottish life.

3 To encourage the many organisations and individuals within Scotland who contribute to health improvement and to allow them the opportunity to influence future work and phases of this long-term plan for change.