Improving Health in Scotland - THE CHALLENGE
MEETING THE CHALLENGE - A FRAMEWORK FOR ACTION
The Executive has a clear and well-established commitment through Towards a Healthier Scotland,1Building a Better Scotland2 and Our National Health: A plan for action, a plan for change3 to improving health and shifting the emphasis away from ill health to one that focuses much more on prevention and health improvement. As part of that commitment, and aligned with the Executive's strategies for promoting social justice and closing the opportunity gap, there is a particular focus on tackling health inequalities as the 'overarching aim' of the health improvement agenda. The commitment to improving health, integrated with the pursuit of social justice, includes the need to bridge the opportunity gap for all equally, regardless of age, gender, sexual orientation, geographical or economic position, ethnicity, disability or faith.
The tools available to the Executive to help improve health are as follows:
Cabinet's leadership to ensure that health and well-being is part of the daily life of all Scottish Executive departments.
Policy making - almost all the Executive's policies influence the determinants of health.
Improving the physical environment - using national and local level interventions to safeguard and improve the physical environment.
Improving the social environment - working towards a social environment which minimises crime and other threats while promoting trust and mutual support.
Strengthening individuals - developing the confidence, resilience and capacity of individuals and families to make choices that support health while also making healthier choices the easier choices.
Reorienting services - delivering services that empower individuals and communities and promote health.
Create a new Directorate of Health Improvement within the Scottish Executive.
This action has already taken place and a Director of Health Improvement appointed to lead this new Directorate. Whilst the Directorate is within the Health Department, a cross-cutting approach will be established resulting in work across boundaries, linking the different agendas that impact on health.
Scottish Executive to champion the commitments described in this paper with visible leadership and clarity to deliver the change in Scotland's health record.
Local and national communications rationalised and combined under an overarching national communications framework by summer 2003.
Some single-issue advertising and communications campaigns have proved to be extremely successful. However, these individual messages can be clearer, more consistent and reinforced if they are seen to be an integral part of a co-ordinated health improvement communications programme. This will be achieved by:
establishing a Scottish Executive co-ordinating group to plan, develop and ensure the delivery of health improvement communications activity (spring 2003)
agreeing a detailed communications plan in support of the health improvement activities across the Executive (summer 2003)
developing the evidence base necessary to underpin successful social marketing activities
drawing on the established expertise of NHS Health Scotland (the merged HEBS/PHIS organisation), the Scottish Executive, COSLA and local/single issue communication specialists
the creation of a 'healthy living' brand, agreeing implementation and delivery mechanisms and a visual identity system as part of the communications plan
identifying and assessing successful communication campaigns on related areas and in other countries
co-ordinating media planning and research activities
integrating national advertising campaigns with other forms of local and national communication.
Objective for Health Improvement
By 2010-12, improve life expectancy and 'Healthy Life Expectancy' for all men and women living in all areas of Scotland. Also reduce inequalities between the most affluent and most deprived groups.
By 2020-22, further improve life expectancy and 'Healthy Life Expectancy' of men and women living in all areas of Scotland. Also further reduce inequalities between the most affluent and most deprived groups.
In 1980-82 the average life expectancy for men in affluent areas was 71.5 compared with 66.2 years in deprived areas. In 1999-01 the figures were 76.7 and 68.9 respectively.
In 1980-82 the average life expectancy for women in affluent areas was 77.0 years compared with 72.7 in deprived areas. In 1999-01 the figures were 80.7 and 75.9 respectively. 4
Whilst the target to improve health is expressed as life expectancy, the indicators to measure success will include a wide variety of indices and will relate action by the Health, Development and Education departments in partnership with other sectors. School attainment, for example, is as important to health as an increase in young people being active. See Annex B for an illustration of the indicators and targets within Health Department plans.
The Scottish Executive is leading:
a working group to establish a target for reducing health inequalities supported by a number of indicators; to be published by spring 2003 (see Annex A)
work to examine the application of healthy life expectancy indicators to support life expectancy; report due autumn 2003.
Create a national focus for health improvement by bringing together the Health Education Board for Scotland and the Public Health Institute for Scotland by April 2003 to create NHS Health Scotland.
The integration of the existing organisations will build on the strengths of the Health Education Board for Scotland (HEBS) and the Public Health Institute for Scotland (PHIS). The integrated organisation will:
deliver health improvement programmes to a wide variety of audiences and stakeholders working to improve Scotland's health
employ knowledge about health and its determinants in a way that will influence policy and practice to improve health within Scotland
play a key role in the successful implementation of programmes of health improvement.
The work of NHS Health Scotland will include the following functions:
working in partnership with the NHS, local government structures, the community and voluntary sectors, academic sector, business sector and other relevant groupings to further the aims and objectives of the health improvement challenge
leading and developing programmes, including multimedia communications activity, to deliver support for the health improvement challenge
assembling, disseminating and explaining the evidence base for Scotland's health improvement strategy
further developing methods for the application of integrated public health data to inform health improvement interventions at national and local levels
playing a central role in the delivery of the Health Improvement Challenge by fulfilling a wide range of implementation roles
co-ordinating the evaluation of the Health Improvement Challenge
developing the capacity of the public health workforce and the wider workforce to deliver Scotland's health improvement activities
reviewing published information on innovations, insights and evidence that will lead to enhancement in future approaches to health improvement.
To ensure Health Improvement is 'mainstreamed' by active inclusion of Health Improvement in public sector plans and organisations by autumn 2003.
The Scottish Executive programmes for government, the community planning process and joint health improvement plans, together with NHS Board local health plans are all key levels of policy and decision making. By ensuring that public sector plans demonstrate an integrated approach to action and policies involved in health improvement, health improvement will become a mainstream rather than a separate entity.
The Executive will use an integrated policy impact assessment tool currently in development to analyse plans, and will link the analysis into the management processes of the Performance Assessment Framework within the NHS and the Community Planning Partnership processes.
Create and maintain networks to drive health improvement activity by August 2003.
The Health Improvement Directorate, the wider Scottish Executive and the new NHS Health Scotland, will work with NHS Boards and other NHS bodies, the academic community, local authorities and the voluntary sector to build upon existing processes and develop effective networks of people who contribute to Scotland's health improvement activities. NHS Health Scotland will agree with the Executive an action plan for further development of learning networks building on and learning from work underway by August 2003.