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Good Places, Better Health: A New approach to the Environment and Health in Scotland: Implementation Plan



The implementation of the prototype requires us to think, plan and deliver in new and more effective ways at national and local level. This will ensure we deliver the outcomes effectively. We aim to ensure that cross-cutting working is effective and that we challenge the silo working that traditional approaches in many environment and health policy areas may have created. The proposed approach will tackle the complexities in a holistic way and provide a new link between environmental policy and health outcomes.

We will deliver this new approach by developing a national infrastructure that will help local delivery. We will do this by:

  • Framing the problems, gathering intelligence and analysing the relationships. A model will be used to illustrate transparent relationships between physical environment and health and how we deliver actions.
  • Taking a systems approach to link science, research, practice and policy making in real time.
  • By uniting around a shared approach and common language we will bring various stakeholders together to consider the issues and move forward with actions.

The following sections provide further information on how we plan to frame the problems and what the systems approach will look like.

6.1 Framing the Problem: A New Model

It is important that we are able to demonstrate clearly the relationship between physical environment and health outcomes, even where these are complicated. We know a simple 'cause-and-effect' model is not adequate to do this.

We have therefore identified a new model that can represent issues and frame problems for policy makers in a way which facilitates consideration, firstly of higher level determinants of environmental quality and, secondly, of a range of contextual issues which influence whether good environments translate into positive health and wellbeing or poor environments impact negatively on health and wellbeing. By recognising the contribution of a wider set of issues, a more coherent cross-cutting policy response can be made. Fundamentally, this is a common sense approach that focuses on cross-cutting health and wellbeing policies and effects a clear blueprint for delivery.

An effective model which can frame the complex relationships between environment and human health is the Modified DPSEEA model. 2 This model will be used to frame the problems and identify the solutions.

Annex 1 provides further details of the model.

Figure 1: The Modified DPSEEA Model 2

Figure 1: The Modified DPSEEA Model

6.2 Taking Things Forward: A Systems Approach Built Around Priorities

Once we have framed the problem and demonstrated the important factors in the relationship we must act upon those insights. This will involve a robust process that allows us to work through evidence to implementation of actions.

The process we will implement will collect and analyse relevant data and combine this with research findings and operational expertise. This allows evidence to be linked to policy through a robust process of evaluation. This more comprehensive co-ordinated evaluation of wider environmental health intelligence is intended, with development, to be a basis for more effective decision making and policy.

Critical to the process of linking evidence to policy on an ongoing basis are three core systems which are the cornerstones of a strategic approach. These are: an intelligence system, an evaluation system and a levers of change system. However, there is already much good and promising practice which will inform meaningful action for the future. An important benefit of the strategic framework will be its potential to add value, to co-ordinate and augment existing activity in Scotland.

Figure 2: The Three Core Systems and Their Outputs

Figure 2: The Three Core Systems and Their Outputs

The intelligence system will make us smarter about what we do. It will bring four key intelligence streams together to highlight the links between environment and health and wellbeing. The intelligence system will deliver strong relevant evidence. Each intelligence stream will be led by an appropriate agency with co-ordination through a Scottish environment and health information network (ScotEnvH). It is important to note from Figure 3 that we view intelligence as more than just research and that we will also add to the evidence, learning on what works in practice, and knowledge and opinion from experts and those working to deliver in these areas. We will build on the strong networks that are already found throughout the fields of public health and environment to gather intelligence at a national and local scale. The evidence produced by the intelligence system will then be disseminated appropriately.

Figure 3: The ScotEnvH Intelligence Streams

Figure 3: The ScotEnvH Intelligence Streams

The evaluation system will ensure appropriate rigour in the evaluation of evidence in this complex area. It will draw upon the valuable evidence produced by the intelligence system whether this relates to information (usually in the form of data), products of research or lessons from "Practice - what works". Effective evaluation will point the way to solutions which may be delivered through policy.

An important part of the system in terms of moving from evidence to action is a levers of change system. We need to ensure that we are able to work nationally and locally to implement the appropriate policy recommendations. Where a policy recommendation needs action at a national level, e.g. the removal of a barrier or resolution of clashing policies, the issue will be raised within the appropriate parts of government. There are likely to be a number of policy recommendations arising from analysis of practice or research evidence that we will wish to make available to inform actions at a local level. We will support implementation of actions at a local level through existing learning networks and the links through the field prototypes ( see section 7).