Learning from 25 years of preventative interventions in Scotland

2. Introduction

Within Scotland, there has been a long standing interest in preventative approaches and a recognition of the important role that prevention can play in improving outcomes, realising longer term savings and reducing future demand on services.

“Prevention” is often used in different contexts to mean slightly different things. Broadly speaking it refers to intervening to prevent problems from arising in future, or reducing their severity when they do.

While recognising that there are several definitions of prevention, this report uses the public health definition, but adapts it to a broader context that goes beyond health.^[1] This definition describes prevention in relation to:

• Primary prevention: Action that tries to stop problems happening either through actions at a population level or actions to address the cause of the problem.
• Secondary prevention: Action which focuses on early detection of a problem to support early intervention and treatment and reduce the level of harm.
• Tertiary prevention: Action that attempts to minimise the harm of a problem through careful management.

The aim of this work was to create a bank of examples of preventative interventions that have been successfully introduced in Scotland and draw out some overarching observations.

It is important to acknowledge that there is a large body of work which discusses prevention in the context of public service reform and the challenges and barriers that have prevented a more radical shift towards prevention.^[2] It is hoped that this report will add to and complement this knowledge base, but also root it within the context of some of the more successful preventative interventions that have been implemented within Scotland over recent years.

This report is split into two parts. Part 1 draws together overarching observations from 15 case studies of post devolution preventative interventions. Part 2 sets out the 15 case studies. The case studies have been carefully selected to highlight a range of interventions introduced over the last 25 years and reflect a mix of national and local projects (Figure 1). They were drafted between November 2024 and March 2025.

• 20 mph limits
• Access to Welfare in Schools
• Breastfeeding Friendly North Lanarkshire (BFNL)
• Childsmile
• Covid-19 Vaccines
• Fair Start Scotland (FSS)
• Family Nurse Partnership (FNP)
• Financial Incentives for Smoking Cessation in Pregnancy
• Housing First Pathfinder (HFP)
• Minimum Unit Pricing of Alcohol (MUP)
• Safeguarding Vulnerable Road Users (Project PRIME)
• Scotland’s National Naloxone Programme (NNP)
• Scottish Child Payment (SCP)
• Smokefree Legislation
• The Caledonian System

The case studies follow a standard format and have been designed to provide a descriptive and evidence based account of each of the interventions. They are largely descriptive in nature and do not seek to provide a critical appraisal of either the intervention or the associated evidence.

This report is also an opportunity to recognise, learn from and celebrate some of the important preventative interventions that have been introduced in Scotland and build the case to further prioritise prevention.