Learning from 25 years of preventative interventions in Scotland

6. Approaches to Prevention

The case studies include a range of examples of different types of interventions, some of which are highlighted below:

• Providing targeted cash transfers . Direct cash transfers, predominantly made through the welfare system, are a key policy lever that governments can use to alleviate poverty, prevent short term hardship and improve medium and longer term outcomes.^[17] The SCP case study illustrates how direct payments act as a mechanism to improve outcomes for children and families and could reduce future demand on public services.
• Legislation and regulation. Regulatory levers prevent, mandate or limit certain behaviours.^[18] Several of the case studies show how laws were passed to introduce preventative public health measures, with accompanying regulation to aid implementation. The MUP case study shows how the Alcohol (Minimum Pricing) (Scotland) Act 2012 set a floor price below which alcohol cannot be sold, which led to changes in alcohol consumption and is estimated to have contributed to reductions in alcohol-related deaths and hospital admissions for alcohol-related causes.

The Smoking, Health and Social Care (Scotland) Act 2005, (Smokefree legislation) is another policy case study. The law prohibits smoking in wholly or substantially enclosed public spaces to protect people from the health harms of second-hand smoke, and has led to reductions in second-hand smoke exposure, health improvements and cost savings.

• Delivering vaccination programmes. Vaccination programmes are the most effective way to prevent many infectious diseases. The Covid-19 vaccination programme in Scotland case study shows the concentrated focus on vaccination as part of health protection in a crisis situation which required immediate and direct action. The programme prevented tens of thousands of deaths and many more admissions to hospital.
• Providing incentives to facilitate behaviour change. The smoking cessation in pregnancy case study is an example of how financial incentives in the form of shopping vouchers, given to mothers at key points in their attempt to give up smoking, combined with support from existing smoking cessation services, is both effective and cost-effective. The Childsmile case study shows how the programme is designed to instil good toothbrushing habits from an early age, and includes the distribution of free toothbrush and fluoride toothpaste packs for home use.
• Providing income maximisation advice and support. Welfare and other/wider advice services play an important role in helping to address the complex problems associated with poverty and inequality. The Access to Welfare in schools case study shows how ‘Maximise!’ – a service embedded in schools across Edinburgh - offered parents and carers accessible welfare advice and wider services at an early stage and prevented families from reaching a crisis point. It was a cost-effective way of addressing social, economic and health inequalities by improving a range of outcomes amongst parents, carers, children and young people.
• Delivering intensive support programmes. Intensive support programmes are approaches which support high risk groups with multiple needs, or include the option of intensive support for particular groups. They are a key attribute of ‘person-centred approaches’ (see section 8).^[19] Several of the case studies involved intensive support programmes. FNP is an example of an intensive one-to-one home visiting programme for young first time mothers, which shows measurable improvements in outcomes for children and families. Housing First is another example of a programme which gives people with high support needs settled accommodation with intensive support. It has been successful in providing sustainable housing solutions for homeless people with complex needs.
• Conducting community engagement and outreach. A number of components were integral to the success of increasing breastfeeding rates in North Lanarkshire, one of which was community engagement. The BFNL case study shows how nine community-based ‘Breastfeeding Champions’ were established in Community Learning and Development to promote and support breastfeeding, particularly in deprived areas. Similarly the Childsmile Community and Practice Programme is designed to address oral health inequalities, through embedding support workers within the more disadvantaged communities and offering oral health support to families with young children, in the family home.
• Improving outcomes through changes to the physical environment. This can be a very direct way of improving outcomes and was central to the case study on Safeguarding vulnerable road users. This road safety intervention was developed in collaboration with riders alongside academic, engineering, and government partners and led to reductions in motorcycle injury collisions at the sites where these had been installed.

Many of the types of interventions set out above led to changes in the ways in which services were delivered and organisations work together and link to wider work around public service reform.

There are other approaches available to policy makers that were not covered in the case studies. This includes interventions related to education, enforcement, screening programmes, mentoring programmes or new technologies.