Scotland's Population Health Framework: Equality Impact Assessment

Background

After many decades of improvement in life expectancy, progress has stalled. Austerity, the COVID-19 pandemic and more recently the cost-of-living crisis have eroded the health of our population and widened inequality.

The Population Health Framework (PHF) is one of the three core reform products set out by the First Minister in January 2025 on public service reform. Co-authored between Scottish Government and COSLA and co-developed in partnership with Public Health Scotland and Scottish Directors of Public Health, this Framework takes a refreshed cross-government and cross-sectoral approach to health.

Focused on prevention this approach aims to promote wellbeing, reducing health-harming behaviours and improving equitable access to care. Most importantly, reflecting our shared commitment to addressing the social and economic conditions that, more than anything else, shape people’s health and drive inequalities.

With the aim of the Framework being two-fold – to improve life expectancy whilst reducing the life expectancy gap between the most deprived 20% of local areas and the national average by 2035.

The Framework is based on five key primary prevention drivers of health^[1]:

• Social and Economic Factors
• Places and Communities
• Enabling Healthy Living
• Equitable Access to Health and Care
• Prevention Focused System

The Framework sets out initial actions across these drivers. It also identifies two initial evidence based priorities – embedding prevention in our systems and improving healthy weight.

Complementing upon current policies, like the 2023 Mental Health and Wellbeing Strategy and the Drugs and Alcohol National Mission the Framework shall seek to build upon this work with additional actions, as part of a coherent approach to address population health challenges. Targeting our action to areas and communities most in need to ensure equity in our approach to avoid widening inequalities further.

To date, extensive engagement has taken place to support the development of the PHF. Throughout the first part of 2024, local and national government officials, analysts, academics and public health system leaders participated in evidence sessions and policy workshops to help develop thinking for the PHF. With over 75 engagement sessions taking place in second half of 2024 with a wide set of stakeholders across the public, private and voluntary sectors.

Stakeholders overwhelming agreed with the PHF’s wider focus on primary prevention and early intervention through a whole system approach, with a call for clear definitions for each term. Respondents varied in how they thought the PHF should be taken forward and what areas should be prioritised, with some calling for a small number of key priority areas and others asking for action across a wide spectrum of topic areas. Despite these differences, many placed an emphasis on the need for the appropriate implementation of a ‘health in all policies’ approach through greater local and national leadership and for all actions taken forward to be developed through the use of evidence.