Scotland's Population Health Framework: Fairer Scotland Duty

Stage 3 – assessment and improvement

By adopting a preventative approach, the Population Health Framework has significant potential to reduce health inequalities, especially those driven by socioeconomic disadvantage. By addressing the root causes of poor health such as low income, employment, education and social isolation, the Framework aims to create the conditions that enable all individuals and communities to thrive.

Initial actions in the Framework have been designed to intervene early in the life course and across public services, shifting the focus towards long-term investment in physical and mental health and wellbeing. This upstream approach can break cycles of disadvantage by tackling the structural barriers that disproportionately affect people living in poverty or marginalised communities. As other actions under the Framework are developed, the potential for reducing socio-economic inequalities will be central to the aim of the PHF of reducing inequalities in outcomes.

Importantly, the preventative nature of the PHF ensures that resources and support are delivered before poor outcomes develop or worsen thereby reducing the long-term burden on individuals and public services. To ensure that this is targeted effectively to help those most in greatest need, we have developed an overarching aim to:

Improving Scottish life expectancy whilst reducing the life expectancy gap between the most deprived 20% of local areas and the national average by 2035.

This aim was developed following a programme of work undertaken by Health and Social Care Analysis (HSCA) and academic and public health experts which included examining existing evidence on the adoption and use of aims and targets, wider stakeholder engagement to discuss the considerations involved in setting an aim, and bespoke analysis and modelling by PHS.

Life expectancy was chosen as an appropriate measure due to its objectivity, long standing trend and because there are available projections of what we might expect to happen in the future. However, this measure does not track wellbeing or quality of life and improving these are crucial to the success of the PHF. Therefore, healthy life expectancy will also be tracked through including this measure on the Population Health Dashboard.

To make progress on primary prevention across all five drivers of the PHF and make initial steps towards achieving this aim, an initial set of actions have been identified for the first two years of its ten-year lifespan to be taken forward between 2025-2027. The initial actions to be taken forward between 2025-2027 are a product of extensive engagement carried out throughout 2024 which included feedback from a range of stakeholders across local and national government, NHS, analysts, academia and public health system leaders, as well as national and local health groups.

As part of this engagement, the community and voluntary sector played a central role with input from Community Planning Partnerships and key third sector organisations. This included a session with The Health and Social Care Alliance, bringing insights from members and individuals with lived experience as well as hosting a third sector roundtable.

This engagement process revealed an overwhelming agreement with the PHF’s wider focus on primary prevention and early intervention through a whole system approach, though some have called for clear definitions for each term. Respondents noted the importance of tackling health inequalities and improving life expectancy and healthy life expectancy as clear ambitions for the PHF going forward in light of the current challenges facing the health of the population.

This aim also recognises the importance of addressing the stark inequalities that persist across different communities. By tackling the socioeconomic determinants of health, such as income, education, housing and access to services, the Framework aims to reduce inequalities in life expectancy. This will require targeting action to groups most in need who may face multiple or compounding disadvantages.

While the PHF presents a significant opportunity to improve overall health and reduce inequalities, risks must be acknowledged and actively managed to ensure successful implementation. If actions within the Framework are implemented in a universal but not sufficiently tailored way, they may disproportionately benefit individuals and communities who already experience fewer barriers to good health. ^[24]This risk highlights the importance of proportionate universalism – where all benefit but those in greater need receive more intensive support.

To mitigate this, the Framework will embed equity considerations as part of delivery of each action by directing action towards areas with the greatest need and applying targeted interventions where necessary. To effectively deliver the aim of the PHF, a robust governance and accountability structure will be required to provide transparent monitoring of the delivery of actions and to drive future collaboration and responsive decision making to emerging needs and challenges. This governance system led by both national and local government shall include key stakeholders to ensure that the voice of those with lived experience of poverty will be appropriately understood.

Given the high-level and strategic nature of the PHF, it is not yet possible to assess the full impact of each individual action on socioeconomic inequalities. However, we are committed to ensuring that equity remains central throughout implementation. As the Framework is taken forward further, appropriate impact assessments will be conducted at specific action level as required. These assessments will help ensure that individual actions are appropriately designed and targeted to reach those who are most in need.