Scotland's Population Health Framework

Social and Economic Factors

Improve the social and economic factors that support better health and reduce inequalities.

Economic and social factors are vital to people’s health. This driver is about creating nurturing environments from birth, building and maintaining healthy relationships with others and achieving good educational outcomes that lead to increased productivity in adulthood. It is about ensuring work contributes to good health and people have enough money to meet their needs throughout their lives. These form the foundations which enable people to live longer, healthier and more fulfilling lives.

Poverty is one of the most significant and persistent determinants of poor health. People living in the most deprived communities face significantly worse physical and mental health outcomes - higher rates of illness and shorter life expectancy - compared to those in more affluent areas. Poverty limits people’s ability to access essential resources such as nutritious food, safe spaces for physical activity, stable housing and opportunities to fully participate in society. Poverty can impact children’s development, leading to lower birth weight and concerns related to speech, language and communication that can have lasting effects on education and wellbeing.

Addressing poverty, in particular child poverty, is crucial to enabling healthier lives and breaking the cycle of ill health that perpetuates inequalities. The Framework seeks to complement and build upon ongoing and planned action described in the Best Start, Bright Futures: tackling child poverty delivery plan. It acknowledges the need to address structural barriers that limit access to services and support by targeting action to those most in need. This includes action by the NHS in Scotland to reduce child poverty through the NHS Anchors programme, with recruitment, employability, progression schemes and wider work with partners focusing on the six child poverty family priority groups.

Building Upon Existing Action

Actions within this driver build upon existing action already being progressed under the following, non-exhaustive, list of policies and strategies:

• Mental Health and Wellbeing Strategy
• Best Start Bright Futures: Tackling Child Poverty Delivery Plan
• Early Child Development Programme
• Early Learning and Childcare Provision
• Getting it Right for Every Child
• Keeping the Promise
• The National Islands Plan
• National Strategy for Economic Transformation
• No One Left Behind: Employability Strategic Plan
• National Carers Strategy
• National Youth Work Strategy

A healthy working-age population contributes to economic prosperity by providing a vibrant workforce that is more engaged and productive. Conversely, unemployment and insecure work have negative effects on mental health, and poor working environments are associated with a greater risk of developing depression, anxiety and work-related stress. The business sector is an important partner for creating health with a key role in creating good employment.

Conditions for Change

We envision a society where everybody can thrive from early in life and where we have a sustainable, inclusive economy which benefits everyone. We need to ensure that individuals at all ages – from conception into adolescence and from working-age into their older years – are supported to achieve their full potential.

Building upon current action to tackle child poverty and prevent and mitigate adverse childhood experiences, we will continue to strive to give babies, children and young people the best start in life, when the foundations for lifelong health and wellbeing are laid. We will continue to benefit from the crucial role that our Children’s Services Planning Partnerships play in improving the wellbeing of children and young people in local areas across Scotland. We will invest in midwifery care, our health visiting service and targeted support for young parents through family nurse partnerships to improve early years and child development. This also includes ensuring children and young people are able to achieve their full potential whilst in education by taking a holistic public health approach to learning.

We will embed a community wealth building approach to economic development and do more to harness the full potential of public sector anchor institutions. To further address inequalities, we will ensure greater local wealth retention by growing our economy in a manner that is inclusive for all. This will include the adoption and promotion of inclusive and democratic business models such as social enterprises, co-operatives and employee-owned businesses. We will also work to ensure procurement practices and disposal of public assets achieve the greatest level of value, with benefits extending to communities.

We must support our working-age population and our non-working adult population, including carers in and out of employment, volunteers and older people. We must ensure the system can enable all individuals to participate in the economy and wider society by tackling social isolation and helping them access the support they require. To grow economic activity, we will improve the support employees receive to remain in work when facing poor health or with caring responsibilities, as well as continue to help employers support mentally healthy workplaces.

Whilst the Scottish Government continues to allocate over £3 billion a year to a range of actions which help to tackle poverty and mitigate the continued effects of the cost-of-living crisis, we need to go further. We will ensure that those who need income assistance through welfare services can access income maximisation support easily within healthcare settings to allow them to appropriately participate in society.

In the medium to long-term our aim is to:

• improve early childhood health and development
• boost equity in educational attainment
• improve workforce participation
• strengthen financial security
• increase local economic resilience
• obtain a greater standard of living across the population

Building for Our Future

Over the next two years we will progress the following actions with our partners:

Early Years and Child Development

Take action to reduce the proportion of children with developmental concerns at 27-30 months, including reducing inequalities.

This will include:

• improving continuity of midwifery care to ensure pregnant women and new parents get access to the health and care support and help they need
• meeting our breastfeeding stretch aim to reduce drop off at 6-8 weeks, with babies in Scotland being breastfed for longer and inequalities reducing
• supporting young parents’ needs through the Family Nurse Partnership
• improving take-up of Child Health Reviews by delivering the first tranche of actions within the Health Visitor Action Plan, including developing a Health Visitor learning site
• publishing an action plan to support children’s early speech and language development, recognising the critical importance of children’s early speech and language development for their health, wellbeing and life outcomes

Education

Develop and deliver a Public Health Approach to Learning.

This will include:

• collaborating with Education Scotland, Public Health Scotland and Police Scotland to enable stronger whole system, collaborative working focused on improving health and wellbeing, education and justice outcomes among our school-aged population

Economic Activity

Publish a Health and Work Action Plan.

This will include:

• reviewing the evidence for embedding health and disability work advisor models in local healthcare settings
• improving support for people with ill health in work, and those with ill health who wish to return to work, especially those with mental health and musculoskeletal conditions
• assessing (in partnership with UK Government) how the fit note journey can be improved to provide the right support at the right time – including links with occupational health services
• supporting existing occupational health services to maximise capacity and impact
• supporting health boards and partners to maximise impact of health-delivered services related to employment and employment support
• supporting employers to create and promote mentally healthy workplaces, ensuring more people are supported to stay in work, building on the actions in the Mental Health and Wellbeing Delivery Plan (2023-2025)

Income Maximisation

Improve opportunities to ensure that all individuals who require income assistance can access support.

This will include:

• enabling access to income maximisation for families and those most economically vulnerable
• achieving consistent delivery pathways, including in universal services provided through health visiting and family nurse partnerships
• strengthening the NHS’s contribution to maximising the incomes of service users, with a focus on families at greatest risk of poverty, following the PHS review of existing pathways and services

Community Wealth Building

Advance community wealth building in Scotland to address economic and wealth inequality by supporting the generation, circulation and retention of more wealth in local economies.

This will include:

• retaining community wealth to benefit the health of the whole population across the life course – from early years to older people
• taking forward the Community Wealth Building (Scotland) Bill
• supporting the local authority-led Community Wealth Building Practitioners’ Network to aid consistency and practice-sharing
• analysing NHS procurement spend data to estimate its current local economic impact and identify opportunities to increase its impact