Scotland's Population Health Framework

Executive Summary

Scotland stands at a critical turning point in the health of the population. After many decades of improvement in life expectancy, progress has stalled. UK Government austerity, the COVID-19 pandemic and more recently the cost-of-living crisis have eroded the health of our population and widened inequality. Demographic trends point to continuing wider challenges. A renewed and long-term focus on prevention across all the areas that affect health is required.

This Framework is for all with a role to play in creating and maintaining good physical and mental health and wellbeing. It represents a shift in culture, from treating illness to prevention and a more whole system approach to improving health. It is the beginning of a live programme of change and improvement, with clear initial actions across the drivers of health and further actions to come over the ten-year period.

We are under no illusion of the financial pressures we currently face across the public sector and society as a whole, some of which affect the resources available to support individuals and services. We also recognise, however, that unless we make this shift to prevention, the demands on support and services will only increase.

Our aim is two-fold – to improve Scottish 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 interconnected prevention drivers of health and wellbeing:^[1]

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

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.

The priorities and actions of the Framework are the outcome of extensive engagement across Scotland. They have been co-created by national and local government, with our national and local public health experts, and reflect the evidence on key activities shown to improve population health and reduce inequality.

Initial Actions

Prevention Focused System

Preventative Investment

Develop new approaches to resource allocation that support prevention across health and other public services.

Accountability

Improve whole system accountability for primary prevention.

Health in All Policies

Develop and implement a ‘health lens approach’ to impact assessment.

Community Planning

Strengthen collective leadership and shared accountability to improve local outcomes and address inequalities through a refreshed focus on the role of Community Planning Partnerships.

Collaboration for Health Equity in Scotland

Introduce Marmot Places in Scotland, a place-based model of cross-agency working that seeks to reduce the social determinants of ill health within specific localities.

Digital Population Health

Ensure digital opportunities are maximised to improve the prevention of poor mental and physical health.

Research and Innovation

Support research and innovation that improves the prevention of ill health.

Evaluation and Learning

Develop a comprehensive evaluation and monitoring approach to measure the impact and value of the Population Health Framework.

Social and Economic Factors

Early Years and Child Development

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

Education

Develop and deliver a Public Health Approach to Learning.

Economic Activity

Publish a Health and Work Action Plan.

Income Maximisation

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

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.

Places and Communities

Community and Voluntary Sector

Build a resilient and sustainable community and voluntary sector that supports the creation of healthy communities.

Social Prescribing

Develop a National Social Prescribing Framework for Scotland.

Planning

Embed health and wellbeing considerations into the development and delivery of Local Development Plans (LDPs).

Housing

Support the contribution of better housing to health.

Climate Change and Nature

Maximise efforts to tackle the climate and nature emergencies given the close links between environmental and human health.

Enabling Healthy Living

Food Environment and Nutrition

Publish a two-year implementation plan of preventative action to improve the food environment, diet and healthy weight.

Physical Activity

Implement the evidence-based physical activity policy actions in the National Physical Activity for Health Framework.

Tobacco Free Generation

Deliver the initial two-year Tobacco and Vapes Implementation Plan, including legislation to create a tobacco free generation.

Drugs and Alcohol

Publish an Alcohol and Drugs Plan, building on progress made by the National Mission on Drugs, to reduce alcohol and drug related harms and deaths.

Preconception and Pregnancy

Reduce health harming risks during preconception and in pregnancy.

Healthy Digital Use

Develop a robust approach to reducing health harms associated with the digital environment.

Gambling Harm

Progress interventions to reduce gambling harms as the Gambling Levy comes into operation.

Equitable Health and Care

Healthcare Inequalities

Develop a Healthcare Inequalities Action Plan.

Vaccination and Immunisation

Deliver the actions of the Scottish Vaccination and Immunisation Programme (SVIP) 5 Year Framework and Delivery Plan (2025-2030).

Screening

Innovate and improve screening and early detection of disease.

Health Protection

Support better health protection in Scotland.

Sexual Health and Blood Borne Virus

Progress delivery of improvements to sexual health and wellbeing.

The Framework is supported by the following complementary publications:

• Sector Summaries - which have been developed with partners and outline the role and contributions of various parts of the system in improving population health and reducing inequalities. These summaries focus on the local and national delivery of the Framework by local government, the National Health Service (NHS), the community and voluntary sector^[2] and the business sector.
• Evidence Paper - which sets out trends in Scotland’s health and health inequalities in detail, covers the opportunities and barriers for change, and provides the structure for the range of evidence-based work needed over the next ten years. It has been used to inform our aim, approach, priorities and actions.

Given the long-term focus of the Framework, we are committed to continued engagement with partners and stakeholders to review and update the priorities and actions on a regular basis. Over the next ten years we will continue to work together across government, public, community and voluntary and business sectors to identify further actions that can be taken to support improvements to the health of the population.

Realising our vision for a Scotland where people live longer, healthier and more fulfilling lives can only be achieved through shared responsibility across all sectors. It will require the collective efforts of government at all levels alongside the support of the NHS, businesses and the community and voluntary sector and all of society.