Scotland's Population Health Framework

Our Approach

Right to Health

The right to enjoy the highest attainable standard of physical and mental health alongside the protection of health and the right to social and medical assistance are fundamental human rights.^[9],10 Everyone should enjoy the benefits of good health, regardless of their background, socioeconomic status, circumstances or where they live.

In Scotland, the persistence of health inequalities means that the right to health is not experienced equally by everyone. It is in everyone’s interests to improve population health and address longstanding health inequalities to ensure everyone’s right to health is protected, respected and fulfilled.

This matters because inequality affects the whole population. As the accompanying Evidence Paper sets out, health inequality not only worsens our individual and collective wellbeing – it hinders economic growth, increases pressure on public services, threatening fiscal sustainability, and pushes people into poverty.

Central to the Framework’s approach is improving the health of the whole population, with a particular focus on enabling all children regardless of background the right to enjoy good health. Children and young people in Scotland continue to face significant and persistent health inequalities which are driven by wider inequalities closely linked to socioeconomic status, environmental and wider structural factors.

One of the most stark indicators of inequality is child poverty, with children experiencing poverty at a higher rate than both working-age adults and pensioners. These disparities early in life can have lasting effects on physical and mental health, as well as educational attainment and wider opportunities throughout life.

Building Blocks of Health

The evidence is clear that our health is closely linked to the circumstances and environments in which we are born, grow up, live, work and age. These are known as the wider determinants or ‘building blocks’ of health.

The building blocks include a focus on the earliest years of life (including preconception and during pregnancy), good education, fair work and income, healthy places, social networks and appropriate public services. Research shows that these social, economic and environmental factors are the primary drivers of health and together have a greater effect on health than individual behaviours and health services.

Inequalities in the quality and access to the building blocks of health lead certain groups of the population to experience health differently, with people living in the most deprived areas more likely to experience poorer physical and mental health.

Driving these inequalities is the unequal distribution of income, power and wealth between groups in society - the ‘fundamental causes’ of health inequalities.

The Framework is a deliberate shift to prioritise upstream actions to support the building blocks of health, especially for those who are most likely to experience ill health.

Life Course Approach

Actions that improve the building blocks of health will create health, not just prevent disease. Activities which strengthen the building blocks of health make a difference across the life course, from pre-birth to adolescence to working-age and older age.

A focus on early years is crucial to the future health and wellbeing of our population and the evidence suggests more can be done to improve outcomes in the pre-birth to age three period. The evidence also highlights the importance of appropriate action during critical life stages, settings and transition periods.

Adopting a life course approach is about addressing the protective and risk factors relevant to health and wellbeing at each stage of life. Such an approach recognises the importance of focusing and tailoring different health and wellbeing efforts to improve population health and reduce inequalities at all ages.

Prevention

Prevention and early intervention activities seek to create health and wellbeing by improving years lived in good health and enhancing quality of life.

A key lesson from the pandemic is that our resilience to future health threats is dependent on reducing health inequalities and creating environments where it is easier to live healthier lives.

While public health recognises three types of prevention, in particular, the Framework is focused on ‘primary prevention’ – action that is designed to stop problems from emerging in the first instance. The evidence on forecast burden of disease, rising service demand and financial sustainability is clear that better prevention of poor health and the creation of good health is required.

Public Health Approach to Prevention

Prevention in public health is about keeping people healthy and avoiding the risk of poor health and early death. When people and organisations talk about prevention, they often use the same language to talk about different things. This is a barrier to investing in the full range of prevention needed to improve the health and wellbeing of the people of Scotland.

Public Health Scotland has set out a ‘public health approach to prevention’ to provide a common language for partners within health and social care and the wider system to use.

Public health recognises three types of prevention as central to addressing poor outcomes:

Primary prevention is action that tries to stop problems happening. This can be either through actions at a population level that reduce risks or those that address the cause of the problem.

Secondary prevention is action which focuses on early detection of a problem to support early intervention and treatment or reduce the level of harm.

Tertiary prevention is action that attempts to minimise the harm of a problem through careful management.

Prevention is one of the most cost-effective interventions the NHS and wider system can make in relation to improving population health and reducing inequalities. Maintaining a focus on primary, secondary and tertiary prevention is critical in delivering long-term sustainability.

Primary prevention is 3-4 times more cost-effective than investing in treatment. The return on investment (ROI) for £1 invested was £34 for health protection (for example vaccines and immunisation) and £46 for legislative interventions (for example the ban on smoking in public places).

Source: Public health approach to prevention - Public Health Scotland