Scottish allied health professions public health strategic framework implementation plan: 2022 to 2027

Why is Public Health Important

Even before the COVID-19 pandemic, Scotland, like the rest of the UK was facing a number of significant public health challenges due to its changing demography. This change in demographics is driven by improvements in life expectancy with people living longer and reaching older ages. Along with this, there has been a decrease in fertility, people are having fewer children or having children later in life, younger people moving away from remote and rural areas towards towns and cities.^[3] We know that this brings both opportunities and challenges for the delivery of public services and society at national and local levels.

The public health emergency presented by the COVID-19 pandemic has undoubtedly impacted population health as a whole, with the greatest impact upon those already experiencing inequality, exacerbating inequality for many.^[4] It is evident that COVID-19 has impacted individuals, groups and communities in different ways.

We recognise that there are widening gaps in healthy life expectancy for people in the most deprived areas of Scotland compared with the least deprived. There has also been a general stall in life expectancy in Scotland, with it decreasing in the most deprived areas. Public Health Scotland has identified COVID-19, enduring health inequalities, stall in life expectancy, drug-related deaths, environmental sustainability and climate change as significant challenges currently facing the people of Scotland.^[5]

Scotland's ageing population will require a focus on preventative and early intervention measures that can help enable people to continue living well independently and in the community as they get older. Local lockdowns during the pandemic has undoubtedly negatively impacted the health, mobility and independence of many people both young and old.

Pre-pandemic, children and young people living in areas of higher deprivation were already more likely to experience poorer mental health and socio-economic disadvantage which can impact them across their life course.^[6] We know that children and young people have had their access to school, social activities and employment severely impacted by the COVID-19 pandemic which has negatively impacted on their physical and mental health.^[7] The effects of this are thought to have had a more significant impact on physical and mental health in areas of higher deprivation than lower.^[8]

We are also acutely aware that there are many ways in which being a member of a minority or marginalised group can increase the likelihood of experiencing health inequalities or socio-economic disadvantage, this is even more the case when you take an intersectional view of how people are impacted. The COVID-19 pandemic has exacerbated the poorer health and wellbeing outcomes that people in these groups experience. The Scottish Government remains committed to tackling health inequalities that impact groups with protected characteristics, with the 'Race Equality: Immediate Priorities Plan' detailing how this is being coordinated and the different reports, expert groups and streams of work that are feeding in to this.^[9]

The Scottish Government is also committed to 'building back better' and has published a COVID-19 Recovery Strategy which sets out our vision for recovery and the actions we will take to address the systemic inequalities that have worsened due to the pandemic, make progress towards a wellbeing economy, and accelerate inclusive person-centred public services.^[10]

The aim of the COVID-19 Recovery Strategy is not only to drive the recovery of our NHS, but to redesign the service with an improved public health focus, through increased work on prevention, improving life expectancy and promoting physical and mental health. This will be achieved by creating a whole system approach and community approaches, putting in place services, environments and wider approaches that support people to live healthy lives.^[11]

In this context, it is clear that an explicit focus on public health approaches is essential to address these challenges that we are facing at a population level, focusing on prevention and early intervention and creating conditions for wellbeing in our communities.

Public Health Priorities for Scotland

Recognising the significant health inequalities that existed across Scotland, in June 2018, the Scottish Government and the Convention of Scottish Local Authorities (COSLA) published Scotland's Public Health Priorities.^[12] The priorities represent agreed core areas for improving Scotland's health and wellbeing, and are now the core priorities for Scotland.

The Public Health six priorities are:

• A Scotland where we stay in vibrant, healthy and safe places and communities
• A Scotland where we flourish in our early years
• A Scotland where we have good mental health and wellbeing
• A Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs
• A Scotland where we have a sustainable, inclusive economy with equality of outcomes for all
• A Scotland where we eat well, have a healthy weight and are physically active

These priorities have acted as a foundation for the whole system: for public services, third sector, community organisations and others, to work together better to improve Scotland's health, and to empower people and communities. These priorities have only become more important in light of the COVID-19 pandemic and this implementation plan seeks to enhance the role that AHPs can have in delivering on national priorities such as mental health and wellbeing, physical activity, diet and healthy weight and health literacy as examples.

Scotland's National Performance Framework

The strategic aims of this implementation plan are in alignment with Scotland's National Performance Framework (NPF) which sets out our ambitions to create a more successful country, give opportunities to all people living in Scotland, increase the wellbeing of people living in Scotland, reduce inequality and give equal importance to economic, environmental and social progress.^[13] It is made up of national outcomes that describe the vision for Scotland that the NPF is designed to help create, which are represented in the image below.

The NPF is designed to inform and guide the discussion and planning of policy and services in Scotland, and to involve the public sector, businesses, civil society and communities collaboratively to achieve these ambitions.^[14] This approach is essential in improving public health in Scotland, as reducing health inequalities and the drivers of poor health outcomes requires collaboration across a range of stakeholders.