Scottish Government Prevention Unit: Areas of Shared Interest

Area of Shared Interest 6 – Preventable Outcomes and Demand

Introduction

This area of shared interest focuses on understanding the factors that drive negative outcomes for individuals, families and communities, alongside the factors that generate demand for public services.

A preventative approach requires a deeper understanding of how and why negative outcomes arise, how risks accumulate over time, why people’s needs are not met at the earliest opportunity, and which interventions are most effective in reducing the likelihood of poor outcomes occurring in the first place.

This area provides a cross-cutting perspective on prevention, bringing together insights from across the wider Areas of Shared Interest, including community-led prevention, person-centred support, action early in the life course, partnership working across the public, private and third sectors, and approaches to investing in prevention.

Why we are interested in the topic

In supporting preventative approaches across Scotland, the Prevention Unit's overarching aim is to improve outcomes for people and communities, build resilience, and reduce avoidable demand on public services. This ambition to address outcomes and demand sits at the heart of Scotland's Public Service Reform Strategy, which includes a Workstream on Mitigating Drivers of Demand.

Achieving better outcomes through prevention has become increasingly important as public services seek to respond to rising demand within a constrained fiscal environment. Public services across Scotland face growing and increasingly complex demand. Population ageing, health inequalities, poverty, economic insecurity, mental health challenges, substance use, housing pressures and changing demographic patterns all contribute to rising pressures across service systems.

Many people experience multiple and interconnected challenges. Poor health, for example, may be linked to housing insecurity, unemployment, social isolation, loneliness or financial hardship. Negative outcomes and demand for public services are therefore often shaped by a combination of factors rather than a single issue or event. Understanding these interactions is essential if preventative action is to address underlying causes rather than respond only to immediate symptoms.

Demand can also be created or intensified by the way services and systems operate. People may encounter barriers to accessing support, be passed between services, or receive responses that fail to address the root causes of their needs. These missed opportunities can contribute to "failure demand", where unresolved issues lead to repeat contact with services, escalating need and poorer outcomes over time.

Developing a stronger understanding of the drivers of outcomes and demand can support more effective policy design, inform the targeting of preventative interventions, and help identify where resources can achieve the greatest long-term impact. This includes understanding not only the factors that contribute to demand, but also how demand varies across places, population groups and service systems, and how different forms of disadvantage interact to shape outcomes.

Existing Work in This Area

There is a substantial body of evidence examining the drivers of demand and outcomes, and the factors associated with poor outcomes across a range of public services.

In Scotland, the Christie Commission 2011 highlighted the importance of shifting focus from responding to demand towards addressing the underlying causes of disadvantage and vulnerability. The report argued that preventative action offers opportunities to improve outcomes while reducing future demand on public services. Since then, there have been a wide range of reports published on what drives outcomes and demand across the system. Some examples include

• Marmot Review (2010) – The “Fair Society, Healthy Lives” report is regularly cited as a key resource on understanding health inequalities and the social determinants of health. It demonstrated how outcomes and future demand for public services are shaped by social, economic and environmental factors across the life course, including education, employment, housing and income.
• Scottish Health Equity Research Unit (SHERU) – In their 2025 report on the Inequality Landscape, SHERU analyse socio-economic and health inequalities in Scotland, including evidence on drug-related deaths, alcohol harms, suicide and other preventable causes of poor outcomes. The reports highlight how failures in prevention contribute to increasing demand for services.
• Prevention Review Group – Their 2021 report Preventing Homelessness in Scotland, included detailed analysis and recommendations on homelessness prevention.
• Violence Reduction Unit – The VRU publishes a number of resources around the theme of preventing offending. For example see research on Approaches to Preventing Youth Offending
• The Scottish Government Tackling Child Poverty Priority Families Overview is on example of a growing base of insights around child poverty in Scotland. It outlines that child poverty is concentrated among six priority family types, including lone-parent, larger, minority ethnic and disabled households. The report emphasises the importance of addressing the structural inequalities and intersecting challenges that place these families at greater risk of poverty.

Areas for Future Exploration

Despite a strong evidence base, important questions remain about how demand arises, how it changes over time, and how it can be reduced through preventative action.

There is scope to improve understanding of the complex set of socio-economic determinants that drive a particular outcome or demand for public services. For example, using demand driver mapping or systems thinking to consider how underlying economic, housing, health conditions lead to demand for homelessness services for example. Research could explore how different risk factors interact, how needs develop across the life course, and which points offer the greatest opportunities for intervention.

There is a need for stronger evidence on the system-wide costs associated with the drivers of preventable outcomes and demand, including the impacts on public services, individuals and communities, and how these costs may evolve over time. Better understanding the scale and distribution of these impacts can help demonstrate the potential benefits of preventative action. For example, there is a growing evidence base on the current and future costs of obesity across multiple public services and wider society, which has helped inform thinking on where preventative interventions could have the greatest impact. There is also increasing interest in how emerging trends, such as artificial intelligence, climate change, demographic change and technological developments, may influence the drivers of demand and alter the scale and nature of future pressures on public services.

Alongside understanding the costs associated with the drivers of demand, there is a need to strengthen the evidence base on the effectiveness and value of preventative interventions designed to address them. While evidence exists in some areas, significant gaps remain in understanding which interventions are most effective, for whom, and in what contexts. Further appraisal and evaluation would support better decisions on where preventative action can achieve the greatest impact.

Finally, there is a need to strengthen understanding of how evidence on outcomes and demand can be translated into policy, culture and operational decision-making. This includes identifying how governments, public services and their partners can use data, analysis and evaluation to inform decisions about preventative investment, resource allocation, service design and targeting. Improving the link between evidence and decision-making is essential to ensuring that preventative approaches are embedded more systematically across policy and service delivery.

Shared research and policy questions

To support the development of thinking in the area of Preventable Outcomes and Demand, we have established a set of shared research and policy questions set out in Figure 7.

Connecting on this area of shared interest

The key Scottish Government leads for this area of interest are the Scottish Government Prevention Unit, in conjunction with a range of specific portfolio interests in areas like health, justice, child poverty, homelessness, environment, amongst others.

The Prevention Unit is leading the Public Service Reform Strategy workstream focused on understanding and mitigating the drivers of demand and poor outcomes. This work aims to develop an overarching framework and narrative for understanding demand across Scotland's public services, including the role of wider social, economic and environmental determinants in shaping outcomes and generating demand.

As part of this programme, the Unit intends to develop a series of case studies on key outcome and demand drivers from 2027 onwards. These will provide an evidence base for the development of costed, preventative approaches to addressing these drivers and improving outcomes over the longer term.

Given the breadth and complexity of the factors that influence outcomes and demand, there is significant scope for collaboration across Scotland. Research, analysis and practical learning from across the public, private, third and community sectors can all help strengthen understanding of key demand drivers and inform effective action to address them.

Any research or policy thinking relevant to a particular outcome or driver of demand will be used by the Prevention Unit to support policy proposals to tackle these drivers, with specific policy leads being connected in to understand the relevance for their local policy area.

Contact

To discuss this area of shared interest or share relevant evidence, research or learning, please contact the Prevention Unit at PreventionUnit@gov.scot.