Public Health Reform Scotland

By Professor Marion Bain, Co-Director of the Executive Delivery Group for Public Health Reform, Scottish Government.

Health and wellbeing for people in Scotland has seen quite remarkable improvements over the centuries. Much of this improvement has been due to public health action.  Public health can be defined as the science and art of promoting and protecting health through the organised efforts of society. These ‘organised efforts’ have included providing clean and safe water and sanitation, delivering safer working conditions, immunisation programmes that have led to the eradication of infectious diseases, and more recently, action on lifestyle factors such as smoking and alcohol.

While recognising those achievements, it is clear that Scotland in 2019 is experiencing challenges around our health and wellbeing. As a nation we have a relatively poor health status compared with other countries, and there are stubborn and significant health inequalities across the country. Like many countries we are facing challenges in the increasing demands for health and care services as people are living longer. Key issues such as obesity, mental health, alcohol and substance misuse remain a challenge.

Central to this is a focus on how we can achieve a ‘culture for health’ in Scotland where citizens achieve the highest attainable standard of health and are able to take responsibility for their own health and care. Our collective challenge as a society is to create the social and economic conditions which support, encourage and motivate people to do so.

We recognise one of the key levers available to achieve this lies in realising the potential of data and information. These have always underpinned public health, but we are now on the cusp of an unprecedented opportunity to drive the improvement of Scotland’s health through data science – the approach to understanding and predicting patterns in ever increasingly complex systems utilising large volumes and varieties of data.

There is more data available than ever before: on people’s health, on their circumstances, on their genetic make-up, on their habits, on their environment. Affordable computing power is rapidly increasing capacity to enable analysis of such data. Technology is more readily available to people and communities and will become more accessible in the future – including smart devices, at home diagnostics, and smart and digital therapeutics.

In the future we will be able to think beyond decisions based on traditional datasets, time consuming studies and retrospective analyses. We will be able to more rapidly analyse and make use of large amounts of data – in real time. We will have new partnerships – across the public, academic and commercial sectors – to collaborate and innovate to improve health and wellbeing.

Digital solutions will provide citizens with the tools to drive change in their communities and make more informed decisions about their health and healthcare, enabling and driving improved health outcomes.All of this allows us to imagine a future where challenges that currently elude us can be effectively addressed. The future offers the potential to develop highly effective preventative approaches that reflect the multifactorial causation of most diseases. The future will put citizens in control of managing their own conditions, and data and technology will create environments which actively create and support wellbeing in our communities.Innovation and advances in the application of data and technology are already in development and being implemented across the world. Scotland needs to be at the forefront of this development.

Changes of this scale ‘will require a ‘positive, holistic, eclectic, and collaborative effort, involving a broad range of stakeholders’ (For debate: a new wave in public health improvement  Davies, Sally C et al.  The Lancet , Volume 384 , Issue 9957 , 1889 - 1895). All that we do needs to reflect our respective contribution and embrace a whole system approach which supports individuals, communities and organisations to work effectively together to improve health and reduce health inequalities.  This is at the heart of our reform programme.

To support this whole system approach and drive collaboration, national and local government have agreed public health priorities for Scotland. These are priorities for the whole of Scotland to work together on, and reflect public challenges that are important, and that we can do something about. They reflect our ambition for a Scotland where:

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

The priorities provide a focus for our collective endeavour and the opportunity to apply a whole system approach, that realises the potential of data, evidence and technology to innovate and work with communities to deliver new solutions.

We recognise the scale of the challenge, which is why Scottish Government and the Convention of Scottish Local Authorities COSLA are establishing Public Health Scotland. The new body will have an enabling, supporting and challenging role - and provide support for delivery of change at the local level, and also leadership in areas such as public health research and developing and supporting the public health workforce across Scotland.

Public Health Scotland will come into being in early 2020 and will play a key role, in collaboration with partners, to achieve the improvements that we aspire to for Scotland’s health.

The vision and our aspiration for the public health reform work is that it delivers a Scotland where everybody thrives – individuals, communities and the public services and arrangements that support them. Public Health Scotland, the public health priorities, and a commitment to work in partnership as a whole system are the foundations of Scotland’s reform programme. To achieve the vision our approach builds on Scotland’s inherent capabilities and takes full advantage of all that data science and innovation can contribute to improve health and wellbeing.

With thanks to Professor Marion Bain and the Public Health Reform programme. 

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