Welcome to Public Health Scotland’s first strategic plan.
As Scotland’s new national organisation for public health, we are ambitious in our vision for Scotland. We were established to do things differently to tackle Scotland’s public health challenges, and this strategic plan says how we will do that. It sets out what we will focus on, how we will do it and how we will measure our impact.
While ambitious, we are confident that by working with others across the country, we can achieve great things for our communities. Together we can.
The plan builds on the engagement and the evidence gathered throughout public health reform. It is a three-year rolling plan which we will review regularly, drawing on evidence and listening to our partners. We will continue to engage as we develop the detail that underpins this plan.
Collaboration is this plan’s theme. In Public Health Scotland, we know we cannot do this alone. We need to work with and through our partners. Scotland’s response to COVID-19 has shown us what we can achieve when we work together across organisational and sectoral boundaries.
To make a positive difference to our public health challenges we will all be challenged to do different things and do things differently.
We share the Scottish Government’s ambition for Scotland to have a world-class public health system. We are proud to play our part in working to prevent illness and improve community wellbeing in Scotland. We know that together, we can create a Scotland where everybody thrives.
Jim McGoldrick, Chair
Angela Leitch, Chief Executive
This strategic plan is part of building a new approach to public health in Scotland. We have an ambitious vision:
We want to see a Scotland of flourishing communities. Communities need health and wellbeing to succeed. Community health and wellbeing is complex.
Its foundations include:
- an inclusive economy with good work
- quality housing and education
- accessible and effective health and social care services
- clean open spaces
- water and sanitation
Scotland faces considerable health and wellbeing challenges: COVID-19, our relatively poor life expectancy, health inequalities and climate change – to name just a few. If we, as a society, continue to do the same things, the same way, we will not address these challenges.
We all need to:
do things differently,
do different things
to make a difference
Public Health Scotland’s mission is to lay a solid foundation that supports long-lasting good health and wellbeing for all our communities – especially the most disadvantaged. A whole system of people, organisations and groups are responsible for different parts of the foundations of community wellbeing. This includes, but goes far beyond, the NHS. Local government is responsible for many of the foundations for community health and wellbeing. The third sector and community planning partners, like police and fire services, play a vital role too.
We can only do this by working closely with other organisations and sectors. A Scotland where everybody thrives is a Scotland where people, organisations and groups join forces to create the foundations for communities to flourish.
Scotland faces significant health and wellbeing challenges:
Thousands of people in Scotland have died as a direct result of COVID-19. The indirect impact of COVID-19 on Scotland’s health, economy and society will affect thousands more.
Life expectancy is relatively poor and has not improved since 2012.
Health inequalities are wide and have worsened over the last ten years.
Climate change’s potential to affect the foundations of community health and wellbeing - foundations like safe drinking water, sufficient food and secure shelter.
These are considerable challenges. Everybody has the right to health. Scotland needs to act to prevent illness, reduce inequality and improve health now.
Scotland has never been in a better position to work together to improve its health and wellbeing.
- The National Performance Framework (external website) describes the Scotland we want to create. It uses outcomes that reflect the values and aspirations of the people of Scotland. The framework gives Scottish public bodies a shared set of goals to collaborate towards.
- Scotland’s public health priorities (external site) define six priority areas for organisations and groups across Scotland to work on together to improve health and wellbeing. They were developed during public health reform (external website) and endorsed by national and local public and third sector bodies.
- Community-focus: Leadership can, and does, come from communities, people with specific problems or experience, or from experts or people delivering services. The Community Empowerment (Scotland) Act 2015 established community planning as the basis for public service providers to work together with local communities to shape and deliver better services.
- Data: Advances in computing and our increasingly technological lives mean
well-analysed data now has the potential to offer more intelligence and insight than ever. By linking and sharing data across public services, we can identify issues more easily and evaluate them faster.
- Public Health Scotland’s joint sponsorship by the Scottish Government and the Convention of Scottish Local Authorities (COSLA) shows a commitment from the two spheres of government in Scotland to have communities at the heart of everything Public Health Scotland does.
As a public health organisation, we:
- focus on the health and wellbeing of Scotland’s communities
- emphasise preventing disease, prolonging life and promoting health and wellbeing so people live longer, happier lives
- support and enable partners to act together.
Public Health Scotland brings together Scotland’s national resources for the three domains of public health: health protection, health improvement and healthcare public health.
A national and local organisation
As a national body, we will shape and implement national policy to prevent illness and improve health and wellbeing.
Recognising the diversity of Scotland’s communities, we will work with and support local partners to make an impact for people and communities at a local level.
We will support and enable local action by providing specialist services and capabilities that are best done once, nationally.
An outcomes-focused organisation
We contribute to many of the outcomes in the National Performance Framework (external site). Our main contribution will be to the health outcomes, and specifically the indicators on:
- improving healthy life expectancy
- reducing premature mortality
There are avoidable differences for some people in these outcomes. We will seek to reduce inequalities in these outcomes.
A data and intelligence-driven organisation
We have access to and collaborate on an enormous range of data both on Scotland’s health and wellbeing, and on health and social care services. This includes a wealth of data and intelligence vital to helping people access quality services, like our cancer services data.
We will continue to develop and improve the quality and linkages between different sets of data. We will use the full range of data – national and local, quantitative and qualitative – to offer vital intelligence to our partners. This will inform their decisions to improve the health and wellbeing of Scotland’s communities.
An evidence-informed organisation
We will provide the best evidence to help inform decisions and spending on services and policies that can affect health and wellbeing. We will generate evidence contributing to the understanding of how to prevent illness and improve health in Scotland, the UK and internationally.
A trusted organisation
As a publisher of official statistics for health in Scotland, we occupy a position of trust. We will make sure our statistics are reliable, high quality and offer public value.
The World Health Organization divides prevention into three types.
- Improve the foundations of community health and wellbeing to prevent people becoming unwell in the first place (e.g. immunisation, preventing the spread of diseases or promoting healthy behaviours)
- Identify illness early, so it can be treated faster and more effectively (e.g. screening)
- Improve treatment and recovery in health and social care services
It is impossible to eliminate ill-health. For example, only around 40% of cancer cases in Scotland have preventable causes (external website). However, we can improve healthy life expectancy by identifying illness early and by effectively treating them. Often people in communities with the poorest health are least able to access services (external website).
In Public Health Scotland we help:
- action to stop people becoming unwell
- share data and intelligence on the health needs of communities
- share data and intelligence on the performance of services so they can improve
The 'domains of public health' is a way of thinking about the different aspects of public health practice. The domains are:
- health improvement, which focuses on improving the underlying determinants of health
- health protection, which incorporates communicable disease control, environmental and other threats to health
- healthcare public health or health service quality improvement, which looks at healthcare systems and service quality, practice, effectiveness and economics.
In reality, these domains overlap and often action is required in all three domains.
In Public Health Scotland, we have a national role in each of the domains.
(Source: Griffiths, et al. (external site))
An official statistic is a statistic that is:
- produced by an organisation named in law
- referred to as an official statistic by that organisation.
Public Health Scotland is named as a producer of official statistics in law.
The UK Statistics Authority regulate official statistics.
We need to do things differently, if we are going to be successful in creating a Scotland where everybody thrives.
We will develop the ‘how’ in partnership. We will be collaborative, innovative, excellent, respectful and work with integrity. The more we embody these values, the more successful we will be as we join with others to improve community health and wellbeing.
Collaborative: working together
- establish purposeful partnerships based on shared outcomes
- pay attention to how we work with others and always seek to be a better collaborator
- work with communities and local, regional and national partners to improve health and wellbeing locally together
- build relationships based on trust
- work alongside our partners and help them take a ‘wellbeing lens’ to their work.
Innovative: creating shared solutions
- quickly seek new ways of working more flexibly and effectively, both internally and with our partners
- lead in the innovative use of data and digital solutions
- support staff to take risks
- be a learning organisation, learning from our mistakes and our successes.
Excellence: making a difference for people and communities
- be people-centred
- be outcomes-focused
- continually improve how we work
Respectfully: valuing every contribution
- value the contributions and perspectives of others – individuals, people with lived experience, professionals and organisations
- treat others with dignity, showing courtesy and kindness
- recognise diversity locally by responding sensitively to different local communities
Integrity: doing the right thing the right way
- deliver what we promise
- be informed by the evidence and data
- have a trusted voice
Public Health Scotland works in all areas of public health. Our range of work will continue. But to make a difference we must have a clear focus.
We focus on four areas: COVID-19, mental wellbeing, communities and place, and poverty and children. They represent complex, linked challenges that require the collective action of many partners, across sectors.
COVID-19: response, recovery and renewal
We deliver a full health protection service, but COVID-19 is an immediate and significant threat to Scotland’s health and wellbeing. It directly and indirectly damages Scotland’s economy, society, and health and social care services. In the short term, we need to focus our resources on meeting this challenge.
- help organisations make decisions about how to respond to COVID-19. We will provide advice and guidance, and share data and evidence on the spread of the virus, as well as its impact on our communities and services.
- enable the public and organisations to contain the spread of the virus. We will support the Test and Protect approach. We will help local and national bodies work together to respond to local outbreaks.
- work with the Scottish Government, local government, the NHS, third sector and partnerships to develop and deliver social and service recovery and renewal plans We will do this by sharing data and intelligence on service performance.
- help partners find practical and evidenced-based actions to build resilience into our services and communities.
- help Scotland prepare for and prevent future disease outbreaks
Mental wellbeing is a combination of feeling good and functioning well psychologically. Mental illness is the third biggest cause of ill-health and early death in Scotland (external site). People living in poverty are more likely to live with mental illness.
We will help local government and national policy-makers understand the levels of mental wellbeing and suicide in their communities. We will help them influence the economic, social and emotional factors that create good relationships and mental wellbeing, and eliminate discrimination and stigma.
We will work with health and social care services to help them improve access to services and outcomes for people. We will focus on making improvements for the most deprived communities.
Communities and place
Our communities and the places we live shape our health and wellbeing. Scotland is a diverse country: what works in our cities may not suit remote rural communities, just as the priorities in our towns may not be the same as those on our islands.
Communities face different challenges. Those more vulnerable to worse outcomes include deprived communities, disabled people or people from some ethnic minority communities. Discrimination because of characteristics like sexual orientation or gender identity can also cause poorer outcomes.
- provide local partners with data and intelligence to enrich understanding of the unique needs of communities
- join forces with local authorities and community planning partners to strengthen the foundations of community health and wellbeing. Together, we will work to prevent obesity, substance misuse, and reduce alcohol consumption and smoking
- work closely with the NHS and health and social care providers to improve access to services, identifying diseases early and treating them effectively to improve outcomes
- work with our local authorities, the NHS and directors of public health to find new ways of working across national and local, and sectoral and disciplinary boundaries. Specifically, we will consult with local authorities and planning partners on a proposal for local plans to improve the health and wellbeing of communities
- provide specific support to local areas to meet their needs, where we have the skills and resources to complement local services. For example, our work on drugs deaths, data analysis and in outbreak management
Poverty and children
Scotland’s most deprived communities bear a greater burden of ill health than other communities. Living in poverty is a significant determinant of your health. Reducing poverty and improving access to services for the most deprived communities will help improve all of Scotland’s public health priorities and many of Scotland’s national outcomes. Action taken to improve and protect health and wellbeing early in life pays dividends for decades.
Investing in reducing poverty and improving child health will help us meet long-term challenges like climate change and future pandemics. They release economic potential.
- work closely with NHS Boards and local government as they develop and implement local plans to create more inclusive economies and reduce poverty. We will do this by working with the Improvement Service and others to share data and evidence, and we will support collaboration to drive action.
- support local and national governments meet their shared commitment under the Child Poverty (Scotland) Act 2017. We will do this by developing and sharing data and intelligence on evidence on poverty and child health. We will work with them to find practical and evidence-based actions to address poverty and improve child health.
- work with local and national partners to understand the health and wellbeing needs of children, where there may be differences, and to identify when action or improvements are needed.
- provide national support to deliver and improve child health programmes locally, including vaccination, health visiting and screening.
- support the health and social care system to use its powers as an employer and procurer of services to reduce poverty.
- work with others to identify, develop, evaluate and share practical actions which work to reduce poverty.
We are an outcomes-focused and collaborative organisation. Scotland’s national performance framework sets the outcomes we will work towards with others for Scotland’s overall wellbeing.
Scotland’s public health priorities are the priorities Scottish Government, COSLA and others have agreed to work together towards to address Scotland’s health challenges.
As Scotland’s national public health body, we have a vital leadership role in, and contribution to, Scotland’s public health priorities.
We will work across all the public health priorities with other key agencies who have a leadership role to play in progressing elements of these nationally held priorities.
Public Health Scotland will focus on four areas we can make the greatest contribution to in the short, medium and long term.
We will be transparent about our success in achieving our vision.
In new work, we will be clear from the start what difference we want to make for people and communities. We will identify who we need to work with to achieve that. We will work with partners to decide what we will do and how we will show success.
For all we produce – from national statistics to advice and guidance, publications and evaluations – we will be explicit from the outset:
- Who will most benefit from it?
- How could it be used?
- How can it support and improve practice?
- What impact will it lead to for people and communities?
All we do will align to the national performance framework’s outcomes and indicators. They measure improvements for Scotland’s people and communities. While we contribute to them, Scotland owns them. Achieving them depends on a wide range of organisations and individuals working together.
To help show the contribution of our work, we will define with our partners shared and measurable outcomes for all our programmes of work. We will use these to evaluate the difference our work has made for people and communities. We will make sure these always link clearly to the national performance framework and the public health priorities.
Making an impact depends on organisations across Scotland working together effectively. Part of our role is to help others work together more effectively to create a Scotland where everybody thrives. These are an important measure of our success. Outcomes could include:
- increased engagement on improving health and wellbeing
- joint strategic planning and shared outcomes across partners
- a greater focus on prevention
- more aligned and collaborative action.
We will work with partners to agree what these outcomes should be.
As well as objective measures, effective partnership is based on trust and listening. We will ask our partners to tell us how we are to work with. This will give us an indication of whether we are acting in line with our values.
As stewards of public funds, we will be accountable for making sure we are making the best possible use of these funds. We will act with transparency.
The people who work in Public Health Scotland are the vital ingredient to our success. We will be an excellent employer.
To turn our ambition into reality our next step will be to work out detailed delivery plans for the different aspects of this strategic plan. In line with our values, we will work closely with others on these.
We will work to change Public Health Scotland so we are more capable of delivering this ambition.
We are confident that by continuing to work together, we can continue to achieve great things for Scotland’s communities.