Thriving places and communities are key to improving Scotland’s health

Scotland’s health is complex. We have an ageing population with increasingly complex health and care needs. As a nation our health is improving but it is not improving equally for everyone. Average life expectancy in Scotland remains significantly lower than in other countries of the UK and the rest of Western Europe and Unfair and unacceptable inequalities in health are still prevalent in many areas of Scotland with up to a 25 year gap in healthy life expectancy - the number of years a person might be expected to live in good health - between the most and least deprived areas.

The scale of the challenge in our communities is significant with more than four out of ten occupied dwellings across Scotland not meeting the Scottish Housing Quality Standard, mostly due to poor energy efficiency. The costs of heating our homes has increased dramatically over the last 15 years with 27% of households in Scotland living in fuel poverty. Just under a quarter of people feel that they can influence decisions affecting their local area although this is a key policy priority across national and local government, and will be vital for effective public health development.

Planning, construction, social housing and transport policy all lay outside the remit of the health service, but all materially affect our health. The extent to which long term considerations of health are taken into account and balanced against other priorities when decisions are made about the places in which we live varies. As we embark on a programme of reform, putting population health as the heart of decision making is central to our collective endeavour.

Place and community is vital to a healthy and thriving Scotland and housing has had a positive contribution in delivering great places to live. As an integral part of the whole system that protects and improves the nation’s health, housing is central to many other determinants of our health, such as education, employment, social relationships, and environmental sustainability. Our homes and where we live are among the places we spent most of our time: they are therefore significant influence on health throughout life, and across the population. However, improvements in the public’s health will only be achievable by supporting communities to develop their own approaches and solutions to local population health challenges. The focus of our reform programme is to create a culture for health in Scotland where individuals take, and are able to take, responsibility for managing their own health and sustain healthy behaviours.

We are not starting from a blank canvas, in areas such as housing there is a proven track record of working to empower our communities as active partners and working collaboratively with the public, private, third and independent sectors to prevent ill health and increase healthy life expectancy.

If we are to create a culture of health in Scotland, communities are the key to delivering our ambitions and developing local solutions to local public health challenges. This will require different ways of working across the public, private and third sector to tackle the wider social and economic issues that affect health, including the places where we live, delivering services in different ways that support communities and indiviudals manage their own health and sustain healthy behaviours.

To support this ambition, the reform programme, working with stakeholders from across Scotland has agreed public health priorities which will be published in June 2018, to provide the focus for delivering our aspirations for a whole system approach to improving the public’s health.   

Through our collective endeavour we can create great places to live, that is why place and community and the impact on related public health issues such as mental wellbeing, poverty and physical activity is a priority where through collective action we have the greatest potential to improve the public’s health.

The formation of a new national public health body with a strong evidence-based approach, to support collective action on Scotland's public health priorities, including place and community, will be the foundation on which we deliver our reform ambitions, housing is uniquely placed to deliver the transformation we aspire to.