Healthy Lives Fairer Futures

A call to action from the Faculty of Public Health in Scotland

Today, people in Scotland still experience many health inequalities, but we now have evidence that such inequalities are not inevitable. Although very challenging, the evidence shows ways in which we can work together in Scotland to ensure that all our people can enjoy equal access to opportunities for a healthy and happy life.

healthy lives Healthy Lives, Fairer Futures sets out some of the actions we believe should be taken to address health inequalities for best effect in Scotland. The priorities within the document are very challenging, mostly requiring concerted action across society as a whole, as well as government action.

As the Faculty of Public Health in Scotland, we want to support action in all the areas we have identified in Healthy Lives, Fairer Futures and to play our part, together with our local communities and our government, in the creation of a healthier and fairer Scotland for everyone.

Healthy Lives, Fairer Futures: our priorities:

Health in all policies

  • Include health in all policies for Scotland.

Reduce health inequalities

  • Make taxation more progressive, including income tax, to reduce inequalities.
  • Mitigate the adverse impacts of welfare reform on our most vulnerable.    
  • Introduce a minimum wage for healthy living.

Improve health for future generations

  • Reduce child poverty and mitigate its adverse impacts.   
  • Prevent Adverse Childhood Experiences. 

Create healthy places

  • Use the Community Empowerment Act to improve population mental health.
  • Increase investment in integrated public transport and active travel and prioritise walking and cycling in the built environment.
    Download Healthy Lives, Fairer Futures

Find out more

  1. ScotPHO. Briefing Notes: The Scotland and European Health for All (HfA) Database 2012. Edinburgh: ScotPHO ISD 2012.
  2. Marmot M. Fair Society, Healthy Lives: The Marmot Review. Strategic Review of Health Inequalities in England post-2010. London: The Marmot Review, 2010.
  3. Leppo K., Ollila E., Peña S., et al. Health in All Policies (HiAP): Seizing opportunities, implementing policies. Finland: Ministry of Social Affairs and Health of Finland, 2013.
  4. McQueen D., Wismar M., Lin V, et al. Intersectoral Governance for Health in All Policies. Copenhagen: World Health Organization, 2012.
  5. NHS Health Scotland. Health inequalities: What are they? How do we reduce them? Edinburgh: NHS Health
    Scotland, 2015.
  6. OECD. Economic Policy Reforms 2012: Going for Growth. Reducing income inequality while boosting economic growth: Can it be done? Paris: OECD, 2012.
  7. Craig P. Health Inequalities Action Framework. Edinburgh: NHS Health Scotland, 2013.
  8. Burton K., Higgins M., Mann L., et al. UK Welfare Reform: Final Guidance for NHS Boards in Scotland on mitigating actions. Glasgow: Scottish Public Health Network, 2013.
  9. Scottish Government. Social Security for Scotland: Benefits being devolved to the Scottish Parliament. Edinburgh: Scottish Government, 2017.
  10. Macdonald W., Beeston C., S. M. Proportionate Universalism and Health Inequalities. Edinburgh: NHS Health Scotland, 2014.
  11. Padley M, Hirsch D. A Minimum Income Standard for the UK in 2017. York: Joseph Rowntree Foundation, 2017.
  12. The Poverty Alliance. Scottish Living Wage: What is the Living Wage? Secondary Scottish Living Wage: What
    is the Living Wage? 2017.
  13. 13. H.M.Treasury. Spring Budget 2017. London: Crown Copyright, 2017.
  14. UK Parliament. Welfare Reform and Work Bill (HC Bill 51). 2015.
  15. UNICEF Office of Research. Child wellbeing in rich countries: a comparative overview. Report card 11. Florence: UNICEF Office of Research, 2013.
  16. All Party Parliamentary Group on Health in All Policies. Inquiry: Child Poverty and Health the Impact of the Welfare Reform and Work Bill 2015-16. London: APPG on Health in All Policies, 2016.
  17. Public Health Wales. Adverse Childhood Experiences and their association with chronic disease and health  service use in the Welsh adult population: The Welsh ACES Study. Cardiff: Public Health Wales NHS Trust, 2016.
  18. WHO. European report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe,  2013.
  19. Guinosso S.A, Johnson S.B, Riley AW. Multiple adverse experiences and child cognitive development. Pediatric Research 2016;79:220-26.
  20. Bellis MA HK, Ford K, Hughes K, Ashton K, Quigg Z, Butler N. Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult healthharming behaviours and mental wellbeing. BMC Psychiatry 2017;17(1):110.
  21. Wahlbeck K, Westman J, Nordentoft M, et al. Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. Br J Psychiatry 2011;199(6):453-58.
  22. Chang C., Hayes R., Perera G., et al. Life expectancy at birth for people with serious mental illness and other major disorders from a secondary mental health care case register in London. PLoS ONE 2011;6(5):e19590.
  23. Lawrence D., Hancock K., S. K. The gap in life expectancy from preventable physical illness in psychiatric  patients in Western Australia: retrospective analysis of population based registers. BMJ 2013;346:f2539.
  24. Weich S., Brugha T., King M., et al. Mental well-being and mental illness: findings from the adult psychiatric
    morbidity survey for England 2007. Br J Psychiatry 2011;199:23-28.
  25. Faculty of Public Health Mental Health Committee MHF. Better Mental Health for All. London: Mental Health Foundation, 2016.
  26. Scottish Government. Community Empowerment (Scotland) Act 2015. Edinburgh: HMSO, 2015.
  27. Sustrans. Ten simple ways to make your street a safe and green place to live Secondary Ten simple ways to make your street a safe and green place to live
  28. Watts N, Adger WN, Agnolucci P ea. Health and climate change: policy responses to protect public health. The Lancet 2015;386(10006):1861-914.

The Faculty of Public Health (FPH) has some 350 members living and working in Scotland, many of whom have supported the production of this call to action. The priorities were developed through an iterative process.

  • A decision was made to amend FPH’s manifesto, Start Well, Live Better for use in Scotland. Experts across the relevant topic areas were then identified to support the development of the document.
  • During the early stages of development, it was agreed that it would be beneficial to widen the areas addressed to cover all of the domains of public health practice. Evidence-based priorities were then drawn up in conjunction with the relevant topic experts and a draft document was prepared for consultation. The draft included 24 main policy priorities with approximately 60 recommendations for action.
  • The draft was circulated to each of the Committee of the Faculty of Public Health in Scotland (CFPHS) representatives to circulate to FPH members locally and to gather feedback using the pre-prepared consultation reporting template. Consultees were asked to provide general feedback on the document, in addition to identifying any additional priority areas or areas which they felt should be removed.
  • The consultation feedback was then analysed and used to support the advocacy sub-group to refine the priorities as part of a long-listing process. 
  • An online survey was then conducted to prioritise the top 20 candidate priorities.
  • Finally, the advocacy sub-group amalgamated similar priority areas before scoring them against six criteria to determine inclusion in the final manifesto. The criteria the priorities were scored against were effectiveness, ability to reduce inequalities, number of individuals affected, cost of implementation, advocacy gap and net positive impact.
  • The highest scoring priorities were then included in the final manifesto.

We are delighted to be working in partnership with many other organisations including the People’s Health Movement and Oxfam Scotland. You can see a copy of the People’s Health Movement's manifesto here and Oxfam's report on poverty and inequality in Scotland, Building a More Equal Scotland: Designing Scotland’s Poverty and Inequality Commission here.

In December 2018 we held a workshop on Health in All Policies: Making it a reality for Scotland. The report of the workshop includes our conclusions about how best to support Health in All Policies in Scotland, and actions for the Advocacy group.