Our contribution to public health 2003 to 2020

Public Health Scotland (PHS), a new national public health agency, will come into being on 1 April 2020. This means that national leadership for health improvement will pass from NHS Health Scotland to Public Health Scotland.

We welcome the creation of PHS and believe that national leadership for public health can be strengthened by bringing all of the public domains together in one single agency.

By April 2020 we will have been Scotland’s health improvement agency for 17 years. Over this time we have learnt a lot about how to make a difference to the public’s health.

Our strategic development

Reducing health inequalities in Scotland was part of our role from the very outset. However our approach to reducing health inequalities today is very different to when we formed in 2003.

We now know that to reduce health inequalities and improve health we need to address

• the fundamental causes of health inequalities – the unequal distribution of money, wealth and power
• the environments in which people live and work
• needs of people experiencing the negative impacts of inequality.

To make a real difference to the public’s health we have learnt the importance of supporting stakeholders to put evidence into action. We know that this requires credible people with relationship, negotiation and effective influence skills working alongside the people developing the evidence.

Developing an outcomes-focussed approach to planning and how we work with partners has also been key to our strategic development. This has proved to be crucial when delivering the broad and wide-ranging policies and initiatives most likely to reduce health inequalities.

Our contribution to alcohol policy

We have made a significant contribution to alcohol policy and practice over the years. This has included

• monitoring and evaluating Scotland’s alcohol strategy
• providing national support to the Alcohol Brief Intervention programme
• improving knowledge and awareness of low risk drinking guidelines
• assessing the impact of Minimum Unit Pricing.

Through this work we learnt that it is important that the recommendations from a public health body are firmly based on the best available evidence especially when an issue has become politicised. It is also very important in this kind of work to have clarity of long-term purpose.

We also learnt that building and maintaining effective relationships with stakeholders is key to making an effective contribution to public health policy and practice. This includes relationships with government, third sector organisations and local delivery partners.

To do this needs staff with a strong understanding of the evidence, relationship management skills and honest brokerage expertise.

Our contribution to place and health

Place has an important role to play in our health and wellbeing and in tackling health inequalities. This over-arching agenda is now well-recognised and is prominent within our own work and within Scotland’s Public Health Priorities.

Over the years we have learnt that initiatives designed to engage communities in public health issues, such as the Place Standard Tool, must be well-resourced to encourage uptake within poorer communities. Without this, there is a risk of inequalities increasing because of more affluent communities being better equipped to engage.

Our work on place has shown that public health work needs to be collaborative and the role of national agencies in facilitating national and local collaboration.

We have learnt that this requires

• skilled staff
• the investment of time to build and maintain relationships
• understanding different stakeholders needs.

Our contribution to early years policy and practice

We have worked on the early years since our inception in 2003, though our focus has changed over the years.

Initially we mostly worked to provide information resources for healthcare practitioners to use with parents. This changed after the publication of A Fairer Healthier Scotland in 2012, when we shifted our focus to the impact of the social determinants of health on early years.

This includes work on Adverse Childhood Experiences and child poverty. In both cases our key contribution is the provision of public health leadership. This involves emphasising the need to

• take collective responsibility for health
• focus on population health outcomes
• tackle the social determinants of health
• reduce inequalities in income, wealth and power.

We have learnt that we are at our most effective when we work collaboratively both internally and externally. By planning and delivering programmes of work together, we can make the most of expertise across the organisation around

• data and evidence
• getting knowledge into action
• stakeholder engagement
• relationship management
• network facilitation
• communications, events and marketing.

We have brought this learning together in the report ‘Building our Future: NHS Health Scotland’s contribution to public health’.

The report provides a description of our strategic development since our inception, followed by an exploration of our contribution to public health in the areas of alcohol, place and early years.

Contact the Policy and Outcomes Team to find out more about this work.