A Scotland where everyone thrives

Paul Johnston, Chief Executive of Public Health Scotland explains why a recent journey was the inspiration for his keynote speech at Scotland’s Health: The State of the Nation event on Tuesday 17 September at Dynamic Earth in Edinburgh.

Recently, while I was in Glasgow I took the subway. It prompted me to reflect on a journey I used to make every day as a student, from Ibrox Station to Hillhead Station. Little did I know then what I do now: the journey is under three miles, yet health outcomes for those living around each station differ vastly.

In the area around Ibrox station, more than half the residents will die before they turn 70. Around one-in-six can’t work, and one-in-three receive income benefits. In Hillhead most of the residents will live to 80 or older. Fewer than one-in-20 can’t work and one-in-50 receive benefits.

Health outcomes and life expectancy are influenced by a complex range of factors. Poverty is, however, the key factor that contributes to huge amounts of ill health. Contrary to what some suggest, this is not all about the choices that we make. It is more about the conditions in which we are born, live and work. Long-term illness and health risk factors like poor diet, alcohol, drug consumption and smoking all have a poverty dimension. Together, the health risk factors alone account for 35% of early deaths in Scotland and 450,000 years of healthy life lost each year.  

Scotland is facing a health crisis. People in Scotland die younger than in any other Western European country. People spend more of their lives in ill health. The gap in life expectancy between the poorest and the wealthiest is growing. Scotland's population is expected to fall over the next 20 years, but the Scottish Burden of Disease study has projected that the total amount of ill health will rise by a fifth.

This isn’t a done deal. We can change this. We need to ensure that the places where people live and work are healthy and sustainable.

We need to improve socio-economic conditions by improving the economy with high quality jobs and fair work practices. We need to take concerted action to increase family income and reduce costs, investing in children’s early years as well as education and youth work.

We need to make it easier to get healthy food, and it needs to be as affordable as unhealthy alternatives. Advertising and promotions on unhealthy, but highly profitable foods also need to be restricted. We must go further to address the preventable harm caused by alcohol, tobacco and drugs.

When it comes to health care, we must make sure that those with poorest health have good access to services and we need to continue to focus on preventative measures such as vaccines for children and adults. This needs to be part of a ‘joined-up’ service between health and care services.

We are taking action, but we can’t do it alone. There needs to be action at a local and national level. We are partnering with the Institute of Health Equity and are in the process of identifying three local authority areas to support collaboration, remove barriers to action and share learning, drawing on the Marmot cities approach that is being applied in areas of England and Wales.

With sustained efforts, we will see results. Improving Scotland’s health will benefit the economy and reduce pressure on public services. It requires sustained focus at both national and local level, and action at both a system and a personal level. Together, we can create a Scotland where everybody thrives.

Image: Andrew Perry