New public health agency, Public Health Scotland, creates an opportunity to redefine how Scotland looks after the population’s health.
While six priority areas for action have been set, it is worth reflecting on whether we are pushing forward the frontiers on a new agenda or taking an incremental approach that builds on what has happened to date. This is a chance to be bold and brave.
A strong focus on mental health and wellbeing is essential. It is clear from our work with people with lived experience, including through the stakeholder engagement work in the Tayside Mental Health Inquiry, that people with lived experience need to be at the heart of solutions, that we need to better connect services (with the third sector able to play a key role) and place an emphasis on ‘recovery’ rather than the traditional medical models.
The House of Care model, for example, provides a framework for a more than medicine approach with people at the heart of their wellbeing.
Community Link workers can also play a vital role in person-centred holistic approaches to ensuring upstream preventive actions to keep people well in their own communities. The ALLIANCE’s 31 “linksters” already working in our most deprived communities have a pivotal role to play in the future public health agenda.
Public health recognises that the determinants of health go far beyond the GP consultation room and, in this vein, tackling addictions of all kinds must be part of Scotland’s approach to the dual challenges of stigma and mental health. The ALLIANCE recently agreed a partnership with the Gambling Commission to amplify the voices of people with lived experience of problem gambling from across Scotland.
Further afield, a look around the globe would suggest that public health is inextricably linked to other major policy areas and so context is not only important but essential. The United Nations Sustainable Development Goals place a huge emphasis on big ticket issues directly relevant to public health reform in Scotland
Anyone who has seen the formidable 16-year-old Greta Thunberg take politicians to task over climate change can be in no doubt of how young people see the linkages between health and land use, between inequalities and food consumption, between have and have nots – perhaps in a way in which traditionalists have failed to acknowledge.
Silo working will not achieve the progress that it will be necessary to make and the setting up of the new body brings opportunities to put change and innovation at the heart of achievable outcomes.
Speaking in a language which people understand, moving from negatives to asset-based approaches and engaging and enthusing our young people are all crucial to future success. Key to the actual message around public health is a communications strategy which captures the imagination.
In 2015, it was reported that livestock farming contributes three billion tonnes of CO2 while food demand is expected to rise 70 per cent in coming decades. Therefore, there needs to be a change in the way we consume food. While not linked directly to public health, this is likely to lead to healthier diets. The Netherlands, during its presidency of the EU, very visibly promoted a flexitarian approach to food and nutrition. If we are looking at getting people to change their behaviour we need to use arguments that capture people’s imagination.
Scotland has made some bold and brave decisions in the past. Banning smoking in public places, at one point unthinkable, is now an accepted norm and saving lives. Campaigns around five fruit and vegetables a day, were unheard of at the start of the Scottish Parliament but are another great example of how we learned from our European neighbours in Sweden and Finland, whose young people were well ahead of us in understanding the importance and implications of encouraging healthy eating. If we are to create a dynamism around this agenda, we will need to move beyond lecturing people on obesity to enlightening them about a diet that contributes to saving the planet.
The upcoming public health focus gives us all a chance to get involved in this important agenda. Essentially, public health is everyone’s business. Let’s not be passive recipients in this agenda – let’s look forward to innovative and creative ideas, discussions and dialogue that will allow us to be bold and brave again.
Irene Oldfather, Director of Strategy and Engagement, Health and Social Care Alliance Scotland (the ALLIANCE).