Creating a healthier Scotland - What matters to you

Leading Healthier Lives

You told us you'd like to see more focus on preventing illness rather than just curing it. Education is key to healthy lifestyles, and you recognise how important it is to establish good habits early on and to encourage and promote them throughout life. Some of you commented on the need for us all to take more responsibility for our own health rather than expecting others to fix it.

You would like more support to help you and your family make the right choices, with most of your comments focusing on healthy eating and exercise. We heard that the affordability, availability and accessibility of healthy options and opportunities often made this difficult. We also heard about the impact of health inequalities, and the need to tackle the underlying causes of ill-health, many of which fall outside the traditional boundaries of health and social care.

You told us that a healthier Scotland needs public services and individuals to be more proactive in preventing ill-health rather than just dealing with the consequences. You highlighted the need for regular contact with health and social care services to allow for early intervention and diagnosis through screening, annual health checks for people with long-term conditions, and regular medication reviews. Some of you felt that there can be too much dependence on the NHS and that there needs to be more individual responsibility for maintaining good health.

"We have to stop fire-fighting and look to the longer term. It's not just about the NHS, but more general population health and prevention."
Joint Scottish Government and Health and Social Care Committee

"There's a need to change the mindset of 'the doctor will fix it' rather than being in control of one's own health."
Health and Social Care Alliance Scotland (Alliance) event, Edinburgh

It came across strongly that you see education as an important factor in living healthily, as well as helping you understand the issues affecting other people's health and wellbeing. There was a strong focus on children, young people and parents. Parents want more support to give their children the best start in life, and want to see more action to promote healthy lifestyles in the school curriculum, including a stronger role for teachers. It was also highlighted that education should be offered for people of all ages, particularly around nutrition, cooking skills and exercise.

"There is an opportunity to further develop the role of education and the teaching workforce to a new preventative and promotional model of child and adolescent health and development."
Children and Young People Health Support Group response

"For those who don't have strong family support in this aspect, school education is all they've got to teach them what is best for them."
Young Scot survey

"One person gave an example of a project which involved people who are disabled or living with long term conditions visiting local schools to talk to pupils, helping to break down the stigma and barriers which can often surround these issues."
Alliance event, Clydebank

"Healthy food should be cheaper and more accessible for lower income families."
Scottish Health Council event, Lothian

"We should raise taxes on things that contribute to bad health and use the proceeds to subsidise healthy food and access to gyms."
Healthier Scotland blog post comment

"I just eat what my key worker cooks me."
Pathways and Disability West Lothian

You told us more should be done to make healthy choices the easy choices. The affordability and availability of healthy food in particular was seen as a major barrier to people living healthy lives. There was enormous support for the need for cheaper fresh and healthy food, and some people talked about raising taxes on sugar and other foods that can be bad for us. Workplaces, prison and care settings were just some of the places you felt your opportunities to eat healthily were restricted.

There was a clear recognition of the role of physical activity in being healthy and you told us that safe, clean communities with better infrastructure would encourage more people to be physically active for example, better bus routes to facilities or cycle routes to support active travel. You also told us you would like subsidised or free access to leisure facilities such as swimming pools and gyms. Physical and environmental factors were identified as being a particular barrier for people with disabilities in getting around their local community and accessing leisure facilities. Some groups suggested that dedicated swimming or gym sessions for women
or transgender people would help reduce gender
or cultural discrimination.

"We'd like to see more access to leisure centres, and more affordable classes."
Scottish Health Council event, Glasgow

"Sports facilities are often inaccessible for wheelchair users, and changing and showering facilities are insufficient."
Healthier Scotland blog contact form

"Gyms cost way too much for people under 16 to get into."
Young Scot Survey

SOCIAL DETERMINANTS OF HEALTH

The social determinants of health are the conditions in which we are born, we grow and age, and in which we live and work. The factors below impact on our health and wellbeing.

Source: NHS Health Scotland

You recognised the role of a wider range of partners in promoting and creating the conditions for good health. You felt more could be done through a stronger partnership approach. For example, we heard about the role of local authorities and town planning to include more green space, cycle lanes and improve accessibility for people with disabilities. Workplaces could provide healthy canteens and cycle to work schemes. There could be more local community groups providing cookery classes and health education sessions. The food industry has a key role in relation to nutritional information/ labelling and reducing sugar content. The government could provide health recommendations and introduce stronger measures such as legislation. Also, the media has a role in promoting healthy role models, good news stories and advertising.

DID YOU KNOW?

• All schools in Scotland follow the Curriculum for Excellence. Health and Wellbeing is one of three cross-cutting strands, along with literacy and numeracy.
• The Early Years Collaborative (EYC) is the world's first multi-agency, bottom-up quality improvement programme to support the transformation of early years. It involves all 32 Community Planning Partnerships and a wide range of National Partners. Its focus is on strengthening and building on services using improvement methodology, enabling local practitioners to test, measure, implement and scale up new ways of working to improve outcomes for children and families.
• The current guidelines are 150 minutes of moderate to vigorous activity per week for adults and 60 minutes a day for children. A third of the adult population and nearly a quarter of children in Scotland don't meet the guidelines.
• Smoking is at its lowest rate since records began and alcohol harm has been falling over the past decade, but 65% of the adult population is currently overweight or obese.

Unhealthy behaviours like smoking, drinking alcohol, taking drugs and practising unsafe sex were mentioned less often than healthy eating and exercise. In general, people were positive about the progress that had been made in reducing smoking, but agreed that there was still more work to be done to help people give up and prevent others from starting. There was a recognition of the need to change the Scottish alcohol culture, with suggestions including increased pricing, reduced marketing and greater community involvement in licensing decisions.

"We should promote alcohol awareness from an early age, and introduce the concept that it's possible to socialise without alcohol."
Alliance event, Dundee

"To improve the health of the nation we should continue to reduce smoking and drinking. We're well on the road with smoking but we should tackle drink similarly."
Facebook comment

Health inequalities featured throughout the Conversation, and you said the underlying causes of ill-health need to be tackled. Your comments highlighted how not everyone has the same opportunities to be healthy due to factors outside their control. The close connection between the Healthier Conversation and the Fairer Conversation (www.fairer.scot) was raised with one of the responses highlighting that, "A Fairer Scotland will be a Healthier Scotland, and a Healthier Scotland will be a Fairer Scotland."
Blog post by NHS Health Scotland

"People with learning difficulties suffer worse health inequality. We need more resources and information must be in easy-to-read formats."
Fairer Scotland event, Dalkeith

"A strong message that came out from several of the groups (particularly those involving young people) was the need to address the social determinants of health and afford them an opportunity at economic security through affordable housing, meaningful employment and worthwhile education that uses and values their skills and interests."
Alliance summary report of six 'seldom heard' group events

"My name is Donna. I have cerebral palsy. I am a wheelchair user. I want the same thing as you.
I want a good life.
I want a flat.
I want a good life. I want a job.
I want a good life. I want love.
I want a good life.
I want to be ordinary. I want a good life.
There is a glass wall between me and a good life. I can see through it but I can't break it.
Everyone else is on the other side. That's where a good life is…
I want to ram my wheelchair into the glass wall and knock it down. I WANT A GOOD LIFE."

A Good Life by Donna O'Hara,
Braidburn School- Contribution to the Alliance's Creative Competition