Review of targets and indicators for health and social care in Scotland

What are we trying to achieve?

5. The health and social care system in Scotland is shaped by Government and Local Authorities. The Scottish Government's overarching policy priority for Scotland ^[1] has been articulated in its Purpose which is "to focus government and public services on creating a more successful country, with opportunities for all of Scotland to flourish through increasing sustainable economic growth." The twin goals of tackling inequality, in all its manifestations, and boosting competitiveness have been identified by the Government as key to the delivery of its purpose. Local government is elected to deliver local priorities and sometimes those priorities might conflict with those of central government. Since the Health Service is under the control of the Scottish Government and many other services which have a direct impact on wellbeing are under the control of Local Government, it is important that the targets and indicators are seen by both sides as supportive of progress towards a better society.

6. Achieving a flourishing population with the capacity to create sustainable, inclusive growth requires considerable engagement of the health and social care system. Improving health and reducing inequalities in health and life expectancy across socioeconomic groups in Scotland is key to achieving the purpose. Boosting competitiveness requires a healthy, educated and engaged workforce. These tasks require all of Scottish society, including government, local authorities, health boards, third sector and voluntary bodies to work together to understand how the complex systems which determine wellbeing and success across the life course can be modified to improve outcomes.

7. An important word in the purpose statement is "flourish." The dictionary definition of flourish is to "grow or develop in a healthy or vigorous way, especially as the result of a particularly congenial environment." Flourishing is also a concept in positive psychology. Corey Keyes, an American researcher defined flourishing as "the product of mentally healthy adults having high levels of emotional well-being; they are happy and satisfied; they tend to see their lives as having a purpose; they feel some degree of mastery and accept all parts of themselves; they have a sense of personal growth in the sense that they are always growing, evolving, and changing; finally, they have a sense of autonomy and an internal locus of control, they chose their fate in life instead of being victims of fate."

8. In essence, people are flourishing when they have a combination of high levels of mental health which is reflected in emotional well-being, psychological well-being, and social well-being. Achieving a flourishing population, therefore, demands not just that we improve physical health but also that all individuals and communities feel supported to grow in emotional, psychological and social wellbeing.