Scotland's public health priorities

Priority 1: A Scotland where we live in vibrant, healthy and safe places and communities

The places we live, work and play, the connections we have with others and the extent to which we feel able to influence the decisions that affect us – all have a significant impact on our health and wellbeing. The immediate physical environment, the social networks we belong to, the local economy, our workplace and the accessibility of services are all important.

How we design our surrounding environment provides opportunities to develop local approaches to improving people’s health that draw on all the assets and resources of a community, including how we integrate public services and how we build community resilience.

Why is place and community important?

People in Scotland live in a variety of environments from cities, medium-sized towns and villages, to large rural areas, coastal communities and islands. Wherever we live, creating well-designed and sustainable communities where we are able to access the amenities and services we need is especially important. Each place has its own assets, as well as health challenges and these vary across Scotland. The homes we live in are an important aspect of how we experience place and community, and everyone should have access to an affordable, safe and warm home. People also need to feel they are fully involved in local decision making and our communities need to be at the heart of decisions about their local environment.

How will we make a difference?

We want to change the places and environments where people live so that all places support people to be healthy and create wellbeing. Whether it is physical improvements to help us move from place to place with ease; empowering communities to make decisions that directly affect them; improving local access to green spaces; or shifting the commercial environment towards the availability of healthier options. The evidence is strong that improvements to our environment have a positive and lasting impact on the public’s health.

Creating safe places that nurture health has long been central to the public health agenda. From the early days of public health this has included access to safe water and sanitation, ensuring accessible health services and improving our environmental health through food safety and improvements to the quality of the air we breathe. We now need the other parts of the system that have a role to play in the shape of communities and places to be increasingly thinking about the health impacts of decisions and activities.

Planning, construction, social housing and transport policy all lie outside the remit of the health service, but all materially impact our health. The extent to which long term considerations of health are taken into account and balanced against other priorities when making decisions about the places in which we live varies – but there is consensus for closer collaboration between those who design and build places, those who live in them and those with an interest in improving the public’s health. For example, the Scottish Government’s 2017-18 Programme for Government includes a commitment around planning systems and the food environment in our schools, and councils are working with partners, including local communities, to tackle fuel poverty, reduce violence, prevent accidents and co-design environments that support more active travel.

Joined-up and better use of data will be essential to understanding the places we live. Partnership activity is now underway through the Health and Justice Collaboration Improvement Board and specifically between, integration authorities and emergency services to better understand demand, to identify and support vulnerable people and to drive the prevention agenda. We will seek to build further partnerships around data of this sort.

The recently published Local Outcome Improvement Plans ( LOIPs) and locality plans prioritise place and community with a strong focus on affordable housing; connected, stronger and safer places; and on maximising community participation in decision making.

The Community Empowerment Act aims to make it easier for communities to have more influence over the decisions that affect their area and the Planning (Scotland) Bill aims to strengthen these powers further and to develop a greater link between community planning and development planning – working towards communities themselves being able to devise plans for their places. The Bill also includes a commitment to work with local authorities to better support people to live an active lifestyle.

In terms of tackling loneliness and isolation, the Scottish Government is developing a vision for a more Connected Scotland, where physical spaces make it easier for communities to gather together for mutual support and self-help. While reducing isolation and loneliness is not always explicitly stated as an aim in planning arrangements, we know that community operated/programmed buildings can bring local communities together. Assets-based approaches, focusing on the strengths of a place to build locally directed improvements, are a positive way to engage with people and support the prevention agenda.

Councils across Scotland are actively working with local communities and the voluntary sector to achieve improvements in the quality of the local environment, through the use of regulatory powers, planning responsibilities, and regeneration of urban environments. Examples include strategic approaches to play provision, green spaces, sustainable transport networks and dementia friendly communities.

In 2016, just over three in ten adults in the 10 per cent most deprived areas of Scotland rated their neighbourhood as a very good place to live, compared to almost eight in ten of those living in the 10 per cent least deprived areas. ^1.1

39,000 of dwellings (2%) in Scotland fell below the tolerable standard (classed as ‘condemnatory’). ^1.2

2 7 % of households in Scotland are living in fuel poverty (649,000 households).

Nearly 7 in 10 people (68%) felt they belonged to their local area ‘a great deal’ or ‘quite a lot’. ^1.3

Improving housing is the third top priority for people in Scotland after education and economy. ^1.4

The most deprived areas of Scotland have twice the density of shops selling cigarettes and twice the density of off-licences per person as the least deprived. ^1.5

Only a third (36%) of households in the most deprived urban areas of Scotland say there is a natural environment or wooded area in their neighbourhood. ^1.6

23 per cent of adults agreed that they can influence decisions affecting their local area. Those living in more deprived communities are less likely to feel they can influence local decisions. ^1.7

Just over a third (34%) of people said they would like to be more involved in the decisions their council makes. ^1.8

Two out of ten adults in Scotland said they did not feel very or fairly safe walking alone in their local area after dark. ^1.9