Scotland's public health priorities

Priority 6: A Scotland where we eat well, have a healthy weight and are physically active

We want everyone in Scotland to eat well, have a healthy weight and enjoy being physically active. A healthy diet and regular exercise bring a wide range of benefits for both physical and mental health. They play an important role in attaining and maintaining a healthy weight and help protect us from a wide range of serious health conditions. Conversely, poor diet, an unhealthy weight and physical inactivity are all major and growing issues for Scotland and impact across all public services and communities, and with significant costs to the economy.

Why are a healthy weight and physical activity important?

Scotland faces great challenges in this area. Our diet and activity levels are influenced by multiple factors, many of which are outside our individual control. For example, our income, the food (including drink) our friends and families consume, the food available and affordable in our shops, food’s energy density, the types of outlets around us and promotional and marketing influences all play a role in our daily lives. Our physical activity levels are influenced by the transport and planning systems, access to affordable and attractive sports facilities and clubs, stigma and social expectations and many other factors.

During the development of the priorities, participants highlighted the value people place on improving diet, reducing levels of overweight and obesity and increasing levels of physical activity. For diet, particular emphasis was placed on the food environment, especially the availability and accessibility of healthy versus unhealthy food, and the role of the food industry in its widest sense in supporting transformational change. For physical activity, highlighted priorities included building the need for movement into our daily lives and making the walking or cycling route the most attractive option.

How will we make a difference?

Addressing complex challenges like diet and physical inactivity requires the whole system to work collaboratively, bringing together local and national decision-makers within healthcare, transport, planning, education and many other sectors. Success depends on clear leadership and effective partnership working at all levels to deliver meaningful and lasting change. We need to build on existing efforts and help strengthen national and local activity. A significant amount of work is under way to address these challenges, but building on this through partnership working across all sectors will be central to success in meeting this priority.

The 2017-18 Programme for Government committed the Scottish Government to progress measures to limit the marketing of products high in fat, sugar and salt which disproportionately contribute to ill health and obesity and to deliver new services to support people with, or at risk of, type-2 diabetes, to lose weight. It set out the aspiration to increase physical activity levels and tackle diet and obesity in Scotland. It includes commitments to boost investment in walking and cycling and put active travel at the heart of transport planning and to publishing a new Active Scotland Delivery Plan. The Scottish Government will shortly publish detailed plans setting out actions across many areas to support people to eat well, have a healthy weight and to be more physically active.

There are significant continuing inequalities in diet, weight and physical activity that need to be addressed. So in taking forward relevant actions, it is particularly important to consider how they would contribute to reducing inequalities. There is good and improving evidence that population approaches including making food healthier by reducing fat, salt and sugar content; marketing restrictions and taxation are effective means to improve the food environment and can help reduce inequalities in diet and weight as part of a whole system approach to acting on the causes of overweight and obesity.

Collective leadership and partnership working can also make a real difference on the ground, especially in achieving benefits through multiple, targeted interventions. Councils and their partners are working to create community environments that support healthier eating and make it easier to stay active through strategies and programmes such as the “Daily Mileˮ initiative, community gardens and numerous projects focused on food as well as the work of local government in developing cycling and walking networks and green spaces.

All of this involves taking a multi-faceted approach, involving among other things, the public and private sector working together to help transform the environment to support healthier choices.

Two thirds (65%) of adults in Scotland are overweight

Obesity ( BMI 30+) ranges from 20% in the least deprived quintile to 35% in the most deprived quintile. ^6.1

Average daily consumption of fruit and vegetables in Scotland is 3 portions against a recommendation of 5. ^6.2

Children tend to consume foods and drinks high in fat and/or sugar more often than adults ^6.3 :

• Half eat sweets or chocolates every day
• A third eat crisps every day
• A third drink sugary soft drinks every day

Dietary risk factors are the second biggest contributory factor to death and disability in Scotland after smoking. ^6.4

The cost to the economy is estimated to be up to £4.6 billion. ^6.5

Physical inactivity contributes to nearly 2,500 deaths in Scotland annually, costing the NHS around £94 million. ^6.6