Response to the Improving Health Commission Stakeholder Survey (Public Health Reform in Scotland)

People Health Movement Scotland response to the Improving Health Commission Stakeholder Survey, part of the Public Health Reform happening in Scotland currently.

1. How do you affect health in your context?

The People’s Health Movement Scotland is a network of grassroots health activists, third sector organisations, academic institutions, campaign groups and individuals in Scotland who are members of a global movement that calls for a revitalisation of the principles of the Alma-Ata Declaration (1978) which promised Health for All by the year 2000 and revision of domestic and international policy and ongoing reforms that impact negatively on health status and health systems. We see our role as helping change the narrative around health and health inequalities being about individual responsibility and only related to health factors such as ‘unhealthy’ behaviours. We aim to provide a critical perspective on the underlying causes and consequences of population health and health inequalities that includes the perspective of people and their lived experiences. We particularly see our role as questioning why there is a consistent gap between rhetoric about health and meaningful change. To this end we run public events, produce briefing papers, share knowledge and facilitate wider networking amongst both like-minded groups and individuals and with those who have alternative views.


2. What do you think is required for all organisations to give priority to their effects on people's health?

There needs to a frank and open debate around questioning if the people of Scotland really want to prioritise prevention and the tackling of inequalities in power, prestige, wealth, and income that drive health inequalities. Significant changes will need to be made by those in powerful and empowered positions across society to help others in our country to create a fairer and more equal society, recognising that a more equal society benefits everyone. This will require systemic change in the form of less hierarchy, more inclusion, more collective intelligence, equal distribution of power and continuity of care based on mutual respect, and not just a change of values (e.g. person centred approach etc.)  Debates and such shifts take time, but while we wait people continue to live with debilitating conditions and die years earlier than they should. We need government and politicians to take the lead in promoting and implementing policy alternatives to the current narrative and ensuring all organisations in the public sector (or who provide services for the public sector) agree to policies such as the dignified wage (above the current Living Wage), pay ratios under 10:1, equal pay and the end of casualised work.


3. What do you think is required to support the ‘health in all policies' approach?  This means ensuring the impact of health is considered in all decisions; including in areas, which are not specifically about health but which affect it (like housing, education, employment, social support, family income, our communities and childhood?

In 2016, PHM Scotland put forward an alternative manifesto, including relevant suggestion:

  •  Scotland must commit to commissioning a Health Rights Commission by and for the people, which will be responsible for undertaking a health and health inequalities impact assessment for all governmental policy decisions liable to impact on health, gender and other socioeconomic inequalities and other social determinants of health.

  • Scotland must commit to action on the multiple causes of social exclusion and its effects on ill health. For example, improving joint working at national, local and service level, that includes greater public awareness of their activities and greater, active public participation.

  • Scotland must commit to supporting the democratisation of research and demonstrate how policy decisions have been informed by local testimonies and lived experiences. For example, allocate more resources and require funders/commissioners of research to consider public perspectives in funding applications.

  • Scotland must commit to the ‘precautionary principle’ being incorporated into regulation/legislation. For example (but not restricted to) in all decisions relating to chemicals in Scotland i.e. as soon as there’s any evidence that an existing chemical is a threat to public health, it should be withdrawn until research can clearly demonstrate otherwise.


4. What do you think is needed to ensure that actions to keep people healthy are prioritised over services that treat people once they are already ill?

We cannot continue to do more, spending less. Commitments to prioritise ill-health prevention and public health are not matched by funding commitments, with prevention budgets still dwarfed by treatment budgets. However, the evidence is there and we need to find better ways of communicating to the public and those in positions of influence that prevention is cost-effective, prevention will save the NHS money in the long-term and the benefits of prevention reach beyond the NHS. As suggested by the BMA we need to move away from annual/short-term budgets that are ill-suited for prevention or reducing health inequalities. We have to ensure that all public money is spent with a consideration for improving public health and reducing health inequalities as it’s not just about health budgets. Therefore, all departments/organisations that receive public money must be made to carry out and publish health and inequality impact assessments as to how their plans to spend their funding will impact on health and health inequalities showing clearly how policy and practice will be changed to address negative impacts. Good practice should be celebrated, shared and built on for this approach to become embedded in the culture.