Health inequalities, health improvement and public service reform

Gerry McLaughlin CEO - NHS Health Scotland

November 2011

Challenges facing Scotland

Economic outlook

Demography

Scotland's public health

Male life expectancy for Scotland and 16 other Western European countries

Trends in male life expectancy: Scotland

Public service reform and health inequalities

Christie resonates with NHSHS’s concerns Risk factor targeting and individual behaviour

change has not reduced health inequalities. Need to address broader determinants

Linear logic has its limits. These are complex issues requiring multifaceted solutions

Engaging local people and communities is at the heart of the new approach – public services are not good at this

A new approach and an opportunity to do things

differently?

Deficits approach Assets approach

Where we are now – deficit approaches

Start with deficiencies and needs in the community, often as defined by external data about the community.

Respond to problems Provide services to users Emphasizes the role of agencies Focus on individuals See people as clients and

consumers receiving services Treat people as passive and

done-to Fix people

Start with the assets in the community Identify opportunities and strengths Invest in people as citizens Emphasize the role of civil society Focus on communities and the

common good See people as citizens and co-

producers with something to offer Help people take control of their lives Support people to develop their

potential See people as the answer

Where an asset way of thinking takes us

Good work on the ground – e.g.

Tayside’s Health Inequalities Strategy: Communities in Control

Edinburgh's Joint Plan for Older People

The Lunch Club: Perth & Kinross Health Communities Collaborative

“Services don’t produce outcomes, people do”Cummins & Miller 2007

Strong policy context

‘Strong, resilient and supportive communities where

people take responsibility for their own actions and

how they effect others’ National Performance Framework

‘Public services are built around people and

communities, their capacities, their needs,

aspirations, capacities and skills, and work to build

up their autonomy and resilience’Commission on the future Delivery of Public Services

Scotland has much to celebrate

Evidence base is growing Clear strategy and policy Good work on the ground

BUT……. While life expectancy has improved, healthy life

expectancy has not Inequalities within have grown

Still challenges ahead…

Scaling up – moving from projects to mainstream approach

Embedding within public sector

Demonstrating impact

Our role in the change

Developing workforce capacity

Supporting and facilitating local and national partnerships

Evaluating, evidence and learning