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