Prevention watch

Prevention Watch is a regular Scottish Health Equity Research Unit (SHERU) round-up that looks at prevention as a means of public service delivery to reduce health inequalities in Scotland.

By prevention, we are referring to public policy interventions that prevent poor outcomes in the future, as opposed to policy which intervenes to mitigate harms once they have already occurred or subsequently deals with the consequences.

The 2011 report on the future delivery of public services by the commission chaired by Dr Campbell Christie advocated for a substantial shift from dealing with the consequences of social problems to preventing them from arising in the first place. The report was widely welcomed and ‘prevention’ has become part of the parlance of policy makers in Scotland. However, there is a frustration that more progress towards realising prioritising prevention has not been made.

At SHERU our focus is on the socioeconomic determinants of health inequalities. In other words we’re concerned with preventing poor health outcomes by tackling causes that sit outwith the traditional realm of health policy the healthcare system. To take one example, damp and mould in a home can cause respiratory disorders. Rather than the NHS treating the illness, a preventative approach would fix the damp and mould. Public health practitioners refer to this as ‘Primary Prevention’.

Prevention Watch was created to shine a light on interesting prevention related developments. This might be new policy evaluations, blogs, or policy announcements… or whatever catches our eye. This page provides an archive of posts and you can also find links to the briefings at the bottom of the page.

Post archive

The Chief Executive of Public Health Scotland on the poverty dimension of health outcomes

September 2024

The Chief Executive of Public Health Scotland, Paul Johnston, has been speaking about the criticality of tackling poverty as a way of preventing health inequalities in the future. Whilst he noted elements of Scottish policy in relation to public health interventions have been bold, he highlighted that Scotland continues to grapple with the social and economic issues that are major contributors to ill health.

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Comments from the Auditor General on the importance of leadership in prevention

August 2024

Stephen Boyle, Scotland’s Auditor General, released a blog in August to mark 4 years in the job and talked about how the Scottish Government needs take on a greater leadership role to ensure urgently needed reforms lead to a shift to a more preventative approach.

 

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The resource implications of prevention in relation to homelessness and suicide legislation

Summer 2024

The Housing (Scotland) Bill and the ‘Creating Hope Together’ suicide prevention strategy have both come up against the ‘double funding’ predicament (as noted in the Christie commission report) where money needs to be spent simultaneously on both prevention and dealing with the existing caseloads.

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The Scottish Government’s ‘vision for health and social care in Scotland’ and being clear what we mean by prevention

June 2024

In June 2024, the Cabinet Secretary for Health and Social Care outlined the Scottish Government’s ‘vision for the health and social care system’. The Cabinet Secretary in his speech, explicitly mentions prevention and early intervention together in the same sentence. Some members talked about one or both, and it often seemed that the two were being conflated.

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A recap on the Christie Commission and its recommendations on prevention

The report on the future delivery of public services by the commission chaired by Dr Campbell Christie was published on 29 June 2011. The main recommendations relating to prevention were in Chapter 6, titled ‘Prioritising prevention, reducing inequalities and promoting equality’. The full report can be found here.

The report advocated for a substantial shift from dealing with the consequences of social problems to preventing them from arising in the first place. It argued that as well as leading to better long-term outcomes, a more preventative agenda should also reduce the overall cost of public services through avoiding more severe problems and higher costs later on.

In 2011, when the Christie Commission was putting forward its recommendations, Scotland had few options for raising revenue from devolved taxation powers, and the report therefore focused on options for shifting resources available to the Scottish Government (from UKG through the Barnett Formula). In 2024, there are now more devolved powers available to the Scottish Government, including on taxation, which opens up new options for delivering prevention action. The Commission was working during a time of declining budgets and recognised that reallocating monies was no easy matter. However, the report stated that there is:

“no alternative: if we do not manage to effect a shift to preventative action, increasing ‘failure demand’ will swamp our public services’ capacity to achieve outcomes. In all aspects of our system of public services, therefore, from setting national policy to reforming the governance and organisation of public services, through to the design and delivery of integrated services, all parties must prioritise and build in action which has the effect of reducing demand for services in the longer run.”

To ensure the effectiveness of preventative measures, the Commission highlighted the importance of monitoring and evaluating initiatives, tracking outcomes, and using data to refine and improve preventative strategies over time.

Click to download pdf versions of the regular round-up