Scotland’s health can’t wait: why prevention must be at the heart of the next parliament

In just under 3 weeks’ time, voters in Scotland head to the polls. Yet despite strikingly poor health outcomes and wide inequalities, party manifestos fail to advocate for the step change in policy that would support a healthier, more equal Scotland. 

Their focus on boosting economic growth neglects to recognise that improving health is essential for economic resilience, as well as being vital for people’s wellbeing. 

While life expectancy in Scotland has recovered to pre-pandemic levels, shockingly, healthy life expectancy – the amount of time people can expect to live in good health – has continued to fall.

In the most deprived areas of Scotland, people can expect to live over 25 years fewer in good health than those in the least deprived. These outcomes are not inevitable – they reflect long‑standing structural inequalities, exposed and intensified by recent crises.

As might be expected, when it comes to health, the parties’ pitches to voters focus mainly on the NHS. 

Yet we know that health outcomes are shaped by the environments in which people live, work and socialise.

A new parliament provides an opportunity to do things differently – in a way that already has public support – by committing to a preventative approach to health, as we set out in our new briefing. 

With public finances under pressure and the population ageing, the case for this approach has never been stronger. 

Supporting choice and removing harms

Alcohol, tobacco and unhealthy food continue to be leading drivers of ill health. Scotland has shown that policy can make a difference: minimum unit pricing for alcohol and strong tobacco regulation have helped reduce harm by reshaping the context in which choices are made. 

Some paint these measures as impinging on individual freedom. But reducing the influence of commercial interests – through mechanisms such as advertising, price and availability – can remove distortion in decision making and increase choice for consumers.

Building on progress to date means going further: strengthening restrictions on marketing, supporting local authorities to manage the density of fast-food outlets and off licences, expanding smoke‑free public spaces, and ensuring that public health policymaking is not undermined by commercial interests.

While individuals have and should take responsibility for their health, there is also an important role for the state in spotting obvious harms and preventing them. Such approaches often lead to changes widely accepted as positive (for instance, the indoor smoking ban).

Supporting healthier working lives

Good work is one of the strongest foundations for health. It provides income, security, purpose and social connection, each of which either support good health directly, provide access to other building blocks such as good quality housing, or prevent poverty.

However, Scotland faces a growing working‑age health challenge.

Economic inactivity due to ill health remains higher than in other parts of the UK, while the number of people receiving health‑related benefits has risen sharply in recent years. Many people also stay in work while managing long‑term conditions, often without the support they need to remain well and productive.

A preventative approach can support people to stay in work wherever possible and intervene early when health problems emerge. This should include caseworker support to help individuals and employers make adjustments, improved pathways into alternative jobs when roles are no longer suitable and fair sick pay. 

Housing as a building block for health

Safe, secure and affordable housing is fundamental to good health. Yet Scotland is in the grip of a housing emergency. The number of homeless households living in temporary accommodation has more than doubled over the past decade, close to 100,000 households are on social housing waiting lists and problems such as damp, mould and overcrowding are widespread.

Children are particularly affected, with profound consequences for their health, development and education. Addressing this crisis demands sustained investment in social housing, stronger action to prevent homelessness and a clear focus on improving housing conditions across all tenures.

Reducing poverty to improve health

Over a fifth of children in Scotland grow up in poverty, with significant consequences for their health. While the Scottish Child Payment has played an important role in reducing poverty, targeting support towards families facing the greatest hardship remains essential to reduce health inequalities.

For the long term, underlying factors that drive poverty must be addressed, including high‑quality employment, affordable childcare and housing, and closing education attainment gaps.

Younger men at risk of early death

One of the starkest examples of the failure to embrace a preventative approach in Scotland is the persistently high number of deaths among younger men from drugs, alcohol and suicide. 

These deaths are overwhelmingly concentrated in deprived communities, and while they peak in mid‑life, the risk builds much earlier. The current approach has dire consequences for individuals and places continued pressure on public finances. Yet manifesto policies to reduce drug deaths focus on tackling acute need.

Some young men face deep disadvantage: insecure work, unstable housing, limited support and worsening mental health. Too often, they are invisible to services until crisis point – when they experience homelessness, enter the justice system or face acute mental health breakdown.

Early intervention before people disengage from work, education or community life can make a real difference. Action should be joined up across health, housing, justice and economic policy to make sure people don’t bounce between systems without underlying problems being addressed, or even worse, are left until they fall into crisis. 

From policy rhetoric to action

Scotland does not lack policy intention. Strategies are plentiful. Evidence is not in short supply. What has been missing is consistent follow-through to bring about sorely needed change to improve people’s lives. 

Though it may not be the stuff of headlines and election speeches, this means clear plans for delivery, shared accountability across national and local government, and sustained commitment over time.

Putting prevention at the centre of policy, addressing the building blocks of health, and making the best use of resources for the greatest impact are essential to building a healthier, fairer Scotland.

When election grandstanding is over, whoever takes power has a chance to reset. The choices made will shape population health for decades. Getting this right will require courage, coordination and, above all, action.