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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