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Why reform is important

Scotland’s current health challenges are complex and go far beyond the control of the NHS. These include:

  • an ageing population
  • enduring health inequalities
  • deprivation and poverty
  • changes in the pattern of disease
  • increasing pressures on health and social care services.

Scotland has seen substantial improvements in life expectancy over the last few decades. However, the rate of improvement in life expectancy and mortality in Scotland has slowed and life expectancy has now remained virtually unchanged since 2012-2014.

Drivers for change

There are three drivers for change. They are the

  • Public Health Review 2015
  • Health and Social Care Delivery Plan 2016
  • Commission on the future delivery of public services 2011

The Public Health Review (external website) made recommendations to strengthen leadership for the public's health and refocus the public health function in Scotland.

The Health and Social Care Delivery Plan (external website) set out the actions Scottish Government and COSLA will lead to deliver the recommendations from the Public Health Review.

The Christie commission on the future delivery of public services (external website) identified the need for public services to work much more closely in partnership, to integrate service provision and to prioritise expenditure on public services which prevent negative outcomes from arising.


The vision for the Public Health Reform Programme is “a Scotland where everybody thrives”. The ambition is for Scotland to be a world leader in improving the public’s health and to create a public health system fit for the future, equipped to respond to the complex challenges of the 21st century.

To achieve the vision, we need to address the nation’s current health challenges – our poor relative overall health status compared with other countries; the significant and persistent health inequalities that exist across Scotland and how our health and social care services can best respond to the needs of a population with more complex needs.

In delivering our vision, public health reform will create a public health system that

  • contributes to a healthier Scotland by reducing health inequalities and avoidable differences in healthy life expectancy across Scotland
  • creates a culture for health in Scotland where public services are focused on preventing ill health and supporting individuals to make healthier choices and adopt and maintain healthy behaviours
  • uses technology to drive change, utilising data and intelligence to improve our understanding of Scotland’s public health challenges to plan and deliver services in a different way
  • empowers individuals and communities by involving them in the design and delivery of services and co-producing solutions to local population health challenges
  • delivers services that are evidence based and can have the biggest impact on improving healthy life expectancy and reducing inequalities
  • protects the nation from public health hazards by creating a system that is effective in identifying, preparing and responding to public health emergencies and challenges.