Creating Wellbeing
“it is not primarily in our hospitals or our GP surgeries that health is first created.
It is in our homes and our communities,
in the places we live and through the lives we lead."
The Public Health Priorities for Scotland
Creating Wellbeing and Place
Place can be an asset to help create health for individuals and communities.
Some places have more of the facilities and characteristics that support good health and wellbeing and enable people to flourish. Some other places lack these characteristics and this can have a detrimental effect on people’s lives.
These inequalities of place are linked to social, economic and health inequalities. A place may be an environment of relative prosperity or relative poverty, or it may well have elements of both, meaning that inequality often exists within communities as well as between areas. Inequalities can be experienced by people through their relationship with a place. For example, a lack of affordable, warm, good quality housing can increase costs for many people and have harmful effects on health and wellbeing. This can reduce a community’s resilience and ability to resist adversity, stigmatising areas and decreasing the potential for positive growth. Subsequently, a place may experience knock-on effects such as social problems, poor access to quality local employment or pressures on schools and education which can lead to communities becoming locked into cycles of systemic poverty and disadvantage.
Health Inequalities in Scotland
Everyone has the right to health . Yet, there are large differences in people’s health.
- On average, males born in the least deprived areas can expect to live an extra 25 years in good health. Females can expect to live an extra 21.5 years in good health. This is compared to those born in the most deprived areas.
- The rates of early deaths in the most deprived areas are four times higher than the least deprived areas.
- 24% of children living in the most deprived areas are at risk of obesity. This is compared to 9% in the least deprived areas.
These health inequalities are not fair and they are avoidable.
Health inequalities can depend on factors such as where someone lives and their household income. They can also depend on their gender or race and if they have a disability.
The disadvantages someone faces can increase when they fit into more than one group. Using an intersectional lens is important to avoid excluding someone’s unique experiences.
Tackling these health inequalities is central to Scotland’s Public Health Priorities. The vision is to create a culture for health that prevents ill health.
The Public Health Priorities for Scotland
The Public Health Priorities for Scotland highlights that the stark inequalities across Scotland’s health mean that society as a whole must increasingly turn towards supporting ‘wellbeing creation’, as well as reducing harm.
This wellbeing creation can supported by, for example, increasing social cohesion, supporting attainment for learners and reducing violence. Public health reform in Scotland promotes a whole system approach where partnerships between a broad range of stakeholders help to deliver positive and sustainable change to health outcomes. This approach acknowledges the important role that all parts of the system have in shaping health and the essential need to consider place and community at the heart of this process.
Although issues such as housing, planning, design and transport lie outside the traditional remit of the health service, they all have a significant role to play in achieving good health outcomes and can be seen as an important and influential element of the public health workforce. The design and creation of good places has complex pressures and drivers.
Using place-based working to support these priorities reflects the well-established understanding that the creation of safe places that nurture health has long been central to the public health agenda. Planning has always been central to efforts to improve public health, from the redevelopment of poor quality housing, to improving sanitation, water and air quality, and ensuring that we have access to health facilities.