Who will safeguard Scotland’s Future Health?

By Tony Robertson, Eva Gallova, Mark Langdon, Sue Laughlin, Giulia Loffreda and Neil Quinn on behalf of the People’s Health Movement Scotland.

The ongoing COVID-19 pandemic has been an obvious game changer since the last Scottish Government elections, not only in terms of its immediate impact on public health but with its current and future impact on employment and economic activity across the UK and globally. It has perhaps tended to overshadow the impact of other significant developments in recent years that are linked to worsening population health and widening health inequalities, such as Brexit, continued austerity, the increasingly obvious effects of climate change (and associated climate injustice) and political turmoil at home and abroad.

These issues evidence the challenges faced by any government in Scotland to address inequalities in health and develop and fund a socially and ecologically just strategic plan which adequately addresses the problems that years of austerity have exacerbated. The Scottish Government has attempted to mediate aspects of the UK government’s assault on the most vulnerable sectors of society, but there is still much more that could and should be done.

The Scottish People’s Health Manifesto comprises a list of 32 demands, set around seven key actions that have arisen from a partnership of individuals, organisations and community groups from across the country. The actions and demands have been compiled from a process of dialogue and debate led by a group of health activists, the People’s Health Movement Scotland (PHMS), which actively sought to engage a wide and inclusive range of voices and perspectives, many of which are not heard when forging national policies, health or otherwise.

In 2016 we created our first People’s Health Manifesto, consisting of 20 demands, categorised within six actions. Ahead of the 2021 Scottish Elections we reached out to our network to help us develop a refreshed manifesto that better fits where our country and world find themselves in 2021. Below you will find our updated actions and if you are interested please see our manifesto for the more specific demands. Most notably the climate emergency has become a new focal point that is now so prescient, alongside the impacts of COVID-19 and a greater acknowledgment of the need to take an intersectional lens across our demands. In addition, the likes of education and inequality cut across multiple actions and demands given their importance. Demands against racial and ethnic prejudice and violence against women have also been introduced to address clear gaps in our previous approach.

As a group of health activists we think the people of Scotland need to consider the country we really want and the country we really could have in the face of the current climate and health emergencies. It is essential that we recognise these challenges are not just new but are linked to legacies of neglect, inequality and injustice. Hopefully these actions resonate with the readers of Bella Caledonia and help reframe and set new priorities for what our main political parties are offering as part of the ‘new normal’.

Once we see the shape of the new parliament we will offer readers our assessment of where election pledges need to be held to account and where the neglect continues, clarifying where campaign priorities should focus.

Seven Actions to Improve Scotland’s Health

Prioritise Health in all Policies

A Health in all Policies approach is an established method for improving health and health equity through cross-sector action on the wider determinants of health: the social, environmental, economic and commercial conditions in which people live. It is particularly important to recognise the role that the economy and the way that it is measured plays in either promoting or limiting health, depending on the decisions that are made.

Tackle Poverty and Socioeconomic Inequalities

Scotland has high levels of poverty and inequality. Approximately 1 in 5 of the population is living in poverty  and the top 10% of the population have 24% more income than the bottom 40% combined. These experiences translate into unacceptable levels of health inequality –  in 1997 premature mortality rates (deaths before age 75) were three times higher in the most deprived areas compared to the least deprived; from 2014-2018 premature mortality rates have been four times higher in the most deprived areas and look on course to continue to rise. These interrelated problems still exist despite considerable policy rhetoric aimed at addressing them suggesting that policies have not been sufficient to make an impact.

Play an Active and Leading Role in Tackling the Climate Emergency

There is a close relationship between climate, the environment and human health. The climate emergency will lead to more deaths, disease and displacement worldwide. Within Scotland, the population is increasingly affected by air pollution, changing weather conditions and a loss of biodiversity. It is still overly dependent on the fossil fuel industry. Whilst the Scottish Government has established a climate change plan, this does not maximise the role that Scotland could play in addressing the climate crisis and in promoting environmental justice both nationally and internationally.

Protect our NHS and Improve Social Care Services

The NHS in Scotland is rightly prized, the COVID-19 pandemic highlighting the need for well organised, publicly funded and publicly run healthcare which is able to respond effectively to both new health emergencies and to regular pressures. It is the NHS that largely deals with the health impact of economic and social policy making, with those experiencing the poorest health as the result of adverse conditions often having the greatest need. There are however still distinct differentials in the provision of health care for those with the greatest need – both physical and psychological. The COVID crisis has brought to the fore the need for a National Care Service for the elderly which is also publicly funded and publicly run.

Improve Democratic Debate and Accountability

Civil society groups and movements can prevent social inequalities, undo inequalities and reduce harm. However they also face challenges like funding, creating partnerships, influencing policy, setting priorities, having enough resources and their own culture. They need to be given more opportunities to flourish and strengthen their impact.

Acknowledge and Address Longstanding Injustices and Protect Equality and Diversity

There is extensive evidence of longstanding social and health inequalities in Scotland, with  particular concerns that women, ethnic minority groups, disabled people and older people are disproportionately affected. We know, furthermore, that multiple structural, contextual and individual factors underpin these inequalities. There is a need to address these existing inequalities to achieve equity in health outcomes, through enforcement of the Equality Act 2010 and  adopting an intersectionality approach within all policies, which acknowledges and addresses systemic discrimination.

Reduce Exposures to Health Risks at Work and at Home

Being out of work has been found to have major health consequences. However, even those in work experience health damaging and health protective exposures, as well as high levels of in-work poverty. As well as these work risks we are also faced with health-damaging exposures from the environments we live in (e.g. pollution) and our interactions with the so-called commercial determinants of health (e.g. tobacco). It is time to put people before profit.


PHMS is part of the wider PHM UK, whose vision is a future in which health equity and social justice is made a reality for the UK and overseas communities. PHMS/UK are part of a European network and global community of health and social justice activists.


For further information or to get involved in our health activism contact us via:

PHM Scotland Website


Twitter (@PHMScotland)

Comments (3)

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  1. SleepingDog says:

    I skimmed through the manifesto, which seems on first glance to be an impressive and well-referenced document. However, there were two or three apparent omissions (or perhaps these were addressed in linked resources).

    One such concern for me would be the current intellectual property model in medicine and the living world. Clearly public health efforts directed against the Covid-19 virus variants are being obstructed by various profitarian IP constraints like vaccine patents, even though the mass of underlying research has largely been paid for out of public funding. On the topic of bioprospecting genetic resources and exploiting local knowledge/cultivation, I recently encountered Access and Benefit-Sharing agreements: https://en.wikipedia.org/wiki/Access_and_Benefit_Sharing_Agreement

    Neither does internationalisation (global public health) feature in the manifesto as strongly as I would have expected, apart from in the climate emergency and environmental justice section. I understand from your blog that some contributors were part of a monitoring group called WHO Watch, attending World Health Organization meetings. WHO is mentioned in the first Action and one of its policies is recommended. Yet there is apparently no reflection on whether WHO itself, as part of the United Nations, is working as well as it should, or what further improvements in global public health the Scottish public may want to take part in shaping.

    Perhaps there is an unwritten philosophical model that could be made explicit, such as the view of the authors of the nature of the relationship between humans and the rest of the planet. I can understand that writing it down could alienate some contributors, or people who disagreed with it. Perhaps a pluralistic section, leaving out any mythical/religious specifics or overly philosophical terminology, would at least set the scene. At the very least, some concept of passing on improved public health to future generations. Population is mentioned 14 times without one mentioning size, or birth control/contraception. Maybe it was simply impossible to get agreements on this from contributors. If this was the case, I suggest an addendum with all the health-related issues that were left unresolved during the manifesto-production process (or a majority/minority report split section), in the interests of further democratic debate.

    1. Colin Robinson says:

      Your find the presuppositions on which the manifesto is dependent (its ‘philosophy’, if you will) in the PHM’s ‘People’s Charter for Health’ https://phmovement.org/wp-content/uploads/2020/06/phm-pch-english.pdf

      I look forward to your critique.

      1. SleepingDog says:

        @Colin Robinson, well, I am puzzled by the initial statement “The attainment of the highest possible level of health and well‐being is a fundamental human right”. I have no idea how that translates into practice. Constraints, competition, conflict, prioritisation, timescales seem absent in what looks more like a wishlist of demands than a policy platform based on a planetary-realistic ideology. Sure, I might agree with almost all of these wishes, but that is easily said. What happens if these demands are not met?

        At least some of my questions were answered:
        “Reject patents on life and oppose bio-piracy of traditional and indigenous knowledge and resources.”
        “Support people’s rights to reproductive and sexual self‐ determination and oppose all coercive measures in population and family planning policies. This support includes the right to the full range of safe and effective methods of fertility regulation.”

        So, no real underlying philosophy (here I mean rational worldview) evident to me, possibly because of the wide consensus-building process. For example, there is no view of the relationship between humans and non-humans. If the document were to state it supported veganism and gave reasons why, then we might see animal health brought into the picture, but no. The difficult questions seem to have been sidestepped. Is this a value statement? A negotiating document? A primer for political party manifesto writers?

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