3 Policy and
3.1 Government Policy
The Scottish Government’s Action Plan, Better Health
Better Care (2007) sets out the Government's programme to deliver a
healthier Scotland. Section 2, Helping People to Sustain and
Improve their Health, Particularly in Disadvantaged Communities,
sets out four key actions to:
- increase healthy life expectancy in Scotland;
- break the link between early life adversity and adult
- reduce health inequalities, particularly in the most deprived
- reduce smoking, excessive alcohol consumption and other risk
factors to a healthier life.
Section 2.4 of the Action Plan, Tackling Health Inequalities
states that ‘poor mental and physical health is both a
cause and consequence of social, economic and environmental
inequalities. Risk factors include … aspects of the wider
social, economic and physical environments including educational
achievement, income / relative poverty, the work environment and
A Ministerial Task Force on Health Inequalities led by the
Minister for Public Health has been established to identify and
prioritise practical actions to reduce the most significant and
widening health inequalities. The Task Force has adopted some key
- improving the whole range of circumstances and environments
that offer opportunities to improve people's life circumstances and
hence their health; and
- reducing people's exposure to factors in the physical and
social environment that cause stress, that are damaging to health
and wellbeing, and that lead to health inequalities.
In December 2008, the Task Force published its report
‘Equally Well’ (Scottish Government, 2008), which aims
to take the emerging understanding of the deep-seated causes of
health inequalities and turn it into practical action. Actions and
recommendations are arranged under five headings:
- Smarter Scotland: Early Years and Young People.
- Wealthier and Fairer Scotland: Tackling Poverty and Increasing
- Greener Scotland: Physical Environments and Transport.
- Safer and Stronger Scotland: Harms to Health and Wellbeing:
Alcohol, Drugs and Violence.
- Healthier Scotland: Health and Wellbeing.
Of relevance to this HIA Report are the recommendations
identified in the Task Force’s report under the heading of
‘Greener Scotland’ which include:
"28. The Government and local agencies and partnerships
should apply the "precautionary principle" across policy
development affecting green space in environment, education and
health. It should increase the priority given to the creation,
retention and promotion of green spaces as essential for health
improvement, especially in communities at risk of poor
34. The Government should take forward action targeting
children from disadvantaged areas who are at greater risk of injury
in road accidents and to encourage local authorities to follow
existing good practice in this area.
35. New Government whole-community initiatives should be
measured on their impact on health and health inequalities, these
include for example, sustainable transport demonstration projects,
designed to engage the whole community."
3.2 Local Policy
Fife’s Joint Health Improvement Plan, ‘A Healthier
Future for Fife, 2007-2010’ was developed by the Fife Health
and Wellbeing Alliance (FHWA). The Plan aims to provide a strategic
framework which would enable community planning partner
organisations to work with the communities they serve to continue
to improve health and wellbeing and reduce health inequalities in
Fife. The key themes of the plan are:
- reducing health inequalities (including reducing
discrimination and promoting equality);
- creating healthier environments; and
- supporting healthier lifestyles.
3.2.2 West Lothian
The West Lothian Health Improvement Team has been set up to
integrate health improvement and well-being, and address
inequalities through the development and implementation of relevant
policies and strategies across West Lothian.
The Health Improvement Team is involved in the development of
the ‘Life Stage Outcome Planning Programme’ which
integrates health improvement into a Community Planning Partnership
approach to tackling health and social inequalities. This process
replaces the previous Joint Health Improvement Plan.
The 2003 – 2006 Joint Health Improvement Plan for
Edinburgh was developed by an interagency Health Action Team set up
by the Edinburgh Partnership. The purpose of the joint plan is to
bring together the interconnecting factors which contribute to a
healthier city and establish a common commitment to achieving good
health in the City of Edinburgh.
The overall vision of the plan is ‘maintained and
improved health and wellbeing for Edinburgh’s residents,
together with sustained action to reduce health
inequalities’. The plan states that ‘the
objectives of improved community health and wellbeing and reduced
health inequalities can only be achieved when health impacts are
prioritised … by the main community planning partners, by
organisations in all sectors, and by individuals themselves –
to work towards a healthier Edinburgh’.
In 2008, the Edinburgh Community Health Partnership published a
consultation paper on the revised Edinburgh Joint Health
Improvement Plan. The vision set out in this paper is ‘for
Edinburgh (city) to show steady improvement in the health and
wellbeing of its people and a reduction in the health inequalities
experienced by its disadvantaged communities’.
Key actions include:
- to improve the physical environment and infrastructure of
the city to ensure physical activity is the easy option for people
(e.g. by identifying mechanisms to ensure physical activity is
included in spatial planning); and
- to increase physical activity of adults of working age (e.g. by
encouraging active commuting to work).
3.3 HIA Guidance
3.3.1 Health Scotland Guidance
Health Scotland advocates the use of HIA and has produced
Guidance on Health Impact Assessment of Transport Projects (Health
Scotland, 2007). The guidance highlights the importance of
transport to health and wellbeing, and refers to data linking poor
transport with health and social exclusion issues.
The Guidance states that ‘Health impact assessment is a
way of applying the evidence in this document, and other relevant
evidence, to a transport proposal in order to inform decision
making. This should be done at a stage of planning when the
proposal is clear enough to be assessed but there is still the
opportunity to make changes that would improve the health impacts
that would arise from that proposal. The evidence must be applied
to the specific proposal and local context.’
3.3.2 West Lothian Supplementary Planning Guidance
West Lothian has produced Supplementary Planning Guidance (SPG)
on ‘Health Impact Assessment’. The SPG provides
guidance on the preparation of HIAs for major new developments in
West Lothian. The aim is to assist decision making by taking into
account key determinants to protect human health.
3.3.3 The Merseyside Guidelines for Health Impact
The Merseyside Guidelines for Health Impact Assessment (2001)
prepared by Liverpool Public Health Observatory, set out a staged
process for undertaking HIA and include criteria to describe the
significance of potential health effects (see Section 4.6). This is
the only guidance which provides criteria to describe the nature of
health effects, and is widely used in HIA.
The HIA scope and approach described in Section 4 below
incorporates elements from each of the above guidance