comment: The will to improve Scottish public health is there - but hard choices abound

Published: 05/09/2002, Volume II2, No. 5812 Page 10

Last week, HSJ suggested that the rest of the UK should take careful note as Scotland reconfigures its health service. We recommend that a close watch should also be kept on plans to tackle its notorious public health record (news, pages 6).

While Scotland's health record may be poor, as Michael White points out (politics, page 13), there are other parts of the UK where it is as bad, if not worse. But recent soundings from Scotland suggest that first minister Jack McConnell and his team are prepared to make some hard choices. While on the record there are familiar noises about ensuring equal access to treatment for all, there is tacit acknowledgement that the health choices made by the older generation have done damage that cannot be repaired by even the most ambitious public health programme. Policy planners openly talk of the need to focus on the more optimistic, easily influenced young.

Food manufacturers and retailers, whose products contribute to poor public health, will come under attack. Expect a propaganda war for young consumers' hearts and stomachs. And what of spending on public health, where real improvement is always years away? Of course, Scotland has no choice. Spending at average European levels while failing to produce comparable results is not sustainable.

Most intriguing is the decision to seize on public health as a key issue for the Assembly elections - the plans are due only months before the next poll. Could that ever happen Down South?