Scotland's public health white paper is due early next month. Barbara Millar reports on what is likely to be in store

Saying their piece: responses to the green paper

Sector No of responses

NHS, health councils213

Local authorities 36

Professional bodies, groups, churches 111

Voluntary sector, community

organisations, alliances, charities129

Private sector, commercial organisations 18

Government departments, agencies,

commissions 4

General public270

Roadshows 7


The green paper Working Together for a Healthier Scotland was hailed by the chair of the Health Education Board for Scotland, David Campbell, as 'the most important public health document in 50 years' when it was published last year.

The white paper due out in early February will not, says the Scottish Office, be dramatically different - which will be a relief to most of the 788 organisations and individuals who responded to the government's consultation exercise.

In an analysis of the feedback, Edinburgh University researcher Steven Platt, and Claudia Martin of Scottish Health Feedback, say people were 'overwhelmingly supportive' of the government's stand on health inequalities.

People also welcomed 'the acknowledgement of the key role played by life circumstances in increasing the risk of poor health and, by implication, increasing health inequalities', says the analysis. But respondents criticised the absence of indicators and targets on health inequalities, and the 'apparent ambivalence' about setting targets, which 'raised anxieties' about the government's commitment to act.

People will be looking for evidence in the white paper of concrete and practical policies, and action which will equalise and ameliorate health 'risk conditions' in Scotland, the analysis adds.

Harry Burns, Greater Glasgow health board's public health director, is sure that 'what we will see in the white paper will be a reflection of what the troops want'.

The Scottish Office has been 'pretty open' in its discussions with the service, says Dr Burns.

'The chief medical officer and his deputy have been working hard canvassing views. The key thing for us is the recognition of life circumstances as determinants of health. What we want to see is something that gives a way of helping us to solve these issues and I am confident we will get it.'

But the fact that the white paper will not be taken forward by Westminster could be a problem, Dr Burns adds.

'It is hard to write a white paper for a parliament which does not yet exist. It could be difficult to firm up some of the proposals until more is known about the legislative process the white paper will have to go through.'

Trevor Lakey, chair of the Scottish branch of the Society of Health Education and Promotion Specialists, fully supports the government's 'decisive shift' to recognise that environmental, economic and social factors are major determinants of health. But as a means of focusing attention and resources, the white paper should include a specific aim to reduce health inequalities over a realistic timescale, he suggests.

SHEPS is concerned that little attention was given in the green paper to ethnicity, disability, sexual orientation and gender issues and their relationship to health, says Dr Lakey.

The white paper also needs to be much more specific in setting out the steps needed to strengthen partnerships for health, particularly links between health services, local authorities and the communities they serve, he adds.

Damian Killeen, director of the Poverty Alliance, would like to see the Acheson committee on health inequalities' recommendations introduced into the white paper.

'We welcomed the identification of life circumstances as causes of morbidity and mortality in the green paper, but most of the remedies set out are to do with lifestyles,' says Mr Killeen.

'The Acheson committee looked at the realities of health inequalities. We would be broadly supportive of those recommendations, particularly increasing incomes of the poorest to enable them to make healthy choices.'

The green paper invited views on a proposal to set up an expert working group to 'draw up a strategic framework for concerted action to promote health at community levels'.

Stuart Hashagen, a director of the Scottish Community Development Centre, fears that its own response - that 'local action is best promoted by recognition, networking, resourcing and support, rather than by expert committees and strategic frameworks' - could be misinterpreted.

'We have gained the impression the whole notion of the expert group is now being reconsidered,' says Mr Hashagen. 'We hope this is not the case. We would like to see such a group formed, but with community representation.'

Mr Hashagen hopes nothing in the green paper on strengthening communities gets 'watered down'. 'We are worried that the white paper might back-track on some of the more radical points.'

Analysis of Responses to the Green Paper on Public Health in Scotland. documents6/phs-res-00.html; lp-main.htm£Research