Closing the gap: why prevention and equitable access to care is vital for Scotland’s Health

Scotland faces a severe public health challenge. The most disadvantaged in the population live significantly shorter lives, and spend a larger proportion of that time in poor health, compared to other Western and Central European countries.¹ The gap in healthy life expectancy - years lived in good health - is around 23 years for males and 24 years for females.¹

This stark difference is heavily influenced by Social Determinants of Health (SDOH): the non-medical factors that shape an individual’s access to resources and opportunities that promote health like suitable housing, access to health foods, stable employment and health literacy.^1-3

The economic case for change

Addressing poor population health is a critical economic strategy, not just a social imperative. Improving health in Scotland could boost the labour market and reduce public sector spending, enhancing national productivity.⁴

A new strategy for health

To fundamentally reverse the trend, the Scottish Government launched this year Scotland's Population Health Framework. This comprehensive strategy aims to create health within communities, moving beyond a model focused solely on treating illness after it occurs. The framework advocates for investing in upstream prevention to stop poor health from taking root. Crucially, it also stresses the necessity of actively identifying and removing barriers that prevent high-risk individuals from accessing essential care.⁴

The prevention approach is structured across three levels:⁴

• Primary prevention: fundamental investments in good jobs, tackling child poverty, improving education, ensuring safe housing and healthy lifestyle choices.
• Secondary prevention: focuses on early detection and intervention, increasing screening and vaccination uptake in deprived communities.
• Tertiary prevention: manages existing long-term conditions to maintain patients’ quality of life.

Linked to the need for effective tertiary prevention, the government also consulted on a Long Term Conditions Framework this year. This initiative aims to unify chronic care, moving away from fragmented, condition-specific approaches to an integrated model that ensures equitable access to information and support.¹⁰

Furthermore, Scotland’s Health and Social Care Renewal Framework 2025-2035 outlines a ten-year transformation plan for the country. This plan prioritises shifting resources from hospitals to community-based, person-led, and digitally enabled services. The ultimate goal is to strengthen integration, tackle health inequalities, and deliver high-quality, equitable care across the whole of Scotland.¹¹

In conclusion, addressing the underlying societal determinants that predispose people to poor health as well as investing in early, effective treatment is the most effective path to improving health outcomes, reducing the burden on the NHS, and securing a healthier, more productive future for Scotland.

Date of preparation November 2025 | M-GB-00025002

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References:

1. Public Health Scotland. Scotland's public health challenges. 2024. Available at: https://publichealthscotland.scot/about-us/what-we-do-and-how-we-work/scotland-s-public-health-challenges/ Last accessed November 2025.
2. The King’s Fund. Illustrating the relationship between poverty and NHS services. 2024. Available at: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/relationship-poverty-nhs-services Last accessed November 2025.
3. Public Health England. Chapter 6: social determinants of health. 2017. Available at: https://www.gov.uk/government/publications/health-profile-for-england/chapter-6-social-determinants-of-health#living-standards Last accessed November 2025.
4. Scottish Government: Scotland’s Population Health Framework 2025-2035. Available at: https://www.gov.scot/publications/scotlands-population-health-framework/ Last accessed November 2025.
5. Visser EM, et al. A new prevalence study of multiple sclerosis in Orkney, Shetland and Aberdeen city. J Neurol Neurosurg Psychiatry. 2012;83(7):719-24.
6. MS Society. What is MS? 2024. Available at: https://www.mssociety.org.uk/about-ms/what-is-ms Last accessed November 2025.
7. Thompson A, et al. New Insights into the Burden and Costs of Multiple Sclerosis in Europe: Results for the United Kingdom. Multiple Sclerosis Journal. 2017;23(2_suppl): 204–216.
8. He A, et al. Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol. 2020;19(4):307-316.
9. Das J, et al. The association between deprivation and the access to disease modifying therapies for multiple sclerosis: An England wide community-based study in the UK MS Register. Mult Scler Relat Disord. 2022:57:103474.
10. Scottish Government: Health: Long Term Conditions Framework. Available at: https://consult.gov.scot/healthcare-quality-and-improvement/long-term-conditions-strategy/ Last accessed November 2025.
11. Scottish Government: Health & Social Care Service Renewal Framework 2025-2035. Available at: https://www.gov.scot/publications/health-social-care-service-renewal-framework/ Last accessed November 2025.