foreword

It is with great pleasure that I present this report - my second report as Director of Public Health - on the state of the public health in Lothian. This report builds on my last report in exploring the way in which everyone needs help to achieve their potential for health.

The concept of the "potential for health" is not new. It reflects the gap that exists between the actual health status of the local community and what it could be if all possible health risks or threats were addressed. In practice we use it every time we talk about avoidable deaths or use measures like healthy life expectancy. However, in the context of the national public health and health service strategies in Scotland, Towards a Healthier Scotland and Delivering for Health, the need to refocus our efforts on realising the potential for health is essential. Without this focus we cannot offer the extra 3-4 years of healthy life to people in the communities with the fewest resources that we are required to deliver over the next ten years.

There is a coherence in policy that provides us with the necessary frameworks to made the difference between potential health and actual health. The need to drive down health inequalities - addressing the life circumstances, behaviours and lifestyle that create many of the main risks to health is at the core of these policies. However, if we are going to realise potential health, in the short-term, we must create opportunities and take all those that are presented to intervene in ways that can improve healthy life expectancy.

Measuring the gap between actual and potential health status, the build up of risks and protective factors across the life course within families and communities, helps us capture what health inequalities mean and provides insight into how we should intervene. The level and nature of the evidence that informs how we intervene to improve health and reduce inequalities varies widely. Yet the evidence that is available is not shared fully: promising interventions require rigorous evaluation. Case studies and randomised trials answer different questions; all require thoughtful answers. The extent to which changes in health status can be attributed to a particular health or healthcare intervention can be difficult to determine. The caution to first do no harm requires all of us in public health to work with and through these uncertainties if we are to reduce health inequalities. To ensure that the best evidence and advice that can aid judgement and support effective decision-making for realising the public health potential is adopted, we must make evidence relevant. In giving voice to the experience of local people we can develop a shared understanding of the priorities for action that builds upon the existing expertise of individuals and the assets available in each community.

In this report, I have tried to explore these issues within four key areas that will have an impact on achieving the potential for health along the life course. In selecting the topics in each of the sections - Starting Out, Keeping Well, Getting and Staying on Track and Capacity for Care, I was seeking to highlight the ways in which it is possible to contribute to improving health and reducing inequalities through health and care interventions. In each case, what is being explored is this issue of potential and how it can be realised.

In this report, I have tried to explore these issues within four key areas that will have an impact on achieving the potential for health along the life course. In selecting the topics in each of the sections - Starting Out, Keeping Well, Getting and Staying on Track and Capacity for Care, I was seeking to highlight the ways in which it is possible to contribute to improving health and reducing inequalities through health and care interventions. In each case, what is being explored is this issue of potential and how it can be realised.

In presenting this Annual Report, I am conscious of the challenge that providing effective ways to realise health potential creates. However, I believe that each area highlighted shows where colleagues across NHS Lothian and its partner organisations are already working hard to provide services that are safe, effective and evidence-based.

I hope that this Annual Report encourages all of us to work to achieve our potential for health in Lothian.

Alison McCallum
Dr Alison McCallum
Director of Public Health and Health Policy