Health and Social Care

There is an established link between deprivation and healthy life expectancy. People living in more deprived areas have shorter lives and are more likely to live with poorer health for longer. Also, children born into families impacted by deprivation are at greater risk of experiencing poorer health outcomes.

Supporting evidence for key areas of local action are highlighted below. There is evidence on ‘Why it Matters’ and ‘What Works’ to improve outcomes.

The Evidence Hub is being continually developed – more key areas for local action and more sources of evidence are being added on an ongoing basis.

Why it Matters…

Obesity is linked to a range of health outcomes including type 2 diabetes, cardiovascular disease (CVD), hypertension, asthma and high cholesterol, having the potential to worsen existing conditions and/or to lead to new ones developing. According to the Scottish Health Survey 2024, a third of adults (31%) were living with obesity in 2024, with a higher proportion of females (35%) living with obesity compared with males (27%), and a third of all children were at risk of overweight (including obesity) (33%). Socioeconomic deprivation emerges as the most pronounced determinant of obesity in Scotland, with adults living in the most deprived areas almost twice as likely to experience obesity as those in the least deprived areas (36% compared with 19%), while children in the most deprived communities are more than twice as likely to be at risk of obesity (Scottish Obesity Alliance, 2025).

According to a report commissioned by Nesta, the annual cost of obesity in Scotland in 2022 was £5.3bn –  equivalent to 3% of Scotland’s 2022 GDP (Frontier Economics, 2023). The biggest driver of the estimated cost of obesity in Scotland was found to be the value lost to individuals through reduced quality of life, lost opportunity and years of life lost (Frontier Economics, 2023). A total value of £4.1bn was lost to ill health by individual people in 2022, including a £109m cost to children (Frontier Economics, 2023).

In a position statement published on behalf of the Scottish Public Health System, Public Health Scotland have called for stronger policies to create healthier food environments, improve access to affordable healthy food, reduce health inequalities, and support physical activity as part of everyday life (Public Health Scotland, 2024).

References

Frontier Economics. (2023). Cost of Obesity in Scotland.

Public Health Scotland. (2024). A position statement on behalf of the Scottish Public Health System.

Scottish Government. (2024). The Scottish Health Survey 2024 – volume 1: main report.

Scottish Obesity Alliance. (2025). Obesity and inequalities in Scotland.

What Works…

Cochrane review on obesity prevention in children

The aim of this systematic review was to assess the effects of interventions that aim to prevent obesity in children by modifying dietary intake or ‘activity’ levels, or a combination of both, on changes in BMI, zBMI score and serious adverse events. The body of evidence in this review demonstrates that a range of school‐based ‘activity’ interventions, alone or in combination with dietary interventions, may have a modest beneficial effect on obesity in childhood at short‐ and medium‐term, but not at long‐term follow‐up. Dietary interventions alone may result in little to no difference. Limited evidence of low quality was identified on the effect of dietary and/or activity interventions on severe adverse events and health inequalities; exploratory analyses of these data suggest no meaningful impact. The authors identified a dearth of evidence for home and community‐based settings (e.g. delivered through local youth groups), for children living with disabilities and indicators of health inequities.

Spiga, F., Davies, A. L., Tomlinson, E., Moore, T. H., Dawson, S., Breheny, K., … & Summerbell, C. D. (2024). Interventions to prevent obesity in children aged 5 to 11 years old. Cochrane Database of Systematic Reviews, 5. Art. No.: CD015328.

Whole systems approaches to diet and weight – review of reviews

This scoping review of reviews aimed to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. The authors reported that the application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations.

Breslin, G., Fakoya, O., Wills, W., Lloyd, N., Bontoft, C., Wellings, A., … & Brown, K. E. (2024). Whole systems approaches to diet and healthy weight: A scoping review of reviews. Plos one, 19(3), e0292945.

Evaluation of whole systems approaches in Scotland

This study aimed to assess implementation of WSA to diet and healthy weight in two council areas of Scotland, longitudinally exploring enablers and barriers. One area followed a Leeds Beckett WSA model (LBM) of implementation, while the other used a hybrid model incorporating existing working systems. The main enablers included: belief in WSA effectiveness; positive relationships between key personnel; buy-in at community and national levels; funding availability; the working group responsible for coordinating the system development comprising individuals with diverse expertise; good communication; and existing governance structures. The barriers included: insufficient funding; high staff turnover; inadequate training in WSA methodology; engaging all relevant stakeholders and reverting to ‘old ways’ of non-WSA working.

Breslin, G., Wills, W., Bontoft, C., Fakoya, O., Greco, H. A., Lloyd, N., … & Brown, K. E. (2023). Whole systems approach to diet and healthy weight: a longitudinal process evaluation in East Scotland. Perspectives in Public Health, 143(6), 347-357.

Modelling of adult excess weight in Scotland

The aim of this study was to use historic data to project estimates of the prevalence of excess weight in Scotland using Bayesian age-period-cohort modelling. Interviewer-validated height and weight measurements were obtained from the Scottish Health Survey (2003–2019) to calculate body mass index (BMI). Relevant socio-demographic attributes were sourced to contribute to modelling and results stratification. The estimations showed that, left unaddressed, there will be a substantial increase in adult excess weight in Scotland by 2040, particularly for females, compounded by increases in obesity and in the proportion of older cases.

De Pauw, R., Lakha, F., Fletcher, E., Stockton, D. L., Baird, E., Connolly, S., … & Wyper, G. M. (2025). Historic trends and future projections of the prevalence of adult excess weight in Scotland, 2003 to 2040: A modelling study. Public Health, 248, 105981.

A place-based approach to diet and healthy weight

This report was developed to support the work of local authorities and health boards across Scotland taking forward Whole System Approaches to diet and healthy weight. The report reviewed the evidence and recommends seven measures which can be utilised as part of a place-based approach to addressing diet and healthy weight. The report recommends action to restrict food marketing, utilise planning to improve food environments, and strengthen public food procurement and provision standards. It further supports moves to work with the out of home sector to reduce calories on menus, promote and support physical activity, protect, promote, and support breastfeeding and healthy diets for children, and improve uptake of school meals.

Obesity Action Scotland. (2023). Local Levers for diet and healthy weight.

MATERNAL SMOKING

Why it Matters…

The Scottish Government’s Tobacco and Vaping Framework (Scottish Government, 2023) identifies smoking cessation among pregnant women as a priority public health intervention within its wider ambition to achieve a tobacco-free generation by 2034.

Annual figures from Public Health Scotland report on a range of information about women booking for antenatal care in Scotland, including smoking status. The ‘Antenatal booking in Scotland’ report for 2025 (public Health Scotland, 2026) shows that women reported smoking in 7% of pregnancies. The proportion of women smoking in pregnancy has shown a slight decrease each year since antenatal booking returns were first recorded. However, deprivation is a key risk factor for maternal smoking, with pregnant women from the most deprived areas reported as being ten times more likely to smoke (13.1% in most deprived area, compared to 1.3% in least deprived area).

The health risks associated with maternal smoking are summarised in a World Health Organization (WHO) briefing (World Health Organization, 2021). The briefing highlights that exposure of unborn children to maternal smoking or second-hand smoke is linked to birth defects, stillbirths, preterm births and infant deaths. Maternal smoking during pregnancy is linked to a doubling of the risk of sudden infant death and birth defects, while exposure to second-hand smoke during pregnancy is linked to a 23% increased risk of stillbirth and 13% increased risk of congenital malformation.

A study (Lawdor, 2019) on the impact of smoking on early childhood health amongst children born in Scotland looked at the retrospective data on almost 700,000 children and found that maternal smoking significantly increased admission for acute respiratory infections, bronchiolitis, asthma and bacterial meningitis. Also, neonatal mortality, post-neonatal mortality, being small for gestational age, and prematurity were higher among the offspring of smokers.

References

Scottish Government. (2023). Tobacco and vaping framework: roadmap to 2034.

Public Health Scotland. (2026). Antenatal booking in Scotland: calendar year ending 31 December 2025.

World Health Organization. (2021). Tobacco control to improve child health and development: thematic brief.

Lawder R, Whyte B, Wood R, et al. (2019). Impact of maternal smoking on early childhood health: a retrospective cohort linked dataset analysis of 697,003 children born in Scotland 1997–2009, BMJ Open, 9, e023213.

What Works…

The Scottish Government Prevention Unit has published a report on ‘Learning from 25 years of preventative interventions in Scotland’. The report includes a number of case studies, including one on ‘Financial incentives for smoking cessation in pregnancy’ which describers initiatives in NHS Tayside and NHS Greater Glasgow and Clyde. Evaluation of the projects demonstrated that adding financial incentives to existing cessation services is effective and cost-effective.

Scottish Government. (2025). Learning from 25 years of preventative interventions in Scotland. Targeting preventative interventions: financial incentives for smoking cessation in pregnancy.

Realist review emphasising relationships

The aim of this review was to improve the understanding of how services in the UK to reduce smoking in pregnancy work, for whom, and under what circumstances. By adopting a ‘realist review’ approach the authors aimed to identify the underlying mechanisms that may explain why and how change occurs. The importance of relationships is a key finding and it is recommended that services identify ways in which positive relationships can be built with pregnant women who smoke. It is suggested that identifying how services can facilitate more regular contact with pregnant women and providing training in coaching and motivational interviewing techniques for professionals can help achieve behaviour change.

Tatton, C. and Lloyd, J. (2023). Understanding for whom, under what conditions and how smoking cessation services for pregnant women in the United Kingdom work—a rapid realist review. BMC Public Health, 2488.

Pregnant women’s perceptions of smoking risk

This review aimed to explore pregnant women’s perception of smoking tobacco risk during pregnancy. Nineteen studies were identified and reviewed, with the majority of the evidence being from the USA. It was identified that pregnant women who smoked were less likely than pregnant women who did not smoke to believe in potential harm to their infant due to smoking during pregnancy. Behaviour was rationalised by citing examples of healthy babies born to women who smoked, viewing reduced smoking as sufficient risk reduction, or believing the benefits of smoking—such as stress relief—outweighed the risks. The review also found that pregnant women often trust advice from family and friends more than healthcare providers, particularly when those personal contacts have pregnancy experience. conclude that smoking-cessation efforts should focus not only on providing information but also on strengthening women’s perception of personal risk and reaching the broader social networks that influence their decisions.

Gulley, T., Hammer, D. and Jarvill, M. (2026). Integrative review: pregnant women’s perception of smoking tobacco risks during pregnancy, Maternal and Child Health Journal, 30, 742–754.

3 Cochrane Reviews on pharmacological interventions, psychosocial interventions and factors influencing uptake of nicotine replacement therapy and e-cigarettes in pregnant women.

A review on pharmacological interventions for promoting smoking cessation during pregnancy looked at nine trials of nicotine replacement therapy (NRT) and two trials of bupropion as adjuncts to behavioural support, with comparable behavioural support provided in the control arms. The overall certainty of the evidence was low but it was indicated that NRT used for smoking cessation in pregnancy may increase smoking cessation rates in late pregnancy. There was no evidence that NRT has either positive or negative impacts on birth outcomes, but again the evidence was of low certainty. There was also no evidence that bupropion may be an effective aid for smoking cessation during pregnancy.

The review suggested that adherence to NRT was low – exploring this, a qualitative review looked at the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke. It concluded that consistent messages from health professionals, based on high‐quality evidence and clearly explaining the safety of NRT and e‐cigarettes compared to smoking in pregnancy, could help women use NRT and e‐cigarettes more consistently/as recommended. This may improve their attitudes towards NRT or e‐cigarettes, increase their willingness to use these in their attempt to quit, and subsequently encourage them to stay smoke‐free.

A further review set out to assess the effects of psychosocial interventions to support pregnant women who are currently smoking or have recently quit, on smoking abstinence, continued postpartum abstinence, and infant outcomes.127 studies were reviewed and it was found that counselling and financial incentives probably support women to stop smoking, while health education, feedback, and social support may support women to stop smoking in late pregnancy, by an amount likely to be important. Psychosocial interventions may also reduce the proportion of infants born with low birthweight, increase mean birthweight, and reduce the number of infants admitted to neonatal intensive care. However, again, the study limitations mean that confidence in the evidence is limited. Also, few studies examined whether intervention effects differed across population groups, leaving insufficient evidence to determine how interventions might be tailored to improve effectiveness in priority populations.

Claire, R., Chamberlain, C., Davey, M.-A., Cooper, S. E., Berlin, I., Leonardi-Bee, J. and Coleman, T. (2020). Pharmacological interventions for promoting smoking cessation during pregnancy, Cochrane Database of Systematic Reviews, 3, CD010078.

Campbell, K., Coleman-Haynes, T., Bowker, K., Cooper, S. E., Connelly, S. and Coleman, T. (2020). Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: a qualitative evidence synthesis, Cochrane Database of Systematic Reviews, 5, CD013629.

Freijah, I., Jones, K. A., Coleman, T., Perlen, S. M., Kennedy, M., Passey, M. E., Mckenzie, J. E. and Chamberlain, C. (2026). Psychosocial interventions for supporting women to stop smoking in pregnancy, Cochrane Database of Systematic Reviews, 4, CD001055.

Financial incentives in Tayside and Glasgow

Scottish Government (2025) Learning from 25 years of preventative interventions in Scotland. Targeting Preventative Interventions: Financial Incentives for Smoking Cessation in Pregnancy, Edinburgh: Scottish Government.

MATERNAL OBESITY

Why it Matters…

A 2018 briefing from the Scottish Public Health Observatory (ScotPHO) provides an evidence summary on maternal obesity. It highlights the increased risk of pregnancy complications and increased risk of childhood obesity and behavioural and emotional problems that are associated with maternal obesity. It also highlights that women in the most deprived areas are more likely to obese than those living in the least deprived.

The annual ‘Births in Scotland’ figures from Public Health Scotland provide information on rates of maternal obesity in Scotland. The 2025 figures show that over a quarter (28.5%) of maternities were affected by obesity. The report highlights that maternal obesity has been increasing over time. The figures also show an inconsistent relationship between unhealthy weight and level of deprivation. At the start of pregnancy, women from more deprived areas were more likely to be obese (or underweight) than those from the least deprived. However, women from less deprived areas were more likely to be classed as overweight than those from the most deprived.

A ‘Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland’ used data from 132,899 first-time deliveries in Scotland between 2008 and 2015. It was found that compared with women with normal weight, the odds of gestational hypertension, gestational diabetes, pre-eclampsia, labour induction and emergency caesarean section were all increased for women with overweight or obesity.

The British Medical Journal (BMJ) published a large-scale systematic review and meta-analysis which used data from 1.6 million women across diverse world regions and income settings to study associations between gestational weight gain (GWG) and broad clinical outcomes. The review identified that GWG above recommendations was associated with higher birth weight and higher risk of caesarean delivery, hypertensive disorders of pregnancy, large for gestational age infants, macrosomia, and neonatal intensive care admission.

References

Scottish Public Health Observatory (2018) Maternal obesity: a short evidence summary, ScotPHO.

Public Health Scotland, Births in Scotland annual statistics.

Doi, L., Williams, A. J., Marryat, L. and Frank, J. (2020) Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland. BMJ Open, 10, e026168.

Goldstein, R.F., BahriKhomami, M., Tay, C.T. et al. (2025) Gestational weight gain and risk of adverse maternal and neonatal outcomes in observational data from 1.6 million women: systematic review and meta-analysis, BMJ, 391:e085710.

What Works…

RCP report recommending on action on wider determinants in England

The Royal College of Physicians (RCP) report on maternal health and obesity reports maternal obesity as a major and growing public health challenge. The focus is on England and the report calls for urgent action across the whole system to support women’s health before, during and after pregnancy. The link between obesity in pregnancy and higher rates of gestational diabetes, pre-eclampsia, caesarean birth and postpartum haemorrhage is highlighted. It is emphasised that obesity is a complex condition shaped by social, economic and environmental factors, rather than individual choice alone. A number of recommendations are made including include addressing the wider determinants of obesity, improving pre-pregnancy and professional education, developing integrated and culturally competent maternity and weight-management services, targeting health inequalities, strengthening data and surveillance systems, and investing in research on maternal obesity and obesity treatments.

Royal College of Physicians (2026) RCP view on maternal health and obesity. London: RCP.

Review on lifestyle interventions for maternal obesity

This review from 2021 collated the findings from 15 previous systematic reviews. It found that lifestyle interventions can help reduce gestational weight gain, but the magnitude of effect is generally small and evidence for improvements in pregnancy outcomes is less consistent. Differences between the included studies in the original reviews meant it was not possible to identify the most effective interventions. Also, overall, the certainty of the evidence was very low.

Fair, F. & Soltani, H. 2021. A meta-review of systematic reviews of lifestyle interventions for reducing gestational weight gain in women with overweight or obesity. Obesity Reviews, 22, e13199.

Review on the effectiveness of interventions to manage maternal obesity

This review of 21 studies found that weight-management interventions significantly reduced gestational weight gain and birth weight. Exercise interventions reduced the risk of gestational diabetes and large-for-gestational-age births, while combined diet and exercise interventions reduced pregnancy weight gain. The authors concluded that interventions can improve some outcomes, but beginning pregnancy at a healthy weight remains critically important.

Kurnaz, D. & Karaçam, Z. (2025) The effect of methods used in the management of maternal obesity on pregnancy and birth outcomes: a systematic review with meta-analysis. International Journal of Obesity, 49, 1013–1023.

Evaluation of a systems-level approach to obesity in pregnancy

The First 1000 Days Program in the USA is a systems-oriented intervention beginning in pregnancy and continuing through infancy. The programme combines screening for health behaviours and social needs, patient navigation, educational support, and tailored health coaching within existing healthcare systems. This evaluation study in the Boston, USA, area examined behaviour, psychosocial, and community resource connection changes in women from low-income households who participated in the First 1000 Days Program. The study identified improvements in obesity-related behaviours during pregnancy, including lower consumption of sugary drinks, increased physical activity, and reduced screen time. The programme was also reported to reduce excessive gestational weight gain among women who were overweight at the start of pregnancy.

Simione, M., Moreno-Galarraga, L., Perkins, M. et al. (2021) Effects of the First 1000 Days Program, a systems-change intervention, on obesity risk factors during pregnancy. BMC Pregnancy Childbirth, 21, 729.

Why it Matters…

Physical inactivity is recognised as a leading risk factor for non-communicable disease. Being physically active can therefore play a vital role in the prevention and management of many diseases and long-term conditions. The Scottish Government ‘Physical activity and sport‘ webpages set out policy on physical activity and participation in sport in Scotland. The ‘Framework for physical activity for health’ is highlighted, setting out actions to improve participation levels at both national and local level, and the site is updated with the latest policy developments and links to key organisations in Scotland involved in promoting physical activity. Public Health Scotland also has a gateway site to resources and policy on physical activity in Scotland.

Data on physical activity levels across Scotland, and the benefits of physical activity, are available on the Scottish Public Health Observatory (ScotPHO) and in the latest Scottish Health Survey. The 2024 figures show that around six in ten adults met the guidelines for moderate or vigorous physical activity, but that the proportion of adults meeting the MVPA guidelines decreased as area deprivation increased.

The ScotPHO site is made available by Public Health Scotland, who have also published a study ‘Estimating the burden of disease attributable to physical inactivity in Scotland’. The study presents data to highlight the link between non-communicable disease and inactivity and examines the impact of personal and structural inequalities. A model is presented estimating the ‘burden of disease’ attributed to inactivity related to ischaemic heart disease at multiple levels – national, health board and by local authority area. A follow-up report in 2024 identified just over 3,000 deaths per year in Scotland can be attributed to physical inactivity with cancer and cardio-vascular disease accounting for around one third of these.

References
Scottish Government, Physical activity and sport, URL:https://www.gov.scot/policies/physical-activity-sport/

Scottish Government (2024) ‘Framework for physical activity‘, Edinburgh: Scottish Government.

Public Health Scotland, Physical activity.

Scottish Public Health Observatory (ScotPHO), Physical activity.

Scottish Government (2025) ‘Scottish Health Survey 2024: volume 1: main report‘, Edinburgh: Scottish Government.

Townsend, N., Strain, T. and Foster, C. (2023) ‘Estimating the burden of disease attributable to physical inactivity in Scotland‘, Public Health Scotland.

Townsend, N. and Kelly, P. (2024) ‘The burden of disease attributed to physical inactivity. Estimating the disease burden attributable to physical inactivity in Scotland‘, Public Health Scotland.

What Works…

Systems-based approach to physical activity in Scotland

This report from Public Health Scotland describes a systems-based approach to physical activity that can be applied strategically at a national and local level. The aim of a systems-based approach is to move away from short-term, solitary interventions towards strategic cross-sectoral efforts that work in a complementary way to maximise limited resources and facilitate population levels of physical activity. The report describes the development of a number of strategic delivery outcomes and associated actions.

Public Health Scotland (2022) ‘A systems-based approach to physical activity in Scotland: a framework for action at a national and local level‘.

Policy solutions to barriers to physical activity

The briefing examines the evidence base regarding physical activity in Scotland to determine current barriers, identify knowledge gaps, and highlight potential policy solutions. The sport and physical activity landscape in Scotland is described with reference to poverty and inequality. Issues of social class, poverty, gender, and geography are explored as significant barriers to sport and physical activity participation.

Meir, D. and Scott, D. (2025) ‘Getting the inactive active: barriers to physical activity and their potential policy solutions‘, SPICe Briefing, Edinburgh: Scottish Parliament.

Reviews of public policies to increase physical activity

The study is a narrative synthesis of ‘reviews of reviews’ of public policies designed to increase physical activity among either youths or the community at large. Based on 12 reviews of reviews published between 2011 and 2022, seven potentially effective physical activity public policies were identified. Six of the seven were youth-based public policies that would be implemented in schools and the seventh was a policy aimed at establishing and promoting walking groups. The authors conclude that policymakers seeking to increase physical activity should consider focusing on school-based physical activity policies and community-based walking groups, as this is where the evidence base is greatest. Due to methodological limitations in the underlying literature and questions of generalisability and reproducibility, the authors advise conducting pilot studies to assess the efficacy of such programmes in local communities.

Alghannam, A. F., Malkin, J. D., Al-Hazzaa, H. M. et al. (2023) ‘Public policies to increase physical activity and reduce sedentary behavior: a narrative synthesis of reviews of reviews‘, Global Health Action, 16(1).

Reviews of place-based interventions to improve public-health, including increasing physical activity

Umbrella reviews are ‘reviews of other reviews’ – there is more information on them in the JBI Manual for Evidence Synthesis section on umbrella reviews. This study looks at systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. Thirteen reviews (covering 51 primary studies) were identified with almost all focusing on changing the physical environment. The outcomes measured included actions to increase physical activity through changes to the physical environment. Tentative evidence was found that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms – can all have positive impacts on health outcomes – particularly physical activity. The effect on health inequalities remains unclear.

McGowan, V. J., Buckner, S., Mead, R. et al. (2021) ‘Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review‘, BMC Public Health, 21, 1–17.

Active travel review

This review of 78 papers found that interventions combining infrastructure change with behavioural/social programmes, interventions involving e-bikes, and cycle-sharing schemes had the most impact on active travel levels. It was recommended that interventions aiming to change behavioural or social aspects of active travel should have long-term funding and should be accompanied by environmental and infrastructure changes, including road space reallocation and access to e-bikes.

Roaf, E., Larrington-Spencer, H. and Lawlor, E.R. (2024) ‘Interventions to increase active travel: a systematic review‘, Journal of Transport and Health, 38, 101860.

Actify

Actify is a free online platform aimed at anyone who wants to improve their own health and fitness, help others to be more active, or build better sports and physical activity programmes. The website includes examples of physical activity initiatives in Scotland. The ‘Active Health and Social Care’ folder is linked to the Scottish Government ‘Framework for physical activity’ and provides access to a number of local case studies and descriptions of national work.

ALCOHOL

Why it Matters…

‘Alcohol harms’ refers to a wide range of negative effects linked to alcohol consumption. Alcohol harms can results in a wide range of health problems, including liver disease, cancers, and type 2 diabetes. In addition to causing physical problems, excessive alcohol consumption can lead to mental health problems such as dependency. Public Health Scotland (2025) report that at a population level, alcohol-related harms include:

increased public spending in hospital admissions, healthcare, social services and law enforcement

crime, disorder and vandalism in communities

family and social relationship difficulties

widening inequalities in health

According to the Scottish Health Survey 2024 (Scottish Government, 2024a), adults living in the least deprived areas were more likely to drink to a hazardous or harmful level (26%) compared with those in the most deprived areas (15%). Public Health Scotland (2026) report that in the 10% most deprived areas of Scotland, the wholly alcohol attributable (diseases or injuries caused entirely by alcohol consumption) hospital admissions rate is over seven times higher than in the 10% least deprived areas. Furthermore, in 2024, alcohol-specific mortality rates were 4.5 times as high in the most deprived areas of Scotland compared to the least deprived areas (Scottish Government, 2024b). In contrast, for all causes of death, people in the most deprived areas are around twice as likely to die as those in the least deprived areas (Scottish Government, 2024b).

Differences in alcohol consumption and deaths causes by alcohol between men and women have also been found. In 2024, the proportion of males that drank to hazardous or harmful levels in Scotland was more than twice as high as that of females (29% and 13% respectively; Scottish Government, 2024a), while male deaths accounted for around two thirds of alcohol-specific deaths (Scottish Government, 2024b). At a local level, in Aberdeen City, Alcohol Focus Scotland (2026) report that 23% of people drink above the Chief Medical Officers’ low-risk guidelines, which includes 15% of women and 30% of men.

Preventing alcohol harm and reducing inequalities needs a public health approach, focusing on collaborative action, which aims to reduce the negative health, social, and economic consequences of alcohol use across entire populations, rather than targeting individuals alone (Public Health Scotland, 2025).

References

Scottish Government. (2024a). The Scottish Health Survey 2024 – volume 1: main report. Alcohol.

Scottish Government. (2024b). National Records of Scotland – Alcohol-specific deaths 2024.

Public Health Scotland. (2025). Alcohol-related harms.

Alcohol Focus Scotland. (2026). Local Alcohol harm profiles – Aberdeen City.

Public Health Scotland. (2026). Alcohol consumption and harms dashboard.

What Works…

Review of workplace interventions on alcohol prevention

The study aimed to quantify the effectiveness of workplace interventions addressing alcohol use by conducting a meta-analysis. The meta-analysis included a total of twenty intervention studies from nine countries with 4484 participants. The meta-analysis found that alcohol prevention in the workplace has a significant effect on alcohol use, specifically when focusing on a reduction of quantity of drinking, although the effect size was small. Because additional analyses did not find any significant differences between studies with regard to prevention program characteristics, it was concluded that programs are effective regardless of the way in which they are implemented at the workplace. Therefore, the met-analysis suggested that single and multiple applications programs that focus on alcohol and health, that are delivered either web-based or face-to-face, as well as group and individual settings, all have an impact on reducing alcohol consumption in individuals.

Fellbaum, L., Mojzisch, A., Bielefeld, L., Benit, N., & Soellner, R. (2023). The effectiveness of workplace interventions for the prevention of alcohol use: A meta‐analysis. Addiction, 118(11), 2043-2061.

Icelandic prevention model

In response to the high rates of adolescent substance use during the 1990s, Iceland has pioneered in the development of the Icelandic Model for Primary Prevention of Substance Use—a theory-based approach that has demonstrated effectiveness in reducing substance use in Iceland over the past 20 years. Since the original development of the model, Iceland has led the decline in substance use in all of Europe. In 2015, average rates of current alcohol use were 48% in Europe but 9% in Iceland. Corresponding to these changes in alcohol and other substance use, Iceland had also witnessed large reductions in risk factors and strengthening of protective factors. This model has informed the Planet Youth approach, which has been adopted in Scotland.

Kristjansson, A. L., Mann, M. J., Sigfusson, J., Thorisdottir, I. E., Allegrante, J. P., & Sigfusdottir, I. D. (2020). Development and guiding principles of the Icelandic model for preventing adolescent substance use. Health Promotion Practice, 21(1), 62-69.

Review of community approaches to reduce alcohol harm

This narrative review synthesises harm-reduction approaches for alcohol evidence across policy-, population-, community-, and individual-level interventions. Policy interventions, including taxation, minimum unit pricing, and outlet density restrictions, consistently reduce alcohol consumption and associated harm. Population-level campaigns improve knowledge and attitudes; however, effects on drinking behaviours are mixed, and stronger effects are observed when paired with policy or community strategies. Community-level interventions – most notably Housing First (provides immediate, permanent, low-barrier, nonabstinence-based housing to people experiencing chronic homelessness) and managed alcohol programs (provide beverage alcohol in scheduled, medically managed doses within supportive housing, shelters, or community service settings) – offer pragmatic, non-abstinence-based supports that improve stability, reduce high-cost service use, and enhance quality of life for marginalised groups.

Stockings, E., Shakeshaft, A., & Farrell, M. (2018). Community approaches for reducing alcohol-related harms: an overview of intervention strategies, efficacy, and considerations for future research. Current Addiction Reports, 5(2), 274-286.

Delivering alcohol brief interventions in youth projects

The aim of this qualitative study was to explore the context, feasibility and acceptability of Alcohol Brief Interventions (ABIs) delivery in youth work projects across Scotland. Individual, paired and group interviews were conducted with practitioners and young people in nine community projects that were either involved in the delivery of ABIs or were considering doing so. The study findings suggest that ABIs are both feasible and acceptable in community youth work settings. Practitioners perceived that there was value and benefit in speaking with young people about alcohol in ways that fitted with the broad definition of ABIs. Young people were generally positive about the idea of having conversations with project staff about alcohol. ABI delivery in youth work settings was considered an important mechanism to reach young people who reported avoiding health services.

Stead, M., Parkes, T., Nicoll, A., Wilson, S., Burgess, C., Eadie, D., … & Bauld, L. (2017). Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study. BMC Public Health, 17(1), 357.

Delivering alcohol brief interventions for people aged 50+

This study aimed to investigate the acceptability of conducting Alcohol Brief Interventions (ABIs) in UK community venues for people aged 50+. ABIs were offered opportunistically in a range of community venues; quantitative data on all ABI respondents were also collected to explore the characteristics of those willing to take part. Acceptability of receiving an ABI in a community venue was assessed via qualitative interview with a sub-set of ABI recipients and ABI practitioners. The results of this study demonstrate it is acceptable to deliver alcohol screening and brief intervention in community venues to an older population. The knowledge gained from participating in ABI motivated many to consider changing their drinking behaviour, with two-fifths of hazardous drinkers who were asked, reporting the intention to reduce their alcohol intake. ABIs delivered in community venues have the potential to normalise conversations about alcohol and engage older people who may not have been asked about their use of alcohol before.

Seddon, J., Bareham, B., Kaner, E., Hanratty, B., & Wadd, S. (2025). The acceptability of alcohol screening and brief intervention for older adults in community venues. Drug and Alcohol Review, 44(1), 37-47.

Evaluation of minimum unit pricing in Scotland

The aim of this paper was to estimate the effect of alcohol minimum unit pricing (MUP) legislation in Scotland on deaths and hospitalisations wholly attributable to alcohol consumption. The implementation of MUP legislation was associated with significant reductions in deaths, and reductions in hospitalisations, wholly attributable to alcohol consumption. Exploratory analyses indicated that the largest reductions were estimated in the 40% most socioeconomically deprived areas in Scotland, indicating that the implementation of MUP has had a positive impact in tackling deprivation-based health inequalities in alcohol health harms.

Wyper, G. M., Mackay, D. F., Fraser, C., Lewsey, J., Robinson, M., Beeston, C., & Giles, L. (2023). Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study. The Lancet, 401(10385), 1361-1370.

DRUGS

Why it Matters…

The annual National Records of Scotland figures for drug-related deaths in Scotland highlight the extreme end of drug misuse in Scotland. The figures show that in 2024, there were 1,017 drug misuse deaths registered in Scotland, a decrease of 13% compared with 2023. Drug misuse deaths have increased over the last two decades to their peak in 2020. They have generally decreased since then, with the exception of a 12% increase in 2023. It is noted that the age profile of drug misuse deaths has become older over time. The average age of drug misuse deaths has increased from 32 years in 2000 to 45 years in 2024. Also, in 2024, people in the most deprived areas of Scotland were 12 times as likely to have a drug misuse death compared to people in the least deprived areas.

The Public Health Scotland gateway site on drugs has information on the treatment and prevention of drug misuse and sources of surveillance, data and intelligence. It includes a link to the Rapid Action Drug Alerts and Response (RADAR) alerts which are issued by Public Health Scotland on a quarterly basis. The RADAR alerts validate, assess and share up-to-date information to reduce the risk of drug-related harm.

The Scottish Public Health Observatory (ScotPHO) has information on the Health Harms and the Social Harms of drug misuse. Alongside the danger to life, statistics are presented on the physical and psychological problems associated with drug use and potential consequences of drug use on the user’s social situation, their family and the wider environment. ScotPHO also has information on the availability and prevalence of drugs in Scotland.

References

National Records of Scotland. Drug-related deaths.

Public Health Scotland. Population health: improving Scotland’s health: drugs.

Public Health Scotland. Rapid Action Drug Alerts and Response.

Scottish Public Health Observatory (ScotPHO). Drug use: health harm.

Scottish Public Health Observatory (ScotPHO). Drug use: social harm.

Scottish Public Health Observatory (ScotPHO). Drug use: availability and prevalence.

What Works…

Scottish Government drug misuse page

The Scottish Government Drugs policy page is the ‘gateway’ site into policy actions to reduce drug-related misuse in Scotland. The 2026 report on ‘Preventing harm, promoting recovery: Scotland’s alcohol and drugs strategic plan 2026 – 2035’ is a key paper setting out the Scottish Government and COSLA’s long-term approach to addressing alcohol and drug harms. The core aims are described as “prevent harm, promote recovery and save lives’. The paper advocated for a person-centred approach which is locally led and guided by national direction and support.

The site also has information on responses to drug emergencies, harm reduction, drug workforce, data and surveillance of drug misuse and monitoring drug misuse. Harm reduction is highlighted as a key underlying principle for drugs policy in Scotland and there is a link to the report ‘A caring, compassionate and human rights informed drug policy for Scotland’. The report proposes an evidence-based public health approach to drug policy. The ‘Person-centred approaches‘ section (to both alcohol and drug misuse) has information on prevention and early intervention initiatives, including the ‘Planet Youth’ prevention scheme and the ‘Routes’ scheme aimed at supporting young people affected by substance use within their families.

Scottish Government, ‘Alcohol and drugs: drugs.

Planet Youth

Planet Youth is a model designed to improve young people’s health, wellbeing and relationships. It is based on the Icelandic Prevention Model (IPM) – a data-driven approach to preventing substance use. At its heart is community collaboration, involving: schools, parents and carers, local services, businesses and young people themselves. The model has been adapted in communities around the world and is being piloted in six areas in Scotland. The key principles are: change the social environment, not just individual behaviour; build protective factors across schools, families, peer groups, and leisure time; engage young people directly, amplifying their voices and lived experience; and ground all actions in detailed, local, and regularly collected data. The ‘Towards a primary prevention model: lessons for Planet Youth’s Scotland’s pilot‘ report in 2025 outlines the background and aims of the project in Scotland and progress made, including local examples of actions that have been implemented.

Planet Youth in Scotland.

Consensus approach to substance harm reduction among children and young people

Public Health Scotland set out to establish consensus and describe the key themes that contribute to a national approach to substance use harm prevention among children and young people in Scotland. A Delphi process was followed with the aim of establishing what a whole-systems approach should look like. The expert panel of stakeholders included public health officials, academics and educators, youth workers, and individuals working in health, mental health, recovery, addiction services, social work, education services, third sector. Through Young Scot, YouthLink Scotland, Fast Forward, Time 4 Us within Transform Forth Valley and Children’s Parliament, children and young people were involved throughout the process.

The panel agreed on the need for a whole-systems approach that fosters collaboration across different sectors and groups. It also recognised the need to involve children and young people in the development and implementation of prevention strategies and approaches.

A findings report and a technical report are available.

Public Health Scotland. (2025). Consensus approach on prevention of substance use harm among children and young people.

Review of the whole family approach

The literature review identifies limited clarity in terms of a definition of a whole family approach, and a need for a general shift in understanding of family structures from primarily defined according to biological ties, to a wider more socially constructed concept which includes individuals not directly related. A holistic approach is recommended where family members affected by the issue are involved in the co-design of the whole-family intervention. Also, the wider context in which substance use occurs and its driving factors (e.g. poverty, trauma) needs to be considered and addressed. Long term, consistent and timely support and good therapeutic relationships are associated with an increased likelihood of positive outcomes. Workforce issues are identified, including challenging negative attitudes, skills training and the need for collaboration across agencies.

Scottish Government. (2023). Whole family approach: rapid review of literature.

HDRCA review on social determinants of health and drug use initiation

The review found that drug initiation is shaped by a complex interplay of social determinants, including poverty, adverse childhood experiences, mental health challenges, and peer influence. Early exposure to trauma and lack of protective factors such as stable housing and supportive relationships were consistently linked to higher risk. Evidence suggests that interventions focusing solely on individual behaviour have limited impact unless combined with structural measures addressing inequality and social support. Overall, the report recommends a multi-agency approach prioritising prevention through upstream interventions – such as improving family support, education, and community resilience – alongside targeted programmes for at-risk groups. It also calls for better data sharing and evaluation to inform future strategies.

Ho, L. (2025). ‘Impacts of social determinants of health on drug use initiation: a rapid evidence review‘, Health Determinants Research Collaboration Aberdeen.

Whole systems response to drug prevention

The report from the Advisory Council on the Misuse of Drugs argues that effective drug prevention requires a coordinated, long-term, whole-systems approach that extends beyond health services to include families, schools, communities, local authorities, and national government. The report synthesises evidence on universal, targeted, and indicated prevention interventions and emphasises addressing the wider social determinants of drug use, including poverty, adverse childhood experiences, education, and community environments. It concludes that prevention should be embedded across the life course, supported by cross-sector collaboration, evidence-based practice, and sustained investment, with the aim of reducing both drug use and related harms among young people throughout the UK.

Advisory Council on the Misuse of Drugs. (2025). A whole-system response to drug prevention in the UK. Home Office.

GAMBLING

Why it Matters…

There is a number of types of gambling legally available in Great Britain ranging from the National Lottery to online gambling, playing bingo to betting or gambling on slot machines or casino table games. The variety of gambling options, particularly online has increased significantly over the past decade. The Scottish Health Survey 2021 – Volume 1: Main Report – chapter 6 – gambling

Many people gamble without experiencing any adverse effects but there are some people who experience difficulties with gambling which can result in spending more time and money gambling than they would like to, or spending money that they may be unable to afford. Introduction – ScotPHO

Figures from the 2021 Scottish Health Survey indicate that around 0.4% of the adult population, equivalent to around 18,000 people, were problem gambling based on either the DSM V score or on the Problem Gambling Severity Index (PGSI) score. A further 1.5% experienced moderate risk gambling based on their PGSI score, an estimated 68,000 adults. The Scottish Health Survey 2021 – Volume 1: Main Report – chapter 6 – gambling

Gambling can have adverse impacts on the health and wellbeing of individuals, families, communities and society, including loss of employment and debt, deterioration of physical and mental health problems which can lead to an increased risk of suicide among individuals affected by problem gambling. The consequences of problem gambling therefore, can be significant and have deleterious effects, not only for the individual, but for their families, friends and communities.

Current policy and regulation of gambling is not currently devolved to the Scottish Parliament. Policy responsibility for gambling is held by the UK Department of Culture, Media and Sport and is regulated by the Gambling Commission with the main legislation being The Gambling Act, 2005 (The Act).

Unlike other public health areas like alcohol or drugs, there are no policy recommendations about recommended levels of gambling, despite problem gambling being recognised as a behavioural addiction. Many academics, health professionals, regulatory bodies, charities and politicians are increasingly advocating for a public health approach to gambling. Scottish Parliament (SPICe Briefing – Scottish Parliament) 2022. A Public Health Approach to Gambling Harms

As of November 2024, The UK Government’s Department of Culture, Media, and Sport has announced a new statutory levy to raise £90–£100 million annually to address gambling harm in Great Britain [with input from the Scottish and Welsh parliaments] to be enforced by April 2025. Further details on the distribution and use of the levy funds, and guidance is expected. ScotPHO (Scottish Public Health Observatory) Gambling: policy context

What Works…

Umbrella review of prevention and harm reductions on gambling behaviours

The study aimed to evaluate the systematic review evidence base on the effects of prevention and harm reduction interventions on gambling behaviours, and gambling related harm. The study also aimed to examine differential effects of interventions across socio-demographic groups.

Ten systematic reviews were identified and reported on 55 unique relevant primary studies. Much of the review evidence-base related to pre-commitment and limit setting (24%), self-exclusion (20%), youth prevention programmes (20%), and machine messages/feedback (20%). The effectiveness of harm reduction interventions are limited by the extent to which users adhere to voluntary systems. Less than half of studies examining youth prevention programmes demonstrated positive effects on behaviour. No review extracted data or reported on the differential effects of intervention strategies across sociodemographic groups. The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted. The evidence base is dominated by evaluations of individual-level harm reduction interventions, with a scarcity of research on supply reduction interventions, and review conclusions are limited due to the quality and robustness of the primary research. Recommendations that future research should consider the equity effects of intervention strategies.

McMahon, N., Thomson, K., Kaner, E. and Bambra, C. (2019). Effects of prevention and harm reduction interventions on gambling behaviours and gambling related harm: An umbrella review, Addictive Behaviors, 90, 380-388.

Mapping review of interventions to reduce public health burden of gambling-related harms

This study identified review-level evidence for interventions to address or prevent gambling-related harms and explore policy implications, using stakeholder consultation to assess the evidence base, identify gaps, and suggest key research questions. The study was a systematic mapping review and narrative synthesis for all forms of gambling in any setting and included participants from the whole population, identified gamblers including self-defined, and specific populations at risk (eg, children and young people).

In total, 30 papers were included in the review which identified whole-population preventive interventions, such as demand reduction (n=3) and supply reduction (n=4) interventions with this greatest number of studies identified which targeted treatment interventions for individuals addicted to gambling, such as therapeutic (n=12), pharmacological (n=5), and self-help or mutual support (n=4) interventions. Two studies (n=2) were found comparing these approaches. Interventions to screen, identify, and support individuals at risk of gambling-related harms and interventions to support ongoing recovery and prevent relapse for individuals with a gambling addiction were not represented in the review-level evidence.

A public health approach suggests that there are opportunities to reduce gambling-related harms by intervening across the whole gambling pathway, from regulation of access, to gambling, to screening for individuals at risk, and services for individuals with an identified gambling problem. The dearth of evidence for some interventions means that implementation must be accompanied by robust evaluation.

Blank, L., Baxter, S., Woods, H.B. and Goyder, E. (2021). Interventions to reduce the public health burden of gambling-related harms: a mapping review, The Lancet Public Health, 6(1), e50-e63.

Delphi panel consensus study on reducing harmful gambling

The aim of this study, focusing on policies and interventions, was to determine if expert consensus could be reached on measures perceived to be effective and could be implemented successfully. A starting set of 103 universal and targeted measures, which were sourced from several key resources and inputs from public health stakeholders, were grouped into seven domains: price and taxation; availability; accessibility; marketing, advertising, promotion, and sponsorship; environment and technology; information and education; and treatment and support.

A summative threshold criterion was used to select a final optimal set of measures for England. The panel reached consensus on 83 (81%) of 103 measures. The remaining 81 effective measures were drawn from all domains. During the evaluation exercise, the 81 measures were assessed for likelihood of implementation success. This assessment considered the practicality, affordability, ability to generate unanticipated side-effects, and ability to decrease differences between advantaged and disadvantaged groups in society of each measure.

We identified 40 universal and targeted measures to tackle harmful gambling (three measures from the price and taxation domain; ten from the availability domain; five from the accessibility domain; six from the marketing, advertising, promotion, and sponsorship domain; eight from the environment and technology domain; three from the information and education domain; and five from the treatment and support domain). Implementation of these measures in England could substantially strengthen regulatory controls while providing new resources. The findings of our work offer a blueprint for a public health approach to preventing harms related to gambling.

Regan M, Smolar M, Burton R et al. (2022). Policies and interventions to reduce harmful gambling: an international Delphi consensus and implementation rating study, The Lancet Public Health, 7, e705-e717.