Prevention happens in communities: why Scotland’s third sector is vital to better health
If we are serious about improving Scotland’s health, reducing health inequalities and creating sustainable public services, we need to think differently about where prevention happens and what that means for how we use our resources.
We know our health is shaped by far more than healthcare. The circumstances in which we are born, grow, live, work and age profoundly affect our chances of living a long and healthy life.
Prevention therefore doesn’t begin when someone arrives at a hospital or GP practice. It happens much earlier, in families, neighbourhoods, workplaces and communities.
Third-sector and community organisations work in exactly these spaces. They are not simply partners in prevention. They are part of the infrastructure that makes prevention possible.
Prevention depends on relationships
One of the third sector’s greatest strengths is trust.
Community and voluntary organisations often have deep relationships with the people and places they serve. They understand what matters locally, can reach people who may not engage easily with statutory services and can recognise problems before they escalate. They also help ensure that the experiences of people and communities shape decisions.
However, prevention is not the sole responsibility of the third sector, any more than responding to illness and crisis is solely the responsibility of statutory services. The strongest approach comes when the public sector, communities and the third sector bring their different strengths together.
We cannot call the third sector essential and fund it as though it were optional
We increasingly talk about prevention, community-based support and addressing the wider factors that shape health. Yet many organisations best placed to contribute continue to face short-term and uncertain funding.
When preventative capacity disappears, the need does not disappear with it. It turns up somewhere else, often later and when problems are more difficult and expensive to address.
If we expect organisations to invest in people, build trusted relationships and work alongside communities, our approach to funding needs to support that long-term role rather than repeatedly treating it as a series of short-term projects.
And not every community starts from the same position. If community capacity is part of our preventative infrastructure, strengthening it where need is greatest must itself be part of tackling health inequalities.
Prevention has to make sense across the whole system
There is another issue we need to tackle. The organisation investing in prevention may not be the organisation that sees the benefits.
Investment in community support may create benefits across the system, including by preventing or reducing demand on the NHS, social care, homelessness services, policing or elsewhere. Yet our funding and accountability arrangements often incentivise investment decisions to be considered through the lens of individual organisational budgets.
That can create decisions which make sense for one organisation but much less sense for people, communities or the public purse as a whole.
None of this means choosing between meeting today’s needs and investing in prevention. We have to do both. But unless we protect the capacity that prevents problems arising or escalating, we will continue spending more and more of our resources responding after the damage has been done.
That means fewer short-term, fragmented funding pots, more multi-year funding, resources directed according to population need, and better recognition of the benefits investment creates across the whole system.
From delivery partner to strategic partner
Funding is only part of the answer.
If we are serious about reducing health inequalities, we also need to think about who has a voice in decisions.
Prevention works best when we design with communities rather than simply for them. That means communities themselves having a meaningful voice in decisions, with third-sector organisations playing an important role in supporting participation and bringing their own knowledge and experience. Third-sector organisations should also be involved when priorities are set and resources allocated, not simply asked to deliver projects afterwards.
That means recognising the third sector as a strategic partner in improving health, not simply a delivery partner.
Making prevention how our system actually works
Scotland already has significant ambition around prevention. The challenge is translating that ambition into how our system actually works.
This is not about the third sector replacing the public sector. It is about recognising that if relationships, support and capacity within communities help keep people well and prevent problems escalating, we need to value and invest in them accordingly.
This is a challenge for all of us working across the public sector, including PHS. We need to consider how our own decisions, partnerships and use of resources support the shift towards prevention.
If we are serious about prevention, we need to invest in the people, relationships and capacity that keep people well and prevent problems escalating. That means recognising the third sector not as an optional extra, but as an essential part of how we improve health and reduce inequalities.
Written by Ruth Glassborow, Director of Population Health and Wellbeing at Public Health Scotland
