Towards a preventative approach to improving health and reducing health inequalities: a view from Scotland

Pressures on the health system are intense. Prevention is often seen as a sustainable way to manage these pressures. However, the impact of prevention on the demand for health and social care is not fully understood. It will reflect the balance of opposing forces: reduced needs for health and social care because of improving health and increased needs associated with increasing life expectancy and the diseases of old age, mediated by how the system manages the resulting pressures. This article illustrates how some of these factors are playing out in Scotland. The article also highlights the substantial growth in the evidence base on the economics of prevention and identifies policy developments with the potential to support a shift to prevention that might help move towards more sustainable demands on the health and social care system. These include recognition of the importance of the social determinants of health, the integration of health and social care and ‘realistic medicine’. The article suggests that more use needs to be made of available evidence on the economics of prevention and that all stakeholders need to be engaged in tackling the technical and political challenges posed by the shift to prevention.