Scotland and the public health politics of independence

When the Scottish government published its white paper setting out the case for independence, Scotland’s Future,1 public health policy was central to its account of the Scottish parliament’s achievements. An emphasis on tackling longstanding health problems through legislation for smoke-free public places and minimum unit pricing for alcohol was unsurprising given the status of these policies as landmark achievements of devolution and the praise lavished on the commitment of successive governments to deal with health inequalities.2

The white paper depicts independence as conferring the ability “to use the full range of levers to promote good health,” yet it is noticeably lacking in specific public health policy commitments. More broadly, the future of public health has received limited attention in the unfolding debates preceding the forthcoming referendum. Discussion of health issues on the pro-independence websites of the “vote yes” campaign and the Scottish National Party focuses on the future of the NHS, while BMA Scotland restricts its guidance on the implications of independence to medical education, training, and professional matters.3 An analysis of how the existing constitutional settlement has shaped developments in public health is needed to inform consideration of alternative futures.

When political devolution took effect in Scotland and Wales in 1999, it was expected to stimulate health …