New figures on healthy life expectancy landed in Scotland with a familiar sense of disappointment last month. Scots can now expect to live longer lives but spend more of those years in poor health and we remain at the bottom of UK league tables. Yet behind the national average lies an even starker reality: the gap in healthy years between our most and least advantaged communities is measured in decades. This gap is not down to bad luck or an accident of biology, rather it reflects the political choices and omissions that allow an unequal and extractive economy that drives poverty, hunger, hopelessness, and despair.
Those of us who care about population health and wellbeing, respond to these statistics in predictable ways. We analyse, we warn and we call for national action. In this space we are exceptionally good at producing policy briefings that we use to implore politicians into action. But in our urgency, we often skip over a fundamental truth:
Politicians act when voters demand it
Right now, the demand for fair, preventive and equity driven policy is simply not loud enough to compete with the polarising discourse shaping public opinion. Support for the populist right is rising across the UK and Scotland cannot afford to think we’re immune to a prevailing wind of blame, prejudice, division and stigma.
Population health and politics are inextricably linked but we stick firmly to politics spelt with a small p. If we want to amplify the conditions that create health, we need to step into the political arena with more clarity, confidence and purpose. Speaking in caveats and qualifiers is no longer enough to counter the malevolent forces that pin health inequalities on personal misfortune, individual failure and blame our most disadvantaged people.
Credibility is not enough
A credible blueprint for a fairer Scotland already exists. This includes ideas already in political debate: putting health in all major government decisions, shifting towards a wellbeing economy, eradicating child poverty, improving housing quality and affordability, and regulating harmful commercial practices. There is nothing radical or out of reach in this list.
But rigour and drive do not automatically translate into public demand. Too often, us evidence-driven professionals speak upwards, briefing ministers, refining manifestos, submitting consultation responses. We assume that if our rationale is strong enough, political leaders will act. But while legislation may be passed in Parliament, the mandate for that legislation is built in living rooms, workplaces, community halls and online spaces.
If the electorate is not demanding action, progressive policy becomes fragile. Now is the time to make progressive legislation feel like common sense and imagine a Scotland where everyone can flourish.
Who is deserving?
But increasingly it seems we have work to do here. As times get harder and everyone feels the strain, progressive policy can be vilified as help for people who are undeserving, or people who bring their own downfall upon themselves. Yet both targeted interventions and societal wide actions benefit the whole country.
Warm, affordable homes reduce illness.
Fair incomes and stable work lift families out of poverty.
Affordable and healthy foods build strong and healthy bodies.
Safe streets, clean air and reliable transport make healthy living part of daily life.
Green space and vibrant communities make us feel good.
Strong local networks create connection, opportunity and hope.
These are universal investments with universal returns. When people see how they improve everyday life for themselves and their families, progressive policy becomes compelling common sense. To counter stigmatising narratives, we need to stop theorising and show these benefits clearly and concretely.
The health and equity community must do politics differently
We can remain non-partisan while being far more politically astute. The question is not whether we enter party politics, we shouldn’t. The question is whether we are willing to take our in-depth understanding of health creation into the mainstream.
That requires a shift in mindset and method and how we articulate the what, the so what, the how:
1. Speak to voters, not just ministers
Persuasion cannot be constrained to parliamentary committees. We need to build public appetite for prevention, fairness and long-term thinking. That starts by talking in human terms, not technical ones.
2. Focus on a small number of clear, costed proposals
People vote for what will make a difference to their lives now and not theoretical frameworks. A short set of clear proposals, explained through the lens of how they make everyday life better, should sit at the centre of meaningful community engagement.
3. Build relationships, not transactions
Trust is currency that grows through presence, honesty and following through on promises. Strong relationships create the foundations for shared purpose. Let real people guide the agenda from the start so communities feel respected and confident to shape change.
4. Shift power back to communities
A fairer, healthier economy depends on recognising where power sits and moving it closer to the people affected by decisions. Sharing decision-making and resources allows communities to lead, not simply respond. When power is local, action becomes more grounded and more effective.
5. Collective leadership
No single organisation can shift societal attitudes. Cross sector alliances and local partnerships create momentum that makes progressive policy politically irresistible. Collective leadership means doing with rather than doing to, and amplifying voices that are too often overlooked.
2026, a pivotal year for Scotland
The Scottish Parliament election on 7 May 2026 is an opportunity to reset Scotland’s direction after a decade of stalled or declining healthy life expectancy. Scotland has led before, on smoke free public spaces, on the Scottish Child Payment, on minimum unit pricing. We can lead again, but only if we stop assuming good policy sells itself.
People care about whether their children are fed and can breathe clean air, whether their heating is affordable, whether their community is safe and if their neighbourhood is a good place to live. We must appeal to hearts and minds with creative storytelling that a better future is possible.
The new healthy life expectancy statistics are a call to action and not a pre-determined destiny. The choice is in our hands – will we continue to describe problems in ever finer detail while the political ground shifts beneath us, or will we roll up our sleeves and build a shared mandate for a Scotland that thrives, for a country where everyone has a fair chance to live a long and healthy life?
I know which vision I want to create for Scotland’s future generations.
Alison McGrory is Associate Director – Public Health at NHS Highland – Argyll & Bute Health and Social Care Partnership