Image source, Science Photo Library

Scotland may need to introduce unpopular policies as part of a bold approach to tackling the country's obesity problem, according to MSPs.

In January, Holyrood's health committee said measures such as restricting cars in towns and increasing parking charges would be politically unpopular.

But they said the policies could also encourage people to be more active.

Almost two thirds (65%) of adults in Scotland were overweight in 2015, including 29% who were obese.

Meanwhile, 28% of children were at risk of becoming overweight, with 15% at risk of obesity.

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SNP MSP Jenny Gilruth asks for examples where work done by NHS Health Scotland to tackle health inequalities through education.

Dr Andrew Fraser from NHS Health Scotland cites the success of HPV immunisation.

He also says the organisation works with Education Scotland.

Gerald McLaughlin raises the issue of tackling childhood obesity. 

Mr Smyth asks if it is strange that public services have to be lobbied to tackle health inequality.

The Labour MSP says it seems NHS Health Scotland is a lobbying organisation. 

NHS Health Scotland chief executive Gerald McLaughlin says he would not say it is a lobbying organisation and that he's worked for them before. 

Dr Andrew Fraser from NHS Health Scotland says "Health in all Policies" may be a slogan but he would like to see NHS Health Scotland everywhere.

He says it is about whether they are listened to. 

Gerald McLaughlin says NHS Health Scotland work across a whole range of organisations including the third sector. 

Labour MSP Colin Smyth says there is still a perception that the government's approach to health focuses on what the NHS can do rather than what else can be done.

Mr Smyth asks if enough is being doe to tackle inequality in Scotland at the moment.

NHS Health Scotland chief executive Gerald McLaughlin says "no" but that things are improving. 

Mr McLaughlin says there are encouraging signs.

He says it can be difficult to free up resources to focus more on a joint effort and there is a role for public services. 

Mr McLaughlin says "simply telling people to be more active will not achieve it". 

Committee convener Neil Findlay asks about cuts to local government budgets.

Dr Andrew Fraser from NHS Health Scotland says less resource available means they can do less to alleviate the effects of health inequalities. 

NHS Health Scotland chief executive Gerald McLaughlin says the government's announcement so far is to reform the national landscape.

Mr McLaughlin says local government are now engaging with it and this will bring in local issues.

SNP MSP Tom Arthur asks what role politicians have in communicating this to constituents.

NHS Health Scotland director public health science Dr Andrew Fraser says happy patients and doctors do not necessarily want to see change. 

Dr Fraser says the argument for having a national health agency is that things can be done "once and well". 

He says cleft palate decisions are best made at national level to get the best use of the public pound.

Image source, Thinkstock

Plans to centralise cleft palate and lip surgeries in Glasgow have been approved by the Scottish government.

The move will mean the closure of surgical services in Edinburgh for the condition, which affects 100 babies born in Scotland every year.

Campaigners against the proposal said it would make life more difficult for families on the east coast.

But Health Secretary Shona Robison insisted it would ensure a "safe and sustainable service" for patients.

Surgery can help babies born with cleft lips or palates to eat and talk when they are older, with Scotland currently having two clinics - in Edinburgh and Glasgow - which specialise in the procedure.

Read more here.

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Tory MSP Miles Briggs raises the issue of Edinburgh cleft palate surgery being moved to Glasgow.

Mr Briggs raises concerns about centralisation of services.

Dr Andrew Fraser from NHS Health Scotland says courageous decisions about interventions in rare diseases must be taken.

Dr Fraser says there must be fewer better centres to free up resources, which means making difficult decisions.

He says patients will accept this if they understand the outcomes and allocation of resources.

Tory MSP Miles Briggs says the committee has done a lot of work on community empowerment. 

Mr Briggs asks how people are being engaged in this.

NHS Health Scotland director public health science Dr Andrew Fraser says community engagement is an important part of improving health. 

Dr Fraser says voluntary organisations must be supported. 

He says there is a job to do to make people aware of community empowerment on the ground.

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SNP MSP Maree Todd lists things she says are not within the control of Holyrood and says this is extremely frustrating.

NHS Health Scotland chief executive Gerald McLaughlin says he shares that frustration.

Mr McLaughlin says Scotland's health compared across Europe has improved at a slightly slower rate than other countries.

He says it is those whose health is poorest who are making the least progress. 

SNP MSP Maree Todd says the Westminster government are decreasing benefits and has targeted disabled people. 

Ms Todd says it is impossible for the Scottish Parliament to tackle inequality because of this.

NHS Health Scotland director public health science Dr Andrew Fraser says his job is to study and research welfare reforms as they are happening. 

Dr Fraser says he will begin to see the effects of welfare reforms on health now and will report back on it.

NHS Health Scotland chief executive Gerald McLaughlin says policy in Scotland can have a real impact on public health.

Mr McLaughlin says there are things that can be done in Scotland to improve inequality. 

NHS Health Scotland chief executive Gerald McLaughlin says his organisation is responsible to Holyrood.

SNP MSP Tom Arthur asks if NHS Health Scotland can achieve its goal without engagement with the UK government, citing the family tax credit cap.

Dr Andrew Fraser says NHS Health Scotland works to the Scottish government but also works with NHS England and other agencies down south.

Mr Arthur asks if the Scottish government is limited to mitigation.

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Dr Fraser says he is not inventing excuses for the limitations of what NHS Health Scotland can do.

He says: "We are extremely worried and frustrated by the direction which welfare is going."

He calls for the evidence and data at a population level.

NHS Health Scotland chief executive Gerald McLaughlin says there are positive signs around the fair work and good work.

Mr McLaughlin says NHS Health Scotland has made a number of contributions to the Fair Work Convention. 

He says the evidence shows that mximising the income available to families has an impact on health. 

Dr Andrew Fraser from NHS Health Scotland says there is a great deal that can be done at national level.

Dr Fraser says a national agency such as NHS Health Scotland needs to exist to press the case of tackling health inequalities.

Committee convener MSP Neil Findlay syas there has been no improvement in health inequalities since 2009-2010.

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Mr Findlay asks: "So who is failing?

Dr Andrew Fraser from NHS Health Scotland says: "I'd like to say not us." 

Mr Findlay says the "bloody frustrating thing" is health inequalities are widening.

Dr Fraser says NHS Health Scotland  is trying to build consensus but he admits not all the decisions he would like to see being taken are not being taken. 

Tory MSP Donald Cameron asks where NHS Health Scotland will fit into the vision for the new public health body.

NHS Health Scotland chief executive Gerald McLaughlin says there is an aim to leave a strong legacy for the new body. 

Mr Cameron says there is a cluttered landscape with a lot of duplication. 

Mr McLaughlin says he is very confident that the national health improvement strategy will only be strengthened by work carried out. 

Douglas Fraser
Scotland business & economy editor

The most deprived fifth of Scots are nearly eight times more likely to be admitted to hospital with an alcohol-related problem than the least deprived fifth.

But it's a more complex picture than you might think. Solving it is certainly a very complex challenge.

Some symptoms of deprivation include a higher incidence of obesity, poor diet, little exercise, heavy drinking, and drug dependency. A lot of the effort that goes into addressing inequality is directed towards those symptoms.

But the underlying causes, according to public health experts, are a long way from those relatively straight-forward symptoms. They have more to do with the distribution of power, income and resources.

The ability to remain relatively healthy is greater if there is more of an incentive, access to an affordable healthy diet is straight forward, if housing isn't damp and adequate in size, and if air quality is good.