All health promotion and health promoting services must be carefully planned and monitored in order to ensure increased benefits for health and wellbeing for all. If not well-managed, these additional investment options could lead to potential unintended negative consequences, such as widening health inequalities or reduced services, particularly for people who are more vulnerable or in difficult conditions. Financing public services is an inherently ethical decision.


In this e-guide we discuss ethical guidelines between investors and services. However, we must stress that this e-guide is in no way supportive of the implementation of charges or increases in charges for users of any public service. Nor is it a call for the easy to reach or easy to fund programmes to be sold off for quick financial profit. Rather, with this e-guide we are making a call to place an ethical framework at the centre of decisions made to improve health promoting services and the health of all people. What do we mean by this? We mean that an ethical perspective involves taking into account societal, environmental, universality, and transparency factors as well as financial returns. Financial returns must not take supremacy.


At the centre of health promoting services are people. For all these services, the number one priority must be to improve the health and wellbeing of all people, no matter their background, circumstance, or their ability to pay. Resources for prevention should be understood as an investment, not a cost. The savings made to overall health budgets are substantial, particularly at a time of ageing populations and increases to social care needs, standards and costs.


An assessment that helps ensure ethical services

One tool that has potential to be used across financial approaches and health promoting services is a Health Inequalities Impact Assessment (HIIA). A HIIA is a tool to assess the impact on people of applying a proposed, new or revised policy or practice. HIIA assesses the impact on; health inequalities, people with protected characteristics, human rights, and socioeconomic circumstances. Many policies, plans, proposals or decisions have the potential to impact on health and potentially widen health inequalities. By conducting an HIIA the potential impacts can be considered and action taken to reduce those impacts.


 Impact assessments help to:

  • ensure non discrimination
  • widen access to opportunities
  • promote the interests of people with protected characteristics.


The HIIA should be conducted when the policy, plan or financial instrument is still in draft. It should be well enough developed to understand the potential impacts, but not so far developed that changes are not possible as a result of the assessment.


For example, visit Public Health Scotland's guidance on HIIA