What are Scotland’s Sexual Health Challenges?
Pp. 18-26 (9)
The concluding chapter in the first section provides an insider view of the development of
Respect and Responsibility - the first sexual health strategy for Scotland. Written by Shirley Fraser, a
leading expert in sexual health policy-making in Scotland, it describes the experiences and challenges in
identifying policy and service responses in sexual health that are acceptable to the public, to clinicians
and managers in the NHS, to national and local government, and the array of interest groups and
communities of interest. The chapter reflects back on the last two decades, during which
significant social, cultural and organisational shifts concerning sexuality and sexual behaviour have
occurred in Scotland and elsewhere, specifically focussing on activity and thinking before and since the
The author covers the political and policy pressures and opportunities surrounding the Scottish strategy,
and describes parallel activity in national sexual health policy elsewhere in the UK. The structures that
were established to create and oversee the implementation of Respect and Responsibility are charted,
alongside the strong political support that the devolved Scottish Government (of successive political
complexions) has provided. The chapter asserts that the Scottish strategy (although changed from draft to
final outcome) contains a broader understanding of sexual activity, and the social determinants of sexual
ill-health, than others in the rest of the UK, with the adoption of a population health approach, and the
decision to see children and young people as a critical target group, but not to the exclusion of others,
differentiating the Scottish perspective.
NHS Health Scotland.