This chapter provides evidence for, and explores reasons why, understanding the poor nature of public health in Scotland is vital to understanding sexual health. As Chair of the Expert Reference Group that devised the first national sexual health strategy for Scotland, and an expert on public health, Professor Hanlon's synthesis illuminates the relationships between inequalities and poor health outcomes, and provides a convincing link to modernity, where norms around consumption and gratification have extremely negative results for individuals and society.
The chapter investigates Scotland's poor health status in comparison with the rest of the UK, and provides population data concerning morbidity and mortality to demonstrate this. Explaining that social and economic deprivation, coupled with the collective and individual experience of postindustrialisation, is often perceived as the main cause for Scotland's poor health, the author proposes that an additional and increasing excess mortality in Scotland, known as the Scottish effect, exists beyond these explanations. This effect is still not fully understood, and other possible contributory factors such as the environment, weather conditions and culture and social mores are discussed. Culture is discussed in detail as an important component of health and wellbeing, and one that may well have a critical impact on individual and collective health experiences. The chapter concludes by saying that it is essential to adopt a multi-disciplinary approach to exploring and investigating the patterns of ill health in Scotland in order to understand and address them further.