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Michael Kellet might want to come in here, because it is not my bill, so my level of detailed understanding of the bill is perhaps not what it would be if it were.

I understand that there are duties on local authorities and that there will be, for example, a requirement to procure locally as well as other measures that will deliver health benefits to the population.

Michael, can you help me out here?

Health services throughout the world are often criticised for being reactive rather than preventative. There is a lot more that we can do to ensure that people live long, healthy lives and that we prevent illness before it happens. We can support people to stop smoking, prevent people from drinking too much alcohol and make the food environment easier to navigate so that is easier to eat healthily than it is to eat unhealthily. We can do all those things, but they do not necessarily sit on the health professionals’ shoulders.

There are also actual health issues involved, too. For example, picking up and treating hypertension is an important preventative strategy. Much of that work lies in primary care.

I will bring in Michael Kellet. I mentioned the work that we are doing with the Convention of Scottish Local Authorities, the NHS and universities—a lot of public services—on using anchor institutions to change the health of the communities that they serve. That is exciting work. It is an exciting approach because it takes the burden off the healthcare professionals who are at the coalface but uses our NHS to improve the nation’s health. It is quite a clever way of doing it.

You are absolutely right—it is an unwelcome reality that, across our society, communities experience health, quality of life and even life expectancy differently. That is not acceptable, and improving health and reducing health inequalities across Scotland are a clear ambition for the Government.

The pandemic has both exacerbated health inequalities and heightened awareness of the people we need to protect. The first thing that we all need to be clear about is that the solution to health inequalities will not lie entirely in my portfolio. Health inequalities relate to inequalities in wealth and power. The solutions to health inequalities lie in, for example, tackling poverty, which is a high priority and a mission for the Government.

We absolutely have to tackle the socioeconomic inequalities. I will bring in Michael Kellet to tell you a bit more about how we recognise that our health and social care institutions can be anchor organisations in tackling socioeconomic inequality, by offering good employment opportunities and leading the way in good work practices. We have a fair amount of work going on in that regard.

On preventative policies, Christie’s work was incredible, and it is always important that we reflect on whether we have made the impact that he hoped we would. I do not think that we have, but we have done some pretty impressive work. If you think about the issue of alcohol, you will see that much of the effort that we put into tackling the problem relationship that we in Scotland have with alcohol is preventative. Much of that work is bearing fruit, but the issues are difficult to tackle and it will take longer for us to feel the benefits of that.

In the past year, there was an increase in the number of alcohol-related deaths all over the UK. No death from alcohol is acceptable and it is devastating that there was an increase last year. However, the slightly lower increase in Scotland shows that preventative policies are bearing fruit here. Although we had an increase, it was not as high as elsewhere in the UK. That can largely be attributed to our preventative policies, such as minimum unit pricing of alcohol, which is a policy that every one of us should be proud of.

It is a substantial piece of work. One of the things that I always say is that we have to understand the health inequalities that women have faced; if we think about the reasons behind the women’s health plan, it is about inequalities in wealth, power and income. Added to that, there have been millennia of mythology and fear about women’s bodies, which will not be undone quickly or easily. However, I think that this is a perfect moment in time to make tangible progress, and I am convinced that we can do that.

The convener spoke about research. One thing that is very clear is that evidence shows that women’s heart attacks are underrecognised and that, even when they are recognised, they are undertreated. That is one of the reasons why women’s heart health is a priority. Women are less likely to be put on to the battery of preventative drugs that are routine for men who have heart attacks.

Women’s heart attacks are often referred to as having an atypical presentation. However, the reality is that, for women, it is not an atypical presentation, but a perfectly normal way for women to present with a heart attack. It simply does not look quite like the way that men present. That is absolutely an insight into the situation that we face. It really is a man’s world—the world is built around the way that men present and the treatment that men need.

To be fair, there are some reasons why that might be. I am a pharmacist by profession and so I know that there are questions of ethics around women, particularly child-bearing women, participating in clinical trials of new drugs. However, most health professionals say that, as they went through medical school, the default setting was men’s bodies, men’s presentations and men’s illnesses. Marion Bain might like to reflect on her own experience of that.

You are right that self-screening is being trialled in Dumfries and Galloway. It is initially being targeted at women who are not presenting for screening—that is, those who are not taking up the offer of cervical screening. Uptake is increasing through the use of self-screening.

You highlight one of the big challenges that women have in accessing healthcare. Women might have caring responsibilities that mean that it is impossible for them to go to an appointment, but that is not the whole story on cervical screening. One of the real problems is that the test is invasive. As we know, many people have experienced sexual violence and going for a test of that nature is a barrier that they cannot overcome.

I can see that some women would find self-screening at home helpful. The challenge is that we have not yet had a test validated or recommended by the national body to say that it is appropriate. As soon as that happens, we will have procedures in place to use it, but we are not quite certain of the technology yet. Dumfries and Galloway is just one of the areas in the UK where work is taking place to ensure that the quality of the test is sufficient to use nationally.

That is a great question and one that we mull over all the time, because we are trying to harness those benefits and ensure that they reach those parts of the population that were not able to change their behaviour during the pandemic. Physical activity and sport are central to Scotland’s recovery. I recognise that obesity is a risk factor for severe illness and death relating to Covid, so it is more important than ever that we tackle it.

The link between physical activity and sport and mental wellbeing was already strongly established, but many people have recognised that on a personal level over the course of the pandemic. I cannot be the only one here who found that the opportunity to get outside in the fresh air, connect with nature and say hello to my neighbours, albeit from a 2m distance, was the most precious thing that got me through the pandemic on a daily basis.

Sports clubs have done an astounding job and we recognise how important they are to their communities. Many sports clubs across the length and breadth of Scotland have stepped up during the pandemic by meeting the needs of vulnerable people in the population. Sport has a reach that we as parliamentarians or Government do not have; it reaches people whom we cannot.

We are reflecting on all that. Over the course of the past 18 to 20 months, as you would expect, relationships between the Government and the sporting sector have been strengthened significantly. That is not to say that it has always been easy, but, boy, we have had to work really closely together to rise to the challenges that the pandemic has thrown at us in order to bring back sport, which is something that we love. Those strong relationships will see us through the remaining tough times of the pandemic. They will also help us work together to tackle the broader health of the nation.

As I said, we are pretty keen to do that, and it ties in with action on climate change. I have already had a bilateral meeting with Patrick Harvie, the Minister for Zero Carbon Buildings, Active Travel and Tenants’ Rights. Increasing activity in relation to transport is part of tackling inequalities, because anyone can walk and you do not need special equipment to do it. Ensuring that we have 20-minute neighbourhoods that are nice to walk in and in which you can access public services and tackling the provision of that infrastructure are important parts of delivering our aims. That will require us to work together and to keep things in focus, but I am absolutely determined that there are opportunities there.

Finally, on the active Scotland delivery plan, we do pretty well in that we buck the international trend and increase our activity levels, which most people would be surprised to hear. Much of that is about active transport, so that is something for us to focus on.

Again, it is impossible to disentangle where we are now from the experience that we have had over the past 20 months. Over the past 20 months, more people than ever before have been dying at home. In some ways, you might consider that to be a positive thing, because if you ask people where they want to die, they largely want to die at home. However, we need to ensure that support systems are in place and that everyone who requires palliative care can access it.

We need to ensure that the offer of palliative care is available to people, whatever condition they are suffering from. There are concerns that palliative care is more focused on conditions such as cancer and is less available for conditions such as heart failure. We need to ensure that palliative care is accessible across the board.

We also need to ensure that palliative care is accessible across our communities. As with every kind of care, there is a health inequality aspect. People from richer areas are more able to access palliative care. That will be a focus for us all.

We need to ingrain palliative care. We need to be having conversations about death and dying, and to be looking at advance directives and advance planning. Those things need to be handled extremely sensitively, and people need to be well informed and supported to make their own decisions. We need to have more conversations about that. A great deal of work is going on, across the board, on palliative care.

What do you mean?

The best thing that you can do is to write to me and explain that particular problem. I am more than happy to find out what the situation is and come back to you. I am not aware of people being unable to access hospice care when they need it, so I want to know the details of that before I give you advice on it.

Again, I will look into that. There is a national system of health alerts. Over the course of my lifetime, television weather forecasters have started to give warnings at times of low air quality, which people with lung conditions pay a great deal of attention to. There is a recognition that that is important for conditions such as asthma—an asthma epidemic in London many years ago prompted that change in practice. The challenge is communicating the information to the people who need to know, but you are right that we have systems in place. People are now significantly more health literate and look after their conditions in a way that they have not done before, so there might be an opportunity to communicate that risk in a different way, rather than broadcasting it on television.