Interview: Joe FitzPatrick on the inspirations and challenges of the public health brief

Public health, sport and wellbeing minister Joe FitzPatrick grew up in one of the most deprived areas of Dundee, where most of the kids he went to school with came from families where nobody had ever worked, in a city that is facing many of the health challenges he is tasked with tackling as a minister for the whole of Scotland.

“I’m not sure you realise that you live in a deprived area at the time,” he tells Holyrood.

“I was always very proud to come from Whitfield – ‘the concrete jungle’, as it was called at the time.

“It was a kind of new housing estate that had been badly planned in the early 70s.

“The concept was great and people moved to Whitfield because it provided an opportunity with new housing, but the planners didn’t get it right and that left challenges.”

FitzPatrick recognises that the city, too, has a number of challenges, then and today, but that Dundee has changed, at least in its attitude.

“There’s much more confidence in the city. There’s still these challenges, but Dundee’s in the place where we’re turning that round.

“So, it is great to have the opportunity to be part of that, to try and influence that.

“The drug death figures are a huge concern, in Dundee and across Scotland, but we’ve also got nearly a 1,000 people [a year] dying in Scotland from alcohol, and that’s going to be predominantly more in the more deprived areas and around 9,000 people dying of tobacco-related harm.

“And again, we can see there’s a correlation between deprivation and these kind of harms.

“So, it’s really important for me that I can challenge those issues head on. It’s great to be in a portfolio where I can do that.”

FitzPatrick’s early upbringing in Whitfield shaped his desire to get involved in politics and make change.

“I think there’s no question that where you grow up impacts on your outlook in life, so equality has always been a strong driver for me, in terms of growing up in an area of deprivation, growing up through the first devolution referendum [in 1979].

“That’s probably around when I first started getting interested in politics and that feeling of injustice when Scotland had voted for an assembly of sorts and then was denied that in spite of that, that was probably about the first strong driver for me.”

FitzPatrick was still at school at the time of that first referendum but took an interest which “kind of developed”, leading to him becoming involved in the anti-apartheid movement and joining the SNP at the age of 16, both of which were about “injustice and how we can make things better”.

After leaving school at 17, he became a forester, living first in Brechin and then studying in Inverness.

It was during his time studying in Inverness that he became active in politics, becoming president of the students’ association at Inverness College and then area convener for the north of Scotland for the NUS, which brought him back to Dundee.

After studying biotechnology at Abertay University, he was about to start a PhD at Dundee University when he was “quite unexpectedly” elected to Dundee City Council and his life took a different turn.

“That’s kind of when you have to decide, what are your priorities, and I was representing the area I’d grown up in and I was determined to do my best for the constituents who had done me the great honour of electing me,” he says, and the PhD went out the window.

FitzPatrick was the Scottish Government’s business manager from 2012 until last summer, when a surprise change brought him the much more outward-facing public health brief.

What did it feel like changing from a role that was largely behind the scenes to one that is very much in the public eye?

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“I really enjoyed the job as being business manager,” he says. “I have to say I thought that was the best job I could ever do and I think I did it well.

“To say that I was not expecting the change I got is maybe an understatement.

“I’d just been covering for health ministers because there had been a change in the new cabinet secretary who hadn’t been formally voted in by the parliament, so I was covering a health debate in the chamber for members’ business and I came back to take the call, which as I thought was just to confirm, well, either thanks very much, you’ve done a good job but your time in government is over, or thanks very much, you’ve done a good job, we’d like you to continue, only to be told I had this new challenge, and it’s been amazing.

“I didn’t realise how much I probably needed a change and to be able to get out of the parliament more, to meet more people. These are the sort of things that people get involved in politics to do.”

Health along with education are probably the two highest profile areas, and in health, the majority of the key problems that need to be tackled – smoking, drinking, drugs, diet and exercise – sit within public health, so there is a lot riding on his current brief.

“Certainly, we have an ageing population so if our NHS is going to be able to cope with that then public health has a big role to play and I think there’s two main areas.

“So, first of all, we’ve got the harm reduction side where [there are] nearly 1,000 deaths from drugs, over a 1,000 deaths from alcohol and around 9,000 people dying because of tobacco-related harm [per year].

“So we need to work on those challenges, and tobacco, obviously, we’re making progress, but it’s still nearly 9,000 people dying because of tobacco-related harm every year.

“That’s a startling figure. That just reminds us why we need the focus that we have on alcohol and drugs.

“And then on the other side, we now know, without any doubt, the importance of physical activity, healthy eating and healthy weight for a whole range of conditions, whether it’s diabetes, it’s people’s cardiovascular health, it’s their mental health, it’s their musculoskeletal health.

“There’s a whole range of conditions where if we can help people make healthy choices in terms of physical activity, their diet and their healthy weight, then we can make a real difference.

“And one of the things I’m hopeful if we can get that right, not just will we take the pressure off the NHS, but one of the figures that haunts me, to some extent, is the inequality when we look at the healthy age, so the age that people can expect to have a healthy life and in some parts, that can be in the late 40s, and that’s a startling figure.

“When we look at life expectancy, a lot of people don’t really care about living to 100, but they do care about the quality of the life that they have and the idea that in some parts of Scotland the healthy life expectancy is so low is something we need to turn around and I think we can help make it easier for people to make those healthy choices.”

The Scottish Government is taking a “two-pronged approach” to tackling public health problems.

One is trying to deal with the causes of deprivation, across portfolios, so free school meals, mitigating some benefit cuts, but the other side is about empowering people to make healthier choices.

And one of the key challenges is understanding what the barriers are to making those choices.

He says: “A big focus on that, about how we break down those barriers, first of all, we need to identify the barriers, so why is it that when girls become teenagers that there’s a drop-off in participation in physical activity?

“What do we need to do to encourage more people from deprived and minority backgrounds to get involved in physical activity?”

And in terms of healthy eating, it’s about changing the environment from one that is geared to push people to make unhealthy choices.

FitzPatrick says: “I’m not going to go around the country with a spoon, feeding people healthy food, that’s a choice that people have to make, but I think it’s our job in government and as the parliament to look at how we can put in place an environment that makes it easier to make healthier choices.”

The reduction in smoking is considered one of Scotland’s public health success stories, but it still leads to over 50,000 hospital admissions every year as well as the 9,000 deaths.

“These are big figures,” says FitzPatrick. “But nonetheless, behind that we can see there’s been a massive reduction in people who smoke.

“And at the end of the day, it’s been people have had to decide themselves to give up smoking the same way, but what government has done is put in place the framework that’s made that easier, so I think that the ban on smoking in public places was a major part of that in terms of making it easier for people to make that choice to give up.”

A lot of the lessons that have been learned from smoking and alcohol can be applied to food as well, FitzPatrick says.

“Ultimately, it’s for the individual to make the choices, but we need to make those choices easier to make.”

The Scottish Government’s public heath targets are ambitious, including, for example, creating a smoke-free generation by 2034, but FitzPatrick says there is “no point in having targets that are easy to just tick off”.

In terms of physical activity, there has been some progress, says FitzPatrick, particularly if you look at recreational walking, which has seen a “massive spike”, bucking trends across Western Europe and North America for more sedentary lifestyles, but as regards the aspiration to reduce the levels of physical inactivity, again, it’s about understanding what the barriers are.

Which links to the other part of FitzPatrick’s portfolio: sport.

Whereas in the rest of the UK, sport tends to go with tourism and culture, the linking of the two portfolios here is something FitzPatrick considers very positive.

“I think we’re unique across the four nations of the UK in that sport is attached to public health, but I think it’s absolutely the right thing to do.

“I think there’s such a connectedness between physical activity and public health, and sport is such a good way of people being more physically active, so one of the great things since being in post, going around speaking to a range of sporting authorities, is that they all understand their responsibility as part of that public health message, so they’re not just about golds.”

FitzPatrick has taken up running himself since being in post, but he believes starting early is key to improving Scotland’s record on physical activity, with schools having a vital role to play.

“Education, obviously, has a major role. We’re keen to see Scotland become a ‘daily mile nation’ and we’re seeing massive progress on that.

“I’ve recently been shown some evidence that shows that the daily mile’s not only a good idea, doesn’t only work in the short term, but has more sustainable impact longer term from that, so that’s something I think we want to see how we can get that spread out further, not just across schools, but maybe in further education and more into employment as well, because it’s such a simple idea that is so easy to sustain in the long term.

“So, it’s got to be a joined-up approach right across government and right across society as well.”

Scotland is on a “good trajectory” in terms of physical activity, though, through the work being done in schools with active schools and the daily mile, he adds.

“These are really important ways in which we can try and make physical activity the norm so that people just grow up with that’s the normal thing that you do: you cycle to work or you walk to school and having a better understanding of healthy food, so that’s why I’ve previously said it’s a systems-wide approach if we’re going to make those changes.

“People just grow up and that’s just the way they are.”