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Section 2 - Background to our strategy


On this page:

 - Context
 - Global issues
 - Welsh legislation and policy
 - Health in Wales



A number of key issues have guided how we have developed our strategy.


Global issues

The United Nations 2030 Agenda for Sustainable Development and its Sustainable Development Goals have played a major part in developing our strategy and have continued to influence us.  We want to make sure everyone can achieve their best health and well-being. The Agenda provides a comprehensive framework for understanding the links between, and need for, urgent action to end poverty and other deprivations, along with action to improve health and education, reduce inequality and tackle climate change. This is closely in line with the worldwide One Health approach, which recognises that the health of people, animals and ecosystems are closely linked, depend on each other and need to be sustainably balanced.


Welsh legislation and policy

A number of key pieces of public health legislation have come into effect in Wales in recent years, which we support and which have shaped our strategy. This legislation challenges public-sector bodies to consider the longer-term effects of their decisions, and to support a greater focus on preventing and addressing inequalities. The legislation includes:

  • the Well-being of Future Generations (Wales) Act 2015;
  • the Health and Social Care (Quality and Engagement) (Wales) Act 2020; and
  • the Socio-economic Duty 2021.

A Healthier Wales (2018) sets out plans for the long-term vision of a ‘whole system approach to health and social care’ in Wales, focused on health and well-being and preventing illness. It aims to help meet future health and social-care challenges, including an ageing population and lifestyle changes.

Our priorities have also been guided by the Minister for Health and Social Services’ priorities for NHS Wales, particularly the support and public health expertise that we can contribute to the wider system. This will help make sure that quality, safety, prevention and good health outcomes are at the heart of the NHS in Wales. We also have to consider our legal duties, including our role as category-1 responder (assessing and dealing with emergencies).


Health in Wales

The Covid-19 pandemic has had significant effects on the people of Wales, and its social and economic consequences have been felt unequally across our society. They have disproportionately affected those who already had the greatest health and social needs. In Wales, life expectancy and healthy life expectancy have failed to increase over the last decade, and we continue to see obvious and continuing inequalities in health.

Typically, people living in the poorest parts of Wales already die more than six years earlier than those in the least deprived areas. The current cost-of-living crisis will add to what were already increasing differences in health between the well-off and the less well-off.

‘Rising to the Triple Challenge of Brexit, Covid-19 and Climate Change for health, well-being and equity in Wales’, shows that the people of Wales have been significantly affected by all three of these challenges.  For example, Brexit, Covid-19 and climate change have affected employment, trade and other factors which affect people’s health, such as alcohol use, the cost of food, and mental well-being.

Wales is a country:

  • with an ageing population and low fertility rate, which will increase our dependency ratio (the number of dependants aged from 0 to 14 and over 65, compared with those aged 15 to 64) in the future;
  • which has clear and continuing health inequalities, with healthy life expectancy for women and men almost 17 and 12 years lower in the most deprived areas compared with the least deprived;
  • where the gap between the least and most deprived areas in Wales for premature deaths from non-communicable diseases (those not caused by an infection) has been increasing in recent years, and the rate of premature deaths from this cause is now almost two and half times greater in the most deprived areas compared with the least;
  • where around one-third of people are following less than three of the five ‘healthy behaviours’;
  • where 1 in 7 of adults in Wales smoke;
  • where loneliness is twice as likely among people living in the most deprived areas; and
  • where there is a large backlog of patients waiting for treatment (at January 2023, there were around 576,000 patients on treatment waiting lists in Wales).

This information and our understanding of health in Wales has influenced our strategy and how we have decided our priorities. Our priorities and the action that we will take under each one is our response to these challenges. We will continue to use the latest public health information and evidence to help us assess the effect we are having and adapt where necessary.