Scotland’s drugs death figures continue to make headlines: 1,017 lives lost in 2024. It is the lowest number since 2017 – but still the highest rate in Europe, and a stark reminder of how delay in turning evidence into delivery can cost lives. 

Homelessness risks following the same path. The recent figures on deaths among people experiencing homelessness show people are dying decades younger than the general population – with a median age of death of just 43 for men and 40 for women, compared to 76 and 80 in the wider population. Scotland has declared a housing emergency, but progress remains slow. And that is why we need to look at homelessness through a public health lens.

We know this approach can work because we have seen it before. In the 1970s, more than half of Scottish adults smoked. Today it is fewer than one in five. That change was not the result of a single campaign or piece of legislation but decades of sustained effort: bold restrictions on advertising, consistent awareness campaigns, support services, and the slow but steady reshaping of public attitudes. The result was one of the most dramatic improvements in public health that Scotland has ever achieved.

Suicide prevention offers a similar lesson. Twenty years ago, Scotland’s suicide rate was among the highest in Western Europe. It took a long-term strategy, backed by investment and political commitment, to change that trajectory. Community-based support, awareness training, and better data combined to save thousands of lives. The progress has not been linear, but it shows that with persistence, collaboration, and evidence, change on even the toughest challenges is possible.

But the opposite is equally true. When evidence is not translated into practice, harms accumulate and become harder to undo. Scotland’s drug deaths crisis makes this painfully clear. For years, the solutions were known — naloxone distribution, supervised consumption facilities, integrated care. Yet delivery lagged behind knowledge, and the result was the highest drug death rate in Europe.

And yet, progress has stalled. Temporary accommodation use is at record highs, with councils spending more than half a billion pounds a year on hotels, B&Bs, and unsuitable units. Families are left in limbo for months, sometimes years. And the same groups remain most at risk: young people leaving care, people discharged from custody or hospital, and those already living with poverty and poor health.

Bridging the gap between vision and delivery

Scotland does not lack ambition. We have some of the most progressive homelessness laws in the world and a long-standing political consensus on the importance of prevention. But legislation alone does not prevent a family from losing their home. The real challenge is translating vision into practice.

That translation depends on the right scaffolding. Good intentions need to be underpinned by systems that make risks visible early, support frontline workers to act, and hold all parts of the system accountable for outcomes. 

To get there, Scotland needs to:

Build a unified data system. At present, information is siloed across housing, health, and justice. A shared data system would allow risks to be identified earlier and would help services coordinate responses before crisis strikes.

Provide delivery support. Passing duties into law is not enough. Services need practical help to change routines and cultures: training frontline workers, creating clear referral pathways, providing tools and guidance. Delivery support is what makes a duty more than words on paper.

Embed shared accountability. Prevention cannot sit solely with housing teams. Health services, schools, social care, and justice all play a role. That means setting joint outcomes, reporting across sectors, and ensuring leaders are collectively responsible for reducing homelessness — not passing the buck to one department.

Invest in rigorous evaluation and rapid learning loops. Promising approaches must be tested in the real world, with robust evaluation to understand what works, for whom, and at what cost. At the same time, learning needs to move quickly through the system so effective practice spreads in months, not years. Without evaluation, learning is shallow; without speed, change comes too late.

At the Centre for Homelessness Impact, we’ve seen that change is possible. Our Test and Learn approach and place-based Accelerator programmes are designed precisely to help local areas build this scaffolding — combining evidence, innovation, and coaching so prevention becomes something that happens in practice, not just in policy.

The way forward

Two developments make this a moment of possibility. The first is the proposed Ask and Act duties in the Housing (Scotland) Bill. These would require public bodies to ask about someone’s housing situation and act on what they find. If passed, prevention will no longer sit solely with housing teams but be embedded across health, justice, education, and community services.

The second is the Homelessness Prevention Pilot Fund. With £4 million to support local authorities, health boards, police, social landlords, and third sector partners, the fund creates important space to start testing how the new duties can work in practice. The opportunity now is to use this resource strategically: not simply to fund a wide array of projects, but to build the scaffolding Scotland needs — unified data, delivery support, shared accountability, and rigorous evaluation. Without that focus, the risk is activity without learning, and investment without impact.

Together, these measures could provide the foundations for a prevention turn. But without the delivery mechanisms to make them real, they risk becoming another set of promises that never lived up to their potential.

A public health approach to homelessness is about more than crisis response. It is about stopping harm before it begins, identifying risks early, and reducing damage when crises occur. For homelessness, that means ensuring no one leaves hospital or prison without a safe place to live. It means teachers and social workers having the tools and confidence to act at the first signs of risk. It means community groups being able to step in with mediation or small grants before a problem escalates. And it means valuing success not only when a new hostel opens, but when a family never has to enter the homelessness statistics at all.

We are working with Public Health Scotland and Cyrenians to consider what a public health approach to homelessness prevention could look like. We will work with partners from housing, health, justice, and the third sector to build a shared vision, surface barriers, and prioritise the most promising opportunities to test and scale.

We want this to be the beginning of a programme of work to close Scotland’s prevention gap — moving from aspiration to action, and from legislation to delivery.

The current housing crisis underlines the urgency. Too many families and individuals are drawn into crisis. Scotland has shown — with smoking and with suicide — that a public health approach works. It has also shown, with drug deaths, the cost of delay.

The Ask and Act duties and the new Pilot Fund give Scotland a real chance to act differently — to shift from aspiration to delivery, and from piecemeal projects to a system built on prevention. Used wisely, they can provide the scaffolding for change: early detection, practical support, shared accountability, and rapid learning.

Homelessness is preventable. The question now is whether Scotland will use the tools already on the table to prevent it.

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