It’s going to be another grim winter in Scotland’s hospitals.

Updating Holyrood this week, Health Secretary Michael Matheson didn’t pick his language from the big book of ministerial euphemisms. “Extremely challenging” was how he described it.

We wouldn’t have believed him if he’d said anything else. We all know by now what winter in the NHS means. Ambulance queues. Patients huddled on trolleys. Staff burnout.

And we know why too. We have increasing demand caused by an ageing population. We have the ongoing treatment backlog caused by Covid. Covid itself has added to the seasonal burden of respiratory diseases.

We have an ongoing problem with delayed discharge causing lines of patients at A&E because there aren’t enough hospital beds for them. This in turn is often caused by gaps in social care.

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And we’ve had years and years of inadequate staffing. Nurse and consultant vacancies are a huge ongoing problem. We’ve struggled to recruit enough overseas doctors and nurses to plug gaps, and have failed to train enough here in Scotland. We’re also failing to retain the staff we’ve got because of pay and working conditions.

So as always, this year’s winter resilience plan focuses on pumping in more cash and recruiting more staff. In particular there will be a boost for the ambulance service and hospital-at-home services. All this will help, certainly, but after a partial easing of pressure brought about by improving weather, there will surely be another crisis next year. And the next year, and the one after that. That’s if you can say the NHS ever really stops being in crisis.

Surely, you might say, there is another way. And of course there is. It’s not a quick fix - there is no such thing - but it could be a sustainable fix. We can address the underlying weaknesses contributing to this annual bottleneck at the hospital door. Some of it involves the obvious things like paying staff better and training more of them, boosting social care funding and increasing care home places.

But we can also stop people getting ill in the first place. Now that really would make a difference. If we can stop so many people getting ill so young, then lives would be improved and we would eliminate a chunk of the existing burden on the NHS. We might even be able to make it sustainable.

That means two things: a war on poverty and a braver stance on health-harming products.

Speak to a doctor at a Deep End medical practice, serving the most deprived communities in Scotland, and there is quiet despair. What they see day in, day out, is ill health claiming the young. Smoking rates are much higher in deprived communities and the health impacts start to show in many people well before they turn 40. It’s a similar story with obesity and illnesses connected to it, like type 2 diabetes and stroke. Deprivation is linked to a higher risk of mental health problems and drug use too. There is a yawning gulf of 13 years in life expectancy for men and over a decade for women between the wealthiest and poorest communities, but that only tells part of the story. Hundreds of thousands of people in Scotland feel unwell - are unwell - for much of their adult lives. There is a 24-year gap in how many years of good health the most well-off enjoy compared to the least well-off.

Twenty four years.

The Scottish Government has introduced the Scottish Child Payment and tried to mitigate benefit restrictions, but much more is needed. Spending on housing, education and skills, and services like the provision of GP link workers, are all part of the drive to tackle poverty but all this funding is under pressure.

More investment - and it would be an investment - is certainly required, but there are other steps the Scottish Government can take, on the marketing, promotion and availability of health-harming products like vapes, alcohol and foods high in fat, salt and sugar.

Unfortunately, due to a sub-par reputation in the business community, ministerial resolve on some of these measures appears to be faltering. Humza Yousaf has rowed back on restricting alcohol advertising. Anti-smoking group ASH Scotland points out ministers have the power to restrict the promotion and visibility of recreational vaping products, such as behind counters, but have yet to do so although a consultation on disposable vapes has been announced. Ministers say they remain committed to restricting the promotion of foods high in fat, salt and sugar, but nothing appeared in this year’s Programme for Government.

They need to press ahead with all these things. The rewards would be huge in preventing heart attacks, strokes, cancer and other diseases. Research by BHF Scotland suggests the ban on smoking in public places alone has prevented about 14,000 ischaemic strokes and 42,000 heart attacks: that’s the power of public health measures. Up to 10,000 lives a year and many, many thousands of hospital admissions could be saved in Scotland by acting on health-harming products. Think of the savings to the NHS.

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And consider this: according to the Non-communicable Diseases Alliance of charities and medical colleges, the estimated cost to the Scottish economy of ill-health and disability caused by tobacco, alcohol and being overweight or obese is between £5.6 and £9.3bn. Think of the lost tax income that could be helping pay for doctors, nurses, medicines and scanners.

The public supports these measures. The industries concerned will object, but they will adapt. As with the ban on smoking in public places, the change is coming anyway, with other nations considering or implementing similar measures: the Scottish Government just has to decide whether it wants to be in the vanguard or bringing up the rear.

Prevention measures alone won’t rescue the NHS. There are countless examples where the NHS could be made more efficient, like detecting and treating blood pressure more effectively, or better integrating health and social care.

But the biggie is prevention. If we can get better at preventing non-communicable diseases, our NHS would look a whole lot healthier all year round. The Scottish Government has been brave before: it needs to stay the course.