Scotland has the worst health in the United Kingdom; worse than comparable areas like the industrial North East of England. Scotland's health also lags behind comparable European countries. In fact, the nearest neighbours in the health "league table" of European nations are Slovenia and Portugal. One has only a limited understanding of what has caused this. The levels of poverty and socioeconomic deprivation experienced by significant numbers of the population are widely recognised as being part of the explanation, but recent analyses suggest that their contribution may be less than is often assumed. The major impacts of smoking, nutrition and alcohol use are clear, but, additionally, there seems to be some, as yet undefined, Scottish effect--perhaps cultural, psychological or social in nature. This paper briefly outlines recent developments in Scotland in public health policy and the infrastructure for delivery and considers some of the characteristics of the research environment that shape health promotion research.