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The voice of Scotland’s vibrant voluntary sector

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Bridging the health inequality gap

This opinion piece is almost 9 years old

Scottish people are healthier than ever before, unless they are poor, arguesIan Welsh, chief executive of theHealth and Social Care Alliance Scotland

Ian Welsh
Ian Welsh

As a nation we are healthier than we have ever been and that fact is important as we reassess our approach in the new world of health and social care integration.

Advances in medical science have significantly improved the quality of the healthcare we receive. A series of initiatives have resulted in short-term public health improvements, mainly for those in more affluent areas. We have embraced practices such as self-management which recognise that, above all, people need to be in the driving seat to decide what is right for managing their condition.

These factors and more have led to a steep improvement in the life expectancy of the Scottish population in the last 30 years.

However, Scotland’s health inequalities remain particularly difficult to budge, resistant to successive waves of investment.

A recent Audit Scotland report, for example, found that men in areas of multiple deprivation died 11 years earlier than their counterparts in Scotland’s most affluent areas. Even more stark is the difference in healthy life expectancy which stands at 59 for men and 62 for women in the poorest areas of Scotland.

These variations highlight our current inability to eradicate a source of national shame, but they also represent a significant human rights injustice which we as a society have yet to address.

The development work this year on human rights in health and social care (a workstream of the Human Rights Action Plan) jointly led by the Health and Social Care Alliance Scotland (the Alliance) and Health Scotland, will add some impetus to calls for reductions in health inequalities. The overarching mission in Health Scotland’s A Fairer Healthier Scotland drive over the next five years will be to ensure a continuing focus on the evidence behind the issue.

Scotland’s health inequalities remain particularly difficult to budge

It is important to see all this in the context of the Scottish Government’s Equally Well programme, the report of its ministerial taskforce for health inequalities, and the number of pilot projects operating across Scotland set up to improve the reach and impact of mainstream local services.

The challenge for us all is to translate evidence into multi-faceted action across disciplines, budgets and communities in the interests of the service user. While deep-seated problems are never susceptible to silver bullet interventions we need to recognise and acknowledge that collective action is required to shape a healthier future for Scotland.

A series of initiatives are required to tackle the causes of health inequalities, such as poverty, employment and housing supplies, as well as to ensure health and social care services themselves direct their resources more effectively towards tackling unequal outcomes. That is why locality planning cannot be undertaken in the new health and social care partnerships without an underpinning commitment to the reduction of health inequalities.

Neither, however, can the impact of social connectivity, meaning and purpose be underplayed. Approaches are required that build confidence, a sense of purpose and social support networks within communities across Scotland.

The Scottish self-management agenda, for instance, places a greater emphasis on such approaches, supporting disabled people and people who live with long-term conditions to make well-informed decisions about their lives. The Alliance’s Self Management Fund in Scotland was highlighted, for example, in a 2013 Carnegie UK report as a leading initiative in public sector reform. This is just one of a series of initiatives focused on discovering the existing strengths within communities experiencing long-term disadvantage.

General practitioners are at the front line in this fight but they are still not signposting to sources of support to live well in their communities. Our Scottish Government-funded Links Worker Programme, delivered in partnership with the Royal College of General Practitioners, the Scottish Association for Mental Health and the Deep End, aims to do just that.

Why? Because working within general practices which serve some of the most socio-economically deprived areas of Scotland to identify local community solutions and match them to the needs of the individuals will improve the social capital of all!

The Aliss (A Local Information System for Scotland) programme exists to make such information more openly available to raise awareness and share information about local community assets. Such links and access must be proactively built in order to support people living in poor circumstances. Most crucially, Aliss works by harnessing community capacity and local ownership, not by delivering a centralised, or top-down solution.

There can now be no doubt the forthcoming integration of health and social care must be grasped as an opportunity to develop more connected approaches locally. Integration and inequalities are not separate agendas and localities, with good data about local needs and strong local voices, must be the real engine behind genuine change.

In the immediate future, the ministerial task force on health inequalities is expected to publish its final report later this month, which could further reinforce the importance of social capital, coproduction, asset-based approaches and of partnership, particularly with the third sector. The health and sport committee will also be examining key aspects of health inequalities, including early years and access to services. The alliance will again be putting health inequalities at the centre of our national conference in May.

All of this is welcome and again puts health inequalities into sharp relief but the time has come for us to move beyond policy and begin to make a practical difference. In order for this to happen, eradication of health inequalities should be a major policy-into-practice aspiration for the Scottish Government before and beyond the referendum, and it should have the highest possible cross-sectoral profile within government.

I was delighted recently to hear the new director general of health and social care in Scotland, Paul Gray, make a strong personal commitment to delivering on health inequalities. He was very clear that we must succeed, not only because the health service will be unsustainable if we don’t, but even more pressingly because people in Scotland are suffering now and suffering severely and that is not acceptable.



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