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Health Inequalities in Scotland:

Prepared for the Auditor General for Scotland and the Accounts Commission Audit Scotland, December 2012

Key recommendations:

The Scottish Government should:

Introduce national indicators to specifically monitor progress in reducing health inequalities and report on progress.

The Scottish Government and NHS boards should:

review the distribution of primary care services to ensure that needs associated with higher levels of deprivation are adequately resourced
include measurable outcomes in the GP contract to monitor progress towards tackling health inequalities, and ensure that the Quality and Outcomes Framework is specifically designed to help reduce health inequalities.

The Scottish Government and CPPs should:

ensure that cost effectiveness is built into evaluations of initiatives for reducing health inequalities from the start
align and rationalise the various performance measures to provide a clear indication of progress in reducing health inequalities.

CPPs should:

ensure that all partners are clear about their respective roles, responsibilities and resources in tackling health inequalities, and take shared ownership and responsibility for actions aimed at reducing health inequalities
build robust evaluation, using all available data and including outcome measures and associated costs, into local initiatives aimed at reducing health inequalities
include in SOAs clear outcome measures for reducing health inequalities which demonstrate impact, and improve the transparency of their performance reporting.

NHS boards should:

monitor the use of primary care preventative and early detection services by different groups, particularly those from more deprived areas. If this identifies systemic under-representation of particular groups, NHS boards should take a targeted approach to improve uptake
monitor the use of hospital services by different groups and use this information to identify whether specific action is needed to help particular groups access services.

NHS boards and councils should:

identify what they collectively spend on reducing health inequalities locally, and work together to ensure that resources are targeted at those with the greatest need.

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Accounting for Scotland’s Excess Mortality:

Towards a Synthesis

Glasgow Centre for Population Health April 2011

Conclusions:

The reasons for the high Scottish mortality between 1950 and 1980 are unclear, but poverty and deprivation linked to particular industrial employment patterns, poor housing and unhealthy cultural and behavioural patterns seem the more likely explanations. From 1980 onwards the mortality pattern changed and this seems most likely to be attributable to the changed political context, produced by neoliberal political attack, and the consequent hopelessness and community disruption experienced in Scotland and Glasgow. This perspective may have relevance to faltering health improvement in other countries, such as the USA. Further research, linked to integration and synthesis of the most likely causal explanations, is merited, as is further work to design policies and interventions to create a healthier future for Scottish communities.

Keywords:

Scotland; Glasgow; mortality; Scottish Effect; Glasgow Effect.

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What kinds of policies to reduce health inequalities do researchers support?

Authors: Smith, K.E. , Kandlik Eltanani, M. , Hill, S.E.

Global Public Health Unit, School of Social & Political Science, University of Edinburgh, Edinburgh, UK

School of Social & Political Science, University of Edinburgh, Edinburgh, UK

Executive Summary:

Background: A wealth of research on health inequalities has been produced over the past 40 years, much of it within the UK, and there have been multiple initiatives aiming to reduce health inequalities in policy and practice. Despite all this, it has been widely reported that these efforts have been unsuccessful and that the UK’s health inequalities have continued to widen. In this context, there have been suggestions that more ‘public health advocacy’ is required, yet there appears to be a lack of consensus as to exactly what those committed to reducing health inequalities ought to be advocating. This report is based on a two-stage online survey which sought to explore this issue by gauging researchers’ support for a variety of policy proposals that have been put forward as potential means of tackling health inequalities in the UK. It aims to explore whether there appears to be a consensus amongst researchers as to the kinds of policies likely to be effective in reducing health inequalities.

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The Role and Impact of Social Capital on the Health and Wellbeing of Children & Adolescents: A systematic review

Dr Kerri McPherson, Dr Susan Kerr, Dr Elizabeth McGee,

Professor Francine Cheater, Professor Antony Morgan

Glasgow Caledonian University and the Glasgow Centre for Population Health: January 2013

Conclusions

To the best of our knowledge, this review is the first to systematically collate, analyse and synthesise the international, empirical, peer reviewed evidence on the role and impact of social capital on the health and wellbeing of children and adolescents. While others have made inroads in this field (e.g. Ferguson), the number of studies included in previous reviews has been much smaller and, thus, less comprehensive in comparison. In conducting such a large scale review, we are able to provide solid evidence to demonstrate that family and community social capital are associated with differences in children’s and adolescents’ experiences of health and wellbeing. Families that are nurturing and cohesive provide an environment in which children and adolescents are able to thrive. Moreover, children and adolescents who are able to acquire social capital in and through their local communities have the potential for much better health and wellbeing. This evidence has significant and wide reaching implications for policy makers, practitioners, researchers and educators alike.

While it is clear that family and community social capital are associated with positive outcomes for pre-school children, school aged children and adolescents, our understanding of how social capital works to facilitate or debilitate in the context of health and wellbeing is more limited. It is now essential that researchers direct their efforts to developing knowledge in this regard. Knowing how the mechanisms through which social capital works to bring benefit will then enable policy makers and practitioners to use social capital as a means of appropriately supporting children and adolescents.

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SCHW Recommended Reading

“Understanding a Community-led Approach to Health Improvement”

 Jane Dailly and Alan Barr, Pub: (SCDC), Scottish Community Development Centre, 2008

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“Asset Based Approaches for Health Improvement: Redressing the Balance

 Jennifer MacLean, Pub: Glasgow Centre for Population Health, 2010

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“Evaluation of the Healthy Lining Centre Programme in Scotland”

 Stephen Platt et al, Pub: Research Unit Health Behaviour

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The Scottish Government

Report of the Ministerial Task Force on Health Inequalities (2013)

Thursday, March 13, 2014

ISBN: 9781784122287

This is the second review by the Ministerial Task Force on Health Inequalities following publication of Equally Well in 2008. The first review was undertaken in 2010 and focused on progress and how well agencies were responding to the principles set out in Equally Well. This review looked at how communities are being engaged in the decisions that affect them and also the importance that "place" has on health inequalities.

The Task Force identified the following areas as priorities:

Development of Social Capital

Support for CPPs and the community planning process

Examine and potentially enhance what we do that impacts on the 15-44 age group.

Support the implementation of a Place Standard

Finally, the Task Force also considered its own input into the work to tackle health

inequalities and agreed that alternative arrangements for coordination of work to tackle health inequalities should be considered.

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Capitalism isn’t working:

by Will Hutton. The Guardian 23/4/14

" Interesting article from the Guardian on the causes of growing and dangerous wealth inequalities in Britain and other western countries. It provides good evidence based arguments for the critical role of community-led organisations...and possible unpalatable solutions! Worth a read."

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Health Inequalities Review Guidance:

Scottish Communities for Health and Wellbeing (SCHW) & Healthy n Happy Community Development Trust

Phone number: 0141 646 0123

Email address: john@schw.co.uk

The Labour Group of the Scottish Parliament is carrying out an enquiry/consultation into strategies to tackle health inequalities. SCHW with a case study from Healthy n Happy community development Trust has provided a submission which is available.

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