Happy 66th Birthday to the NHS in Scotland! While the NHS is great at treating illness, the greatest health challenge in Scotland is health inequality. That requires coordinated action across our public services.
To commemorate this birthday, UNISON Scotland has published a paper on health inequalities in Scotland. I drafted this paper as our submission to the Health Inequalities Review commissioned by Neil Findlay MSP. The review starts from the premise that Scotland’s health inequalities are the unjust differences in life expectancy and these differences are determined by socio-economic position, caused by the unfair distribution of income, wealth and power. Tackling this inequality is arguably the greatest challenge we face as a society.
Overall life expectancy has increased in Scotland in recent years, but continues to be closely associated with deprivation. The average life expectancy of men living in the least deprived areas remains around 11 years higher than in the most deprived areas. There have been many reports describing this problem, but less focus on solutions. That's why this paper focuses on policy recommendations that we believe could make a real difference.
We start with the structural changes that are needed to break down silo working. We need to assess every policy against national indicators on health inequality, but it is at local level, working through Community Planning Partnerships where joined up working needs to become a reality. As Christie recommended, staff and service users should be fully engaged in delivering positive health outcomes.
While health inequality requires cross service action, that doesn't mean we should ignore health actions. The paper sets out a range of actions that address public health concerns around smoking, drugs and alcohol. Social care in Scotland is a national disgrace and much more needs to be done on improving mental health. We also need to ensure that NHS resources are targeted on areas of greatest deprivation. The NHS must be at its best where it is needed the most.
Finally, we set out a range of broader actions. These include action in the workplace through occupational health, health and safety, and measures to tackle worklessness. Improving our environment through design, better housing, sustainable transport policies, as well as measures to tackle climate change. Preventative spending should be at the core of our approach with quality early years provision, followed throughout the education journey to further and higher education.
Eradicating fuel poverty is vital to health inequality. That means raising incomes, freezing energy prices and effective energy efficiency measures. UK child poverty rates are predicted to rise to 24% by 2020, resulting in an additional 50,000 children in Scotland living in poverty. So welfare reform and increasing wages are an essential element of this strategy.
A comprehensive strategy starts with a recognition that health inequalities are caused by socioeconomic inequality. Building on that analysis, we must take action to narrow wealth and income inequality, not just increasing income at the bottom. Other actions require a new structural approach that places health inequalities at the centre of public policy, leading to a range of practical measures that can alleviate and then eradicate health inequalities.
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