Are health inequalities rooted in wider social and income inequalities?

23 January 2015

In the first issue of the online platform we will look at is an example from Scotland. In this series we will be looking at examples from different countries and regions.  The Scottish Parliament’s Health and Sport Committee concluded that most of the primary causes of health inequalities are rooted in wider social and income inequalities. On this basis the Scottish Government announced that reducing health inequalities is to be a priority for the NHS as well as the establishment of partnerships.  The Scottish Government’s Ministerial Taskforce on health inequalities (that was originally convened in 2008) is also prioritizing wider social inequalities and the involvement a range of partners across central and local government, other departments in the public sector and the third sector. The taskforce will establish a Health and Community Care Delivery Group with an inequalities action group, to support changes in community planning partnerships.

We would like to hear your thoughts on policies and practices to improve health and social equity, let us know anything you learned and any ideas from your community.

In your country what can be done to put health and social inequalities on the political agenda?  Do you have examples of cross-party partnerships to address these inequalities?


Health inequalities, public debate and change?
Scotland has recently been through a two year process of discussing and debating what kind of country it wants to be. Although ostensibly the focus of that debate was on a single question ("Should Scotland be an independent country?") , the debate in fact went far beyond constitutional matters and instead became catalyst for a re-examination of what we wanted for our future. Even though the there were many disagreements and disputes throughout that process (although it was almost entirely done in a peaceable manner), there was remarkable consensus from all sides that Scotland was too unequal, that the gaps between rich and poor were too wide, that the injustices that are all too visible in Scotland need to be addressed. Health inequalities in Scotland are wider than anywhere else in western or central Europe and the average mortality rates are improving more slowly as a result. This is not an obscure fact in Scotland. It is not restricted knowledge that is kept hidden within academic or policy circules. It is instead a commonly known and discussed set of statistics which fills the pages of our newspapers, websites and blogs, and which is the frequent topic of conversations on the streets and debates in the Scottish Parliament. This did not happen by accident. For over 30 years, and more recently as part of a crescendo of activity, academics, public health practitioners and leaders (within and outside government), journalists, journal editors, parliamentarians, voluntary organisations and others have all spoken out and kept the issue alive. Scotland regained its own parliament following a referendum on devolution in 1999. Since then, committees have been developed to look at the issue and evidence has been synthesised and presented, and strategies have been written and implemented. Yet, little progress on reducing the overall inequalities in health has been achieved. The report highlighted here, written by the Scottish Parliament's health and sport committee, is an excellent summary of where we have got to, and why progress has thus far been so slow. The issues will be familiar to those who work in the health inequalities field: 'lifestyle drift' in the direction of policy; implementation difficulties in key interventions; limited ambition in the scale of changes implemented. However, we may be closer to making a substantive difference than we have been before. Parliamentarians are fully engaged in the debate and more comprehensively understand what is required to reduce inequalities. Furthermore, there seems to be an increasing consensus that inequalities (including health inequalities, but across the social determinants) are a priority for action. There are also some more powers of the economic and welfare policy levers which have thus far been reserved to the UK Government. Will that be enough to bring Scotland's health inequalities down toward those seen elsewhere? Perhaps ask me that in 10 years time. Are there lessons for other countries? Yes. It is possible, and important, to disseminate the scale and causes of health inequalities to the public, to parliamentarians, to voluntary organisations and the media if a priority is to be given to this agenda. If there is not the same priority given to this agenda in your country, could you do more to collaborate across sectors to change that?

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