Scottish Government’s response to health inequalities

Kay Barton

SG Health Improvement Strategy

27 June 2009

I’ll talk about:

• Health inequalities: what’s the problem?

• Equally Well

• Where do we need to do more?

• How can you help us?

Healthy life expectancyMales, by income-employment

index, Scotland 2005-06

Relative inequalities in mortality by cause, men, Scotland 2001

Scottish Government’s economic strategy

Figure B1

                                                                                       

“We have made tackling health inequalities our top

priority”

Nicola SturgeonCabinet Secretary for Health & Wellbeing

Upstream/downstream: reducing inequalities in health depends on reducing inequalities in life

chances and life circumstances

The most significant inequalities:

• Children’s very early years, which influence the rest of their lives.

• The high economic, social and health burden imposed by mental illness, and the requirement to improve mental wellbeing.

• The “Big Killers” including cardio-vascular disease and cancer. Risk factors for these, such as smoking, are strongly linked to deprivation.

• Drug and alcohol problems and links to violence that affect younger men in particular and where inequalities are widening.

Task Force’s recommendations

• Support for families in early years and young people

• Mental health and wellbeing

• Poverty and employment

• Physical environments

• Alcohol, drugs, violence

Recommendations for health services

• Inequalities-targeted high risk primary prevention (Keep Well)

• Smoking

• Vulnerable groups and diversity

• Eg offenders’ health

• NHS wider role: employer, investor, local community leader and community planning partner

Linked social policies:

Achieving our Potential:

• Reducing income inequalities

• Long term measures to tackle poverty and the drivers of low income

• Supporting people in/at risk of poverty

• Making tax credits and benefits system work better for Scotland

Early Years Framework

• Pre birth to 8 years

• Prevention

• Early intervention

• Building capacity: strong relationships, engagement and empowerment

• High quality of life and access to play

• Collaboration across agencies

Long-term national health inequalities indicators (10-15 years):

• Healthy life expectancy

• Premature mortality

• Mental wellbeing

• Low birthweight

Basket of inequalities measures:

Relative Index of Inequality (RII)

How steep is the inequalities gradient? This measure describes the gradient of health observed across the deprivation scale, relative to the mean health of the whole population.

Absolute range How big is the gap?This measure describes the absolute difference between the extremes of deprivation – the rate in the most deprived minus the rate in least deprived group.

Scale How big is the problem?This measure describes the underlying scale of the problem and past trends.

Making change happen

• Linking up social policies: early years, poverty, health inequalities

• Prevention and early intervention

• Assets, not deficits, approach

• Better use of existing resources

• Community planning and single outcome agreements

• “Collaborative gain”

Bottom up change

• 8 local test sites: planning and health impact, wellbeing, young people and alcohol etc

• Service redesign

• Better client pathways

Govanhill test site:

• Neighbourhood issues

• Integrating migrant communities

• Drugs, alcohol, young people’s issues

Support from the Start

• Breaking the cycle of disadvantage• Fits with strategic focus already adopted

by integrated children’s service planning• Good inter service relationships• Opportunity for the community and

frontline staff to have their say

Equally Well review 2010

• How does the economic climate affect strategy?

• Early check on progress with actions

• How is local delivery going?

• What are we learning from the test sites?

• Contributions from knowledgeable groups (eg RCGP Scotland work on inequalities)

Do we need to do more? Initial thoughts:

• Impact of recession: society’s values, people’s wellbeing, health and work, opportunities as well as problems

• Implement social policies in a joined-up way• Get smarter at transferring learning between

local areas• Shared professional values and approaches• How do we measure progress: short, medium

and long-term?

Where to read more:

Equally Well:

http://www.scotland.gov.uk/Topics/Health/health/Inequalities/inequalitiestaskforce

Health inequalities indicators:

http://www.scotland.gov.uk/Publications/2008/09/25154901/0

Related SG strategies:

http://www.scotland.gov.uk/Home