This document summarizes the Scottish Government's strategy to address health inequalities. It identifies that health inequalities are most significant in children's early years, mental illness, and diseases linked to deprivation like cardiovascular disease and cancer. The strategy focuses on supporting families, improving mental health and wellbeing, reducing poverty, and limiting substance abuse. It also calls for targeted prevention programs, better social policies, community collaboration, and measuring long-term impact on health inequality indicators over 10-15 years. The strategy establishes test sites to pilot local implementation and will undergo review to evaluate progress against recession challenges.

1. Scottish Government’s
response to health inequalities
Kay Barton
SG Health Improvement Strategy
27 June 2009

2. I’ll talk about:
• Health inequalities: what’s the problem?
• Equally Well
• Where do we need to do more?
• How can you help us?

3. Healthy life expectancy
Males, by income-employment
index, Scotland 2005-06

4. Relative inequalities in mortality
by cause, men, Scotland 2001

6. Scottish Government’s economic
strategy
Figure B1

7. “We have made tackling
health inequalities our top
priority”
Nicola Sturgeon
Cabinet Secretary for Health & Wellbeing

9. Upstream/downstream: reducing inequalities in
health depends on reducing inequalities in life
chances and life circumstances

10. 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.

11. 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

12. 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

13. 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

14. 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

15. Long-term national health inequalities
indicators (10-15 years):
• Healthy life expectancy
• Premature mortality
• Mental wellbeing
• Low birthweight

16. Basket of inequalities measures:
Relative Index of How steep is the inequalities gradient?
Inequality (RII) 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.

17. 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”

18. Bottom up change
• 8 local test sites: planning and health
impact, wellbeing, young people and
alcohol etc
• Service redesign
• Better client pathways

19. Govanhill test site:
• Neighbourhood issues
• Integrating migrant communities
• Drugs, alcohol, young people’s issues

25. 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

27. 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)

28. 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?

29. Where to read more:
Equally Well:
http://www.scotland.gov.uk/Topics/Health/health/
Health inequalities indicators:
http://www.scotland.gov.uk/Publications/2008/09
Related SG strategies:
http://www.scotland.gov.uk/Home