SCOTTISH GOVERNMENT AND HEALTH INEQUALITIES What is the Scottish approach?

This presentation looks at Examples of health inequalities in Scotland Reasons for health inequalities Government strategies on health inequalities

LIFE EXPECTANCY The Scottish Government is well aware of health inequalities and the relationship between wealth and health. Equally Well is the Scottish Government’s report into Health Inequalities. NHS National Service Scotland found that in 2010, average life expectancy in Glasgow’s affluent Jordanhill area is 80 years. In Parkhead, in Glasgow’s east end, average life expectancy is just 59, a figure lower than that in Yeman, Laos or North Korea. The five authorities in Scotland with the highest premature death rates are Glasgow City, West Dunbartonshire, Inverclyde, Dundee and North Lanarkshire. These are all authorities with serious problems of social deprivation. So, in many ways, Scotland is not as is often said, “the sick man of Europe”. Scotland’s health problems are concentrated in communities with the highest levels of deprivation. If we could improve health in the above areas, Scotland would, in fact, be one of the healthiest countries in the world! Michael Portillo visits The Calton

EARLY YEARS Equally Well notes that a higher proportion of babies born to mothers living in the most deprived fifth of the population have a low birth weight than those born to mothers living in the most affluent areas (9% compared to 5% in ). Almost four-fifths of 5 year olds in the most deprived areas have some decayed teeth compared to two-fifths of those in the least deprived areas. The rate of pregnancy among 13- to 15-year-old girls in the most deprived fifth of areas is twice as high as the average, and four times as high as in the least deprived fifth.

MENTAL HEALTH In Scotland in 2011, people who had a low household income, or reported finding it difficult to manage on their household income, had poorer mental well-being than those with a high household income or who reported finding it easy to manage on their income. Those living in the most deprived 10% of areas of Scotland have a suicide risk double that of the Scottish average.

LIFE STYLE FACTORS In Scotland in 2006, more than two thirds of the total alcohol-related deaths were in the most deprived two fifths of areas. 49% of men in the most deprived areas smoke regularly compared to 26% of men in the least deprived areas. The divide is similar for women: 43% smoke in the most deprived areas, compared to 24% in the least deprived. Deaths from heart disease are nearly five times higher in poorer areas, and cancer deaths almost twice as high. It is estimated that more than 6,000 children in Glasgow are living with a parent with a substance abuse problem.

SMOKING RATES (%AGE OF ADULTS WHO SMOKE)

NORTH GLASGOW AND EAST DUNBARTONSHIRE North Glasgow has high rates of unemployment and child poverty. By contrast the commuter towns of neighbouring East Dunbartonshire are among the wealthiest in the UK. There is, as you would expect, a health gap.

NUMBERS ADMITTED TO HOSPITAL WITH CORONARY HEART DISEASE

Numbers admitted to hospital with drug conditions

LIFE EXPECTANCY

OBESITY TOO! 38% of people in the poorest areas do not take part in any sport One in five toddlers in Glasgow are obese 20% of men and almost 25% of women in Glasgow are obese

PROF PHIL HANLON GLASGOW UNIVERSITY “Physically, Parkhead has worse housing than Jordanhill. In the womb, Parkhead’s next generation is more likely to be exposed to smoking, alcohol and a poorer diet. And this gets compounded in the early years and adolescence, with people from poorer neighbourhoods being more likely to work in lower- income jobs or suffer unemployment. It’s hard to say what matters most; it’s the complex interaction of factors more than any one.” Health Inequalities in Glasgow

NOT A GLASGOW PROBLEM BUT A POVERTY PROBLEM It would be a mistake to think that only Glasgow suffers from poor health. Other Scottish cities do too. And there are many parts of Glasgow e.g. Jordanhill, Kelvinside where health statistics are among the highest in the UK. But, Glasgow has long standing poverty issues relating to high unemployment, poor housing but also the “Glasgow factor” which has, historically, for its poorest citizens, led to low self esteem unhealthy lifestyles and violence. These are all issues explored in Carol Craig’s book, “The Tears That Made The Clyde”. Housing in Govanhill 2010

Ministerial Taskforce on Health Inequalities The Scottish Government has set up a Ministerial Taskforce on Health Inequalities. Dr Barry Burns, Scotland’s Chief Medical Officer, has played a leading role in its approach. There is now a much bigger focus on early intervention in children’s lives. This is why the Scottish Government, has attempted, among other things, to introduce free school meals for all in P1-P3.

PROF HARRY BURNS: THE BIOLOGY OF POVERTY Prof Burns has investigated why poorer people, particularly in the west of Scotland and particularly since the 1950s, suffer from worse health than richer people. His conclusions are that difficult social circumstances, especially in the early years of life, have a dramatic effect on the body’s host defences. A child who is brought up in a chaotic environment, for example, having parents with drink or drugs issues, instability of care, neglect and/or poor housing will be brought up in an aggressive environment.

Poor lifestyle choices do make a difference to health and life expectancy. But, the middle classes smoke and drink too! So, lifestyle choices on their own do not explain health inequalities. ITS NOT ALL TO DO WITH LIFESTYLE

This has an immediate effect on the child’s nervous system and, later in life, the body’s capacity to fight illness. So, the long term answer to health inequalities is to tackle poverty. In the short term it is to intervene early with children who are at risk from chaotic upbringing. A CHAOTIC CHILDHOOD IS A KILLER

NEW POLITICAL CONSENSUS All the major political parties now accept that there is a connection between poverty and poor health. This wasn’t always the case. All agree that getting people back to work and tackling poverty is required to reduce health inequalities. The Conservatives are still more likely to emphasise individual responsibility.

BAN ON SMOKING IN PUBLIC SPACES “All those who smoke play Russian roulette with their lives but the odds are heavily stacked against those in lower income groups as they are much more likely to smoke”. John Toy, Cancer Research UK The smoking ban has been in existence since 2006 and it has been a great success. There has been a 14% drop in heart attacks since over 40,000 Scots quit smoking since the ban. Further legislation is expected to restrict the display of tobacco products in shops and supermarkets.

ACTION ON ALCOHOL AND TOBACCO The Scottish Government has introduced minimum pricing for alcohol, ending supermarket deep discounting. Next on the agenda could be a ban on branding of cigarette packets. Cigarette plain packaging proposal

2011: PRESCRIPTIONS CHARGES PHASED OUT “Abolishing prescription charges will help tackle inequalities. As more of us live with long-term chronic conditions, increasingly it is the case that prescription charges are a tax on ill-health.” Nicola Sturgeon Health Secretary In April 2011, prescription charges were abolished in Scotland. End of Prescription Charges in Scotland

CAN CULTURE AND SPORT MAKE A DIFFERENCE? Glasgow Life provides free swimming for Glasgow residents under 18 and over 60 and has the largest sports development programme in Scotland. The Scottish Government has high expectations from that the 2014 Commonwealth Games will deliver a range of health and social benefits. This includes encouraging grass roots sport and the regeneration of Glasgow’s east end through new sports facilities and, after the Games, affordable housing for local people. The Scottish Government is hoping for an improvement in health and well-being as the East end of the city is transformed into an attractive place to live and work Commonwealth Games Legacy