Tackling health inequalities – Scottish Government perspective Tony Rednall Creating Health Team: Public Health Division

1.Ministerial Task Force on Health Inequalities 2.Beyond the NHS 3.the Task Force’s priority areas Overview

Equally Well and the latest report of the Ministerial Task Force on Health Inequalities (2013)

Background Equally Well – The report of the Ministerial Task Force on Health Inequalities (published 2008). Found four primary areas for action: - children’s very early years; - mental health and wellbeing; - harm associated with violence, drug and alcohol abuse; - big killer diseases (heart disease and cancers), together with their risk factors, e.g. smoking. Ministerial Task Force reconvened in 2010 and 2012 to review progress.

Latest Ministerial Task Force objectives: Members asked to identify key priorities that would support delivery of Equally Well in coming years. Reflect on changes in the way that people & communities are engaged in decisions that affect them; Consider implications of the Christie Commission’s (2011) conclusions relating to health inequalities; Look at how characteristics of “place” had an impact on health inequalities in Scotland.

The evidence heard: Health in Scotland improving, but more slowly than other European countries – needs faster improvement in most deprived areas, which conventional approaches have failed to achieve; Level of deaths amongst the age group contributing significantly to poor European standing; Despite many similarities, Glasgow & the West of Scotland are experiencing more deaths than comparable cities & regions in the UK. One potential contributing factor identified is the difference in social capital; The immediate environment makes a significant impact on health and wellbeing.

Priority areas identified: Development of social capital; Support for CPPs and the community planning process; Focus on the age group; Support for the implementation of a Place Standard.

Moving forward: The Ministerial Task Force (2013) also committed to alternative arrangements in future. Ministerial Strategic Group for Health & Community Care (MSG) Health & Community Care Delivery Group The Inequalities Action Group

Beyond the NHS: collaboration and innovation Third & voluntary sector crucial to making further progress to improve health and reduce inequalities. Scottish Government sees its role being to encourage and enable innovative local partnerships between national and local government, primary care/healthcare providers, third sector and community-led organisations.

Assets-based approaches Crucial to Equally Well has been helping shift policy focus from dealing with deficits, to instead focusing on individuals’ and communities’ capacities – and how these can be developed to address local needs. The voluntary sector often represents these local community resources, and the means by which individuals can be supported to realise their potential – thereby challenging health inequalities.

Link Worker Programme Partnership developed between the Deep-End GP group and the Health & Social Care Alliance Scotland underpins the programme’s potential to tackle health inequalities. The Scottish Government is funding the programme to explore how GP practices and local community services can work together, to support patients experiencing socio- economic circumstances that impact negatively upon their health.

Social capital: shared value arising from networks of people. Increasing levels of social capital will challenge social exclusion, as part of addressing wider health inequalities. Facilitating social capital building to be a priority in Scottish Government’s on-going work with communities. Developing social capital

Equally Well emphasises cross-agency joint working through CPPs as crucial to delivering change on health inequalities. Ministerial Task Force acknowledged improvement needed. Significant to work towards Christie Commission objective of: “building personal and community capacity, resilience and autonomy”. Support for Community Planning Partnerships

Development of Place Standard Growing recognition of need to shape places which are nurturing of positive health, wellbeing and resilience. The Scottish Government is developing a Place Standard which will be monitored with regards to health inequalities. Poor urban Design Social Exclusion Health Inequalities

Equally Well focus on children, but adult groups vulnerable to socio-economic drivers of health inequalities group found to experience comparably high rates of excess mortality. Leads us to: discussion of third sector contribution to reducing health inequalities amongst vulnerable adults – and the role Scottish Government can play. Focus on the age group

Health Inequalities Tackling the fundamental causes