1. Adult Learning and Health Inequalities
Wilma Reid, Head of Learning and Improvement
NHS Health Scotland
Annexe 2

2. NHS Health Scotland
We are Scotland’s national agency for reducing health inequalities and improving health
We are a National Health Board in NHS Scotland.
Our work focuses on:
Linking together experts from across Scotland to tackle the biggest issues in achieving good health
Compiling world class evidence and research to further Scotland’s understanding of health inequalities
Influencing policy makers at all levels to design targeted interventions to help build a fairer healthier Scotland
Introductory slide to inform audience of who we are and leading upto AFHS

3. Our vision and mission “A FAIRER HEALTHIER SCOTLAND”
Our Strategy :
“A FAIRER HEALTHIER SCOTLAND”
AFHS is the reason and context for all of the work we do in HS - whether an internal support function or it’s about external delivery of our products and services
Our priority is health inequality – this means a sharper focus on improving health for those with the worst health to the level of those with the best health – levelling up.
Note – it’s not only about improving the health of the most deprived, its about reducing the social gradient in health. so it is about improving the health of everyone so it is the same as those with the best health (not just about improving health of the worst)

4. They are the result of social factors and they are not inevitable.
What we mean by health inequalities?
Put simply, they are unfair differences in the health of the population that occur across social classes or population groups.
They are the result of social factors and they are not inevitable.
There is a more technical definition of health inequalities – however- this is the one we want to use as it is simpler- We want to use language that is accessible to people.
This definition stresses the central role that ‘unfairness’ or social injustice has in causing health inequalities.
There are lots of definitions of health inequalities but we simply state that:
Health inequalities are unfair differences in the health differences between population groups in Scotland
Health inequalities are not random or chance, but are caused by social inequalities outwith an individual’s control
Health inequalities are not inevitable, but can be addressed if there is the societal and political will to do so. There have been times when health inequalities have been less than they are now
We know that absolute health inequalities remain high and relative inequalities have increased steadily since 1981. 
Much of what we are setting out in our strategy is informed by knowledge and evidence, but its also based on principles and values- equality, human rights and fairness (and I think that’s why for so many people in the organisation it feels like ‘the right thing to do’).

5. Inequality in health- the consequences
Many different ways in which inequality can be depicted and described.
One of the starkest and most measurable is clearly premature mortality – i.e. people dying younger than they should.
For each station you pass between Jordanhill and Bridgeton, life expectancy drops by 2 years for men and by 1.2 years for women
Or another way to look at this: Imagine you are talking to a classroom of boys in the east end of the city - 50% of those boys will be dead before they reach the age of 65. Now you are talking to a classroom of boys of the same age in Jordanhill - over 83% of those boys will still be alive at 65.

6. The causes of health inequalities are numerous, interrelated and need to be better understood. To take action we need to help policy makers and others understand the underlying causes of the problem. We have developed a theory of causation based on all the evidence to provide a summary of our understanding of the causes of health inequalities
So basically health inequalities are the end point – they are the symptom or end point
But the starting point is what WHO call the ‘Fundamental Causes’. It is increasingly accepted that health inequalities have their roots the major socio- political forces which drive decisions and priorities and result in an unequal distribution of power, money and resources that often lead to discrimination and marginalisation.
These fundamental causes in turn influence the distribution of ‘wider environmental influences’ such as the availability of good jobs, good quality housing, education and learning opportunities, access to social and cultural opportunities and to services etc in an area. Because the distribution of these are all shaped by the same fundamental causes, they tend to be clustered. So some areas/groups have poorer access to jobs, affordable transport, good quality housing and schools, public services, low levels of social capital and democratic engagement.
The wider environment in which people live and work, shape the individual experiences that lead to health inequalities. So the fact that an individual experiences a low income, poor housing and poor diet is shaped by the availability of good jobs, decent housing and healthy affordable food in their area. So the most proximal causes of these health inequalities are seen in the social patterning of individual experiences and behaviours and use of resources such that disadvantaged groups and vulnerable individuals and communities are clearly identifiable.
The end point of this theory of causation is often the visible and measurable effects of wider social and economic inequalities as manifest in the unequal and unfair distribution of wellbeing, ill-health and premature mortality in the population. These inequalities result in the unequal and unfair distribution of well-being, ill-health and life expectancy
This ‘theory of causation’ underlines the need for us to address the ‘fundamental causes’ in order to be able to reverse the worsening trends in health inequalities in Scotland.
To reverse the worsening trends in health inequalities therefore needs to address the ‘fundamental causes’

7. 3 Levels of Action to Reduce Health Inequality
Mitigation: Services designed and delivered in way that helps improve access and support that is tailored to need
Prevention: Resources allocated to improve the environmental conditions and circumstances known to damage health
Undoing of Inequality: Policies designed to avoid inequality being created in the first place- fairer distribution of power, money and resources
This is a small extract from our full logic model combined with the Inequalities Action Framework (‘Pauline Craig’s Framework’).
Our IAF says that action is needed to Mitigate, Prevent and Undo Inequality.
We need to help the system- (policy makers, planners, practitioners, employers) understand that action needs to be taken at each of these levels, and help them determine what those actions need to be.
Key point is that all 3 levels of action are important; prior to AFHS we have tended to work more at the level of mitigation, and even then with a focus on supporting services and the public with behavioural change rather than mitigation of the impact of life circumstances.
We also need action at ‘prevention’ – and ultimately at ‘undoing’ if we have any real hope to reduce health inequalities. 7 7

8. Scope for adult learning to reduce health inequalities
Evidence: Marmot Review identified lifelong learning as a key intervention
Links with health outcomes
Social capital
Health behaviours
Employability
Mental health and wellbeing
Effect on next generation
Principles: life course approach; act at transitions; flexible learning design; work with employers and communities
Public Health England 2014

9. Contribution to health agenda
Health literacy and being better able to navigate the system
Supports a self-management agenda for people with long term conditions
Being local advocates for health issues – community empowerment
Linking to opportunities for volunteering in NHS Scotland
More formal roles eg Link Workers in Primary Care
Early Years interventions

10. Scotland’s Learning Partnership aims to
Challenges
Gradient in participation in adult learning – levelling up
Scotland’s Learning Partnership aims to
‘create, design and deliver innovative projects that reach the most excluded groups’
Improve barriers to adult learning – access, financial barriers, confidence to learn, relevance of provision, support for older people (Chandola and Jenkins, 2014)
Research to better understand: the impact of adult learning on health and wellbeing; the effect of health literacy interventions on health inequalities

11. https://elearning.healthscotland.com/
Learning resources available free on our VLE