Drug Deaths Taskforce response: cross government approach

2. Addressing the social determinants of health

Drug dependency is a health condition and in Scotland, we are taking a public health approach to drugs^[11]. An individual's health does not exist in isolation: our living and working conditions and the wider socioeconomic and cultural environments we exist in all interact and impact on us.

One of the strongest correlations with drug harms is poverty. In 2021, people from deprived areas were 15.3 times more likely to die from a drug misuse death^[12] than those from the least deprived areas and the sharp increase over time is mostly accounted for by an increase in deaths in the most deprived areas meaning the gap is widening. This suggests that it is not only drug use, but also other social determinants associated with poverty which are driving this problem.^[13]

Evidence highlights a strong relationship between deprivation and harm from drugs. It is important to recognise, however, that while many people with problem drug use have experienced poverty, living in deprivation does not necessarily mean a person will develop a substance use problem. Living in poverty does, however, increase the risk of exposure to a range of risk factors^[14]. Problem substance use forms a method of escape or a coping mechanism for those most excluded from society.^[15]

There are also many other complex and intersectional drivers behind why some people develop problem substance use. These include adverse childhood experiences including care experience, parental substance use, social exclusion and trauma. Such experiences throughout the life course can both initiate and exacerbate problem drug use.

The work of the Scottish Government to tackle poverty and inequality therefore plays an important part in our strategy to prevent problem substance use. The National Mission on Drugs is delivered within the Scottish Government's broader strategy to tackle the social determinants of health and inequalities. Key interventions are referenced throughout this report and summarised below. Taken together this suite of strategies represents a complementary approach to tackling the social determinants of health, prevention, early intervention and holistic support for people with problem drug use.

Fairer Scotland Duty: places a legal responsibility on particular public bodies in Scotland, including Scottish Ministers, to actively consider ('pay due regard' to) how they can reduce inequalities of outcome caused by socio-economic disadvantage, when making strategic decisions.

Children and Young People: We want all children and young people to live in an equal society that enables them to flourish, to be treated with kindness, dignity and respect, and to have their rights always upheld. Getting It Right For Every Child (GIRFEC) is our commitment to provide all children, young people and their families with the right support at the right time. This is so that every child and young person in Scotland can reach their full potential. In addition 'Best Start, Bright Futures'^[16], the Scottish Government's second Tackling Child Poverty Delivery Plan, sets out bold action to drive progress to tackle child poverty, including our focus on long-term parental employment support, increased social security, and measures to reduce household costs. The Promise sets out the actions and commitments we will take to improve the lives of our care experienced community.

Employment Support: Young People are further supported by the Young Person's Guarantee established in November 2020. It aims to connect every 16 to 24 year old in Scotland to an opportunity. This could be a job, apprenticeship, further or higher education, training or volunteering. It could also be an enterprise opportunity. Employment support is supported by No One Left Behind, our approach to transforming all age employment support. It delivers a system which simplifies the landscape, is integrated and aligned with other key services including health, justice, housing and advice services, and will deliver better outcomes for people who are further removed from Scotland's labour market to achieve their full potential.

Promoting take-up of benefits: Ensuring that people can access all the Social Security Benefits to which they are entitled is a moral duty and fundamental priority of the Scottish Government. Our second Benefit Take-up Strategy^[17] sets out how we are working to ensure that people from all walks of life can access the support for which they are eligible.

Justice: The Vision for Justice in Scotland^[18] published in February 2022 sets out a vision of the future justice system for Scotland, spanning the full journey of criminal, civil and administrative justice, with a focus on creating safer communities and shifting societal attitudes and circumstances which perpetuate crime and harm. It acknowledges the frequent interactions with the justice system by people who use drugs and the importance of working together to address the underlying causes of crime, providing support to live full and healthy lives. In addition, the Youth Justice Vision^[19] aligns with the objectives of the Promise, GIRFEC and the National Performance Framework in enhancing the wellbeing of children and young people and offering positive support to children and families.

Housing and Homelessness: The Scottish Government's homelessness strategy, Ending Homelessness Together^[20], was refreshed in 2020. It outlines how national government; local government and third sector partners will work together on our shared ambition to end homelessness. A home is much more than bricks and mortar and homelessness is not just a housing problem. A home provides security, a sense of wellbeing and is somewhere to put down roots.

There are three main elements to our strategy:

• Where possible, we want to prevent homelessness from happening in the first place.
• Where homelessness cannot be prevented, we promote rapid rehousing. A housing-led approach reduces the need for many forms of temporary accommodation. Rapid rehousing means making sure that anyone experiencing homelessness is helped into settled accommodation as quickly as possible. Housing First is an important component of our rapid rehousing approach, offering settled accommodation and wraparound support to people with multiple and complex needs. It is a well-evidenced and effective model. The principle of Housing First is that a safe, secure home is the best base for addressing any support needs.
• And we want to eradicate rough sleeping, the most acute form of homelessness.

Mitigating against the Cost of Living pressures: People all across Scotland are being affected by the most severe economic crisis in a generation. And people who use drugs and their families are likely to be disproportionately impacted.

The Scottish Government is doing what it can with its limited powers to ensure people receive the help they need,providing significant support for households to mitigate the impacts of the current cost of living emergency. By the end of March 2023, we will have invested almost £3 billion in a range of measures for households, supporting energy bills, childcare, health and travel, as well as social security payments including the Scottish Child Payment and Bridging Payment.

The Scottish Government has also taken action to protect tenants by freezing in‑tenancy rents and by introducing a moratorium on evictions with some specified exemptions, at least until 31 March 2023.

In the Drugs Policy Division, we will offer third sector and grassroots organisations, who are receiving Scottish Government funding via Corra, a 5% uplift to address cost of living pressures, recognising that the impact is sometimes felt hardest by the smallest of services we support. In addition, we also intend to raise the core funding received by Core Funded Organisations by 5% to support them in this crisis.

As demonstrated throughout this report, the work to tackle poverty and inequality (including health inequalities) across government is wide ranging. The following sections outline our response to each of the Taskforce recommendations in turn and demonstrate in more detail and specificity how this work will deliver the National Mission. There are two key cross cutting themes which will underpin this work.

Stigma: we know that stigma and discrimination may well mean that many are not benefiting as they should. It is essential therefore that we work with partners across government to tackle any exclusion of people who use drugs or their families. We are committed to the fundamental principle that problem drug use should be treated as equivalent to any other health issue and we are working with colleagues across these areas to explore the question: "what adjustments are needed to ensure people affected are included and not discriminated against?"

Listening to Experts by Experience: Our approach to the National Mission and the development of this plan is influenced by the expertise, advice and guidance we have received from people with lived and living experience through a number of channels. However, we need to do more to ensure their voices are heard across government.