Ministerial Task Force on Health Inequalities: report 2013

1. Executive Summary

The Ministerial Task Force was reconvened to consider the latest evidence on health inequalities in Scotland. The Task Force identified key priorities that would support delivery of Equally Well in the next few years. The Task Force were asked to:

• reflect on changes in the way that people and communities were being engaged in decisions that affect them;
• consider the implications of the Christie Commission report for how health inequalities might be tackled; and
• look at how characteristics of "place" had an impact on health inequalities in Scotland.

There was a general understanding that the fundamental principles set out in Equally Well remained extant and that tackling health inequalities should sit at the heart of government policy alongside the other key social policy frameworks.

The Task Force was presented with the latest science behind health inequalities, heard from stakeholders about their experiences and learning, and learned of developments in the public sector since the last review.

A significant development since 2010 has been the report of the Christie Commission and the publication of a Statement of Ambition agreed by both local and national government. The Christie Commission was absolutely clear that a radical change in the design and delivery of public services, and the way in which public services work with each other and with communities, was required. The Scottish Government has agreed this requires that:

• public services are built around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience;
• public service organisations work together effectively to achieve outcomes;
• public service organisations prioritise prevention, reducing inequalities and promoting equality; and
• all public services constantly seek to improve performance and reduce costs, and are open, transparent and accountable.

The Task Force heard evidence that while the health of Scotland is improving, it is doing so more slowly than other European countries. It heard that mortality rates have improved in deprived and affluent areas at broadly the same rate, leading to an increase in relative inequalities, and meaning that in order to reduce health inequalities there needs to be a faster improvement in the most deprived areas. It heard evidence that conventional approaches to the problem that involve attempts to modify the health related behaviours of poorer people have failed, and that a new approach to health inequalities has to be widely adopted to accompany actions which address the wider inequalities in society.

The Task Force heard evidence that the level of deaths amongst the 15-44 age group was contributing significantly to the relatively poor position of Scotland's health in a European context. The Task Force also heard evidence that despite many similarities, Glasgow and the West of Scotland were experiencing many more deaths than comparable cities and regions in the UK. One potential contributing factor identified was the difference in social capital between these areas. Furthermore, the Task Force heard evidence of the significant impact that the immediate environment makes on health and wellbeing through the work of Good Places, Better Health.

Rather than make new specific recommendations, the Task Force agreed to identify priority areas for action. The priorities support existing areas of work that have been developed since the last review.

The Task Force identified the following areas as priorities:

• Development of Social Capital

The Task Force believe that a key function of Community Planning Partnerships ( CPPs) will be how they engage with their local communities. The Task Force supported the objective set out by the Christie Commission, of 'building personal and community capacity, resilience and autonomy' or "social capital", and that this should be a priority in any on-going work with communities.

• Support for CPPs and the community planning process

Equally Well has always placed CPPs at the centre of achieving the ambition set out in the strategy. The Task Force is convinced that Community Planning Partnerships remain the best vehicle for making progress in delivering Equally Well. CPPs have the potential to demonstrate the leadership and collaborative working that is required if we are to realise our ambitions; of realigning available resources towards prevention and engaging all partners - including the Third Sector. These are priorities in line with the Christie Commission.

• Focus on the 15-44 age group

In addition, the Task Force recognised that in taking a life course approach there was scope to examine and potentially enhance what we do that impacts on the 15‑44 age group. The evidence suggested that it was in this age group in particular that Scotland experiences many more excess deaths compared with other European countries and regions. The Scottish Government will review with our partners the current activities that impact upon this age group, in order to identify potential new actions that would impact positively on their health outcomes.

• Support the implementation of a Place Standard

The Task Force noted that the development of a Place Standard was a welcome addition in the fight to tackle health inequalities, and that such development and implementation should be monitored.

Finally, the Task Force also considered its own input into the work to tackle health inequalities. It was clear to members that a regular two yearly review may not be the best way to monitor progress nor influence the current way of working. Furthermore, alternative arrangements for coordination of work to tackle health inequalities, to monitor and to influence progress, should be considered.

All members of the Task Force were clear that the focus of all our efforts should be on tackling inequalities. Moreover, they reflected that by targeting health inequalities we may have inadvertently allowed different parts of the public sector to think that this focus did not apply to their organisation, and that responsibility to resolve the problems arising from inequalities lies only with the National Health Service ( NHS). This could not be further from the truth, and to ensure we maximise participation from all parts of the Government, and the wider public sector, we need to focus our efforts on tackling such inequalities. Achieving successful outcomes in this regard will impact positively on the health of Scotland.