Ministerial Task Force on Health Inequalities: report 2013

2. Background to Equally Well

Equally Well, the report of the Ministerial Task Force on Health Inequalities was published in 2008. At the time the strategy was considered ground breaking in that it focussed on the mechanisms through which the wider determinants of inequalities impact upon individuals' life chances, and emphasised the need for action from all sections of Government. Equally Well was also the first of a set of three linked social policy frameworks for tackling inequality, and sat beside the Early Years Framework and Achieving our Potential (both launched later in 2008).

Equally Well identified four primary areas for action

• children's very early years;
• mental health and wellbeing;
• the harm associated with violence, drug and alcohol abuse;
• and the big killer diseases (heart disease and cancer), together with their risk factors, such as smoking.

The Ministerial Task Force was reconvened in 2010 to review progress. The aims of the 2010 Review were to:

• gauge how well key agencies - including the Scottish Government - had been able to respond to the principles of the recommendations contained within Equally Well;
• make additional recommendations or statements to give impetus to the vision for tackling inequalities set out in the three linked social policy frameworks. This was particularly pertinent when set against the wider climate of reductions in public spending and emerging trends in the key indicators of social inequalities;
• consider how to replicate the progress made by the Equally Well test sites;
• set out arrangements for future monitoring and governance.

The main conclusion of the 2010 review was the need for a greater focus on prevention and preventative spending, as well as reinforcement of the general principle that poor health was not simply due to life style choices, but instead that there were links to people's aspirations, sense of control and other cultural factors. This was described then as a 'sense of coherence', in which the external environment is perceived by individuals as comprehensible, meaningful and manageable. The 2010 review also re-emphasised that a more collaborative approach across different public services was required, and that Community Planning Partnerships working effectively together would be key. The Task Force agreed to reconvene in 2012 to assess progress.

2.1 Remit of the Task Force in 2012

When the Task Force reconvened in November 2012 it was clear from the health inequality data that, for most indicators, the health gap between Scotland's most and least affluent groups had not reduced ^[1] . It was also clear that the impact of the current economic situation had yet to be fully realised and would apply further pressure, whilst anticipated changes to the welfare system were likely to exacerbate health inequalities highlighting a public health issue. In addition the Report on the Future Delivery of Public Services (The Christie Commission) ^[2] had reset the expectations on the public sector and Community Planning Partnerships in particular.

The Task Force was asked to consider the latest evidence on health inequalities in Scotland within this context. Members were provided with summaries of the latest evidence, opinion and analysis from key stakeholders, and representations from a range of organisations. Over the course of 4 meetings, the Task Force sought to identify key priorities that would support delivery of Equally Well in the next few years. Specifically, members 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 ( Annex A) remained extant and that tackling health inequalities should sit at the heart of government policy alongside the other key social policy frameworks.

All the papers and presentations that the Task Force received are available from the Scottish Government website ^[3] . The current report does not seek to replicate that material, and should be read alongside the key background documents - in particular the Scottish Government's report on long-term monitoring of health inequalities and NHS Health Scotland's Health Inequalities Policy Review ^[4] .

2.2 Membership of the Task Force

• Michael Matheson MSP, Minister for Public Health (Chair)
• Margaret Burgess MSP, Minister for Housing and Welfare
• Aileen Campbell MSP, Minister for Children and Young People
• Roseanna Cunningham MSP, Minister for Community Safety and Legal Affairs
• Derek MacKay MSP, Minister for Local Government and Planning
• Paul Wheelhouse MSP, Minister for Environment and Climate Change
• Sir Harry Burns OBE, Chief Medical Officer
• Sandy Watson (replaced Dr Charles Winstanley), Chair of NHS Chairs
• Margaret Burns, Chair NHS Health Scotland
• Professor Carol Tannahill, Director, Glasgow Centre for Population Health
• Andrew Muirhead, Chief Executive, Inspiring Scotland
• Councillor Peter Johnston, Health and Well-being spokesperson, COSLA