Ministerial Task Force on Health Inequalities: report 2013

5. Conclusion

The Task Force agreed that the fundamental principles of Equally Well still hold true, and that Equally Well remains at the heart of inequalities policy in Scotland. Members also agreed that the life course approach should remain central to that policy, and that giving children the best start to life was essential.

Through this review the Task Force heard from a number of contributors about learning and experience since the last review in 2010 and received an update on the latest evidence. The Task Force noted that despite a lot of commitment and resource, the scale of health inequalities - as measured by the national indicators - had not reduced. If the strategy is fundamentally sound and the actions and themes robust, then the focus has to be on delivery and how we go about implementation. The Task Force were asked to consider the latest evidence and to reflect on changes in the way that people and communities were being engaged in decisions that affected them, as well as the impact of the Christie Commission on how health inequalities are being tackled.

The Policy Review noted that whilst the publication of Equally Well in 2008 marked the desire to shift focus to the social determinants of health, link beyond the NHS and engage local authorities, in practice there had been a tendency towards focussing on 'downstream' activities (dealing with people after they have acquired problems) rather than dealing with issues 'upstream' in order to prevent these problems arising in the first place. Often these issues were tackled individually and there was limited joining up of activity.

The Policy Review also noted that there was a significant amount of work that contributes to tackling inequalities undertaken across Government, but which is not explicitly linked to Equally Well. A similar conclusion has been reached by the Health and Sport Committee of the Scottish Parliament, who had planned a review of health inequalities but has recently decided against such a review, seeking instead to widen the debate on health inequalities by inviting other relevant subject committees to consider the question within their remits.

The Task Force was asked to reflect on changes in the way that people and communities were being engaged in decisions that affect them, and the impact of the Christie Commission on how health inequalities are being tackled. In addition the Task Force looked at how "place" had an impact on health inequalities.

Finally, the Task Force noted that welfare reform was a public health issue and that impact was already being felt by the NHS in Scotland. The Task Force noted that there were limits to what the Scottish Government and local government could do to mitigate the impacts of the UK wide changes to the system.

The Task Force identified the following areas as priorities:

• Development of Social Capital

The Task Force believe that a key function of CPPs will be how they engage with their local communities. The Christie Commission argued that 'building personal and community capacity, resilience and autonomy' should be a key objective of future public service reform. The Task Force supported that objective, and noted that this would play a role in generating and maintaining social capital which had been identified as a key difference between communities that are healthy and those that are unhealthy.

• Support for CPPs

Equally Well has always placed Community Planning Partnerships at the centre of achieving the ambition set out in the strategy. This was reinforced in the 2010 review and has been reflected in the recent list of six priorities given to CPPs which includes tackling health inequalities. The Task Force recognised that recently CPPs have received greater attention through the Christie Commission report and the response of national and local government to the challenge. The Task Force is convinced that CPPs remain the best vehicle for making progress in delivering the priorities of Equally Well at sub-national level and in responding to the Christie Commission Report. In particular, the need for Community Planning Partnerships to realign available resources toward shared priority outcomes in new Single Outcome Agreements - including to reduce health inequalities - and engage all parties including the Third Sector is a priority for the Equally Well agenda. The Task Force considers that community planning partners need to act on this, in fulfilment of the Agreement on Joint Working on Community Planning and Resourcing ^[18] , which was published in September 2013.

• 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 current activities that impact on this age group, in order to identify potential new actions that would impact positively on this age group's health outcomes.

• Support the implementation of a Place Standard

The Task Force noted that the development of a Place Standard was a welcome addition to the fight to tackle health inequalities. However, members noted that the processes of implementation of the standard would be critical and that this should be monitored.

• Delivering progress

Finally, it was clear to members that a regular two yearly review by the Task Force may not be the best way to monitor progress nor influence the current way of working. It was agreed alternative arrangements should be considered. As well as reflecting on progress, these arrangements might enable a more frequent exploration of how to respond to evidence about causes of, and responses to, health inequalities; how to best support Community Planning Partnerships in reducing health inequalities within Scotland; and how best to coordinate local and national government activity and the wider public sector.

December 2013