Scotland's public health priorities

Priority 5: A Scotland where we have a sustainable, inclusive economy with equality of outcomes for all

Inequalities are those unjust and avoidable differences across our population and between groups within it. This can be inequality in disposable income, health, wealth, power or social opportunity. The Organisation for Economic Co-operation and Development ( OECD) notes that income inequality undermines educational opportunities for disadvantaged individuals, hampering skills development and ultimately reducing their productivity and earning potential. These are all vitally important, as our health is intrinsically linked to our ability to participate fully in society and having the resources or the social connections to do so.

Why is the economy important?

Poverty and inequality remain the biggest and most important challenge to Scotland’s health, as the majority of health differences find their root cause in differences in wealth and income. During the development of the priorities, participants from across many different organisations and sectors consistently highlighted the importance of prioritising poverty and inequality. There was a strong message to do what is right and to deliver social justice and fairness. There was a strong recognition that if we truly wish to improve the public’s health, then we must reduce poverty and inequality and the effects of poverty and inequality on health.

How will we make a difference?

The health-related harms of relative poverty are complex, but can be reduced and are preventable. To do so, we must reverse the growing gaps in income and wealth in Scotland.

Scotland’s Economic Strategy ( SES) places Inclusive Growth as a core priority. This is defined as ‘growth that combines increased prosperity with greater equity; that creates opportunities for all and distributes the dividends of increased prosperity fairly’. We must share power and create opportunities for all people, families, communities and groups to be involved in decisions that affect them. We must prevent the unfair treatment, exclusion and isolation of both people and groups and the accompanying stigma they feel.

The NHS, Scottish Government and Local Government also have a role as the employers of over 500,000 employees in Scotland – almost two out of every ten people. While those working in public services have a strong tradition of speaking out on inequality and poverty, public funds – and health resources in particular – are overwhelmingly targeted toward treating the consequences of that person’s life in poverty, rather than on tackling the determinants of poverty at a population level. If we are serious about reforming public health, this balance will need to be challenged at a local and national level. We cannot simply keep focusing our time and effort on patching up the impact of such inequalities; we must venture further upstream and fix them at source.

For example, the Fairer Scotland Duty places a legal requirement on the NHS, Local Government and other statutory bodies to set out how they believe they can reduce inequalities caused by socio-economic disadvantage. This goes beyond considering how poverty impacts on service delivery and asks public bodies to address the causes of poverty. Agreeing to tackle this challenge through a whole systems approach would be a significant step forward.

The Child Poverty Act, changes to rates of income tax and efforts to mitigate the effects of benefit changes should all further contribute to reduce inequality.

In addition to the Fairer Scotland Duty, the Fairer Scotland Action Plan sets out another 49 actions to tackle poverty and the impact of poverty, many of which intend to have a direct effect on our health. The planned Scottish Social Security agency will have a pivotal role in this through distribution of £3.3bn of devolved benefits.

Across community planning partnerships, addressing child poverty, closing the attainment gap and children’s mental health are key priorities as partners work together to implement practical steps in communities to improve outcomes for children.

Local partnerships, including the third sector and communities themselves, are best-placed to understand and tackle the inequalities that still exist in Scotland, and which often become most visible when working at the neighbourhood level. By targeting anti-poverty measures to those in most need, councils are working with partners to improve food security by providing out-of-term time meals for children, take action on fuel poverty and ensure people have access to affordable housing.

Healthy Male Life Expectancy at birth in the 10% most deprived areas in Scotland was 43.9 years, 26.0 years lower than in the least deprived areas (69.8 years).

Healthy Female Life Expectancy at birth was 49.9 years in the most deprived areas, 22.2 years lower than in the least deprived areas (72.0 years). ^5.1

It is estimated that 16% of Scotland’s population, or 860,000 people each year, were living in relative poverty before housing costs in 2014-17. This compares to 15% in the previous period. After housing costs, 19% of Scotland’s population, or 1 million people each year, were living in poverty in 2014-17, the same as in 2013-16. ^5.2

The wealthiest 2% of the population own 15% of the nation’s wealth.

Whereas the poorest 40% of the population own only 5%.

The wealthiest 1% of Scots own more wealth than the bottom 50% put together. ^5.3

Data relates to 2012/14 as no updated wealth data is available.

The 10% of the population with the highest weekly income received more than 4x more per week (£912) than the lowest 10% (£240). ^5.4

The top 10% of the population had 24% more income in 2014-17 than the bottom 40% combined. ^5.4

After housing costs, relative poverty rates and child poverty rates have been rising since the all-time low in 2011-14. ^5.5

In-work poverty for working-age adults has continuously increased since 2011-14, and six out of every ten households in relative poverty have at least one household member in work. ^5.6

In 1997, premature mortality rates were 2.7 times higher in the most deprived areas compared to the least deprived; in 2016, rates were 3.7 times higher in the most deprived areas.

The heart attack admission rate in Scotland’s most deprived areas is 2.6 times greater than that of the least deprived.

The coronary heart disease mortality rate was 4.6 times greater in Scotland’s most deprived areas compared to the least deprived.

Of people in the 45-74 year age group, those in Scotland’s most deprived areas are more than twice as likely to die of cancer than those in the least deprived.

Alcohol-related admissions are 6 times more common in the most deprived areas of Scotland compared to the least even though those living in deprived areas are less likely to be harmful drinkers. ^5.7