What works to address health inequalities?

Part Three of Sam's series of articles on health:

In "NHS Health Scotland: Health Inequalities Policy Review" 2013, is a table setting out what would work to address health inequalities. 

Firstly, dealing with the theories of fundamental causes of health inequalities the interventions proposed are policies that redistribute power, money and resources. Social equity and social justice needs to be prioritized. Examples of effective actions proposed are: introducing a minimum wage for healthy living; ensuring the welfare system provides enough income for healthy living and reduces stigma for recipients through universal provision in proportion to need.

There should be more progressive individual and corporate taxation and active labour market policies to create good jobs.

There should be the creation of a vibrant democracy, greater and more equitable participation in elections and in decision-making, including on action on health inequalities.

Second, there are changes proposed to the social, economic and physical environment. The interventions suggested are: the use of legislation, regulation, standards, fiscal policy and structural changes to ensure equity in the environment. Good jobs should be available for all and there should be equitable provision of high-quality and accessible education and public services. 

The examples of effective actions proposed are wide ranging. They include addressing housing quality standards: neighbourhood standards: air and water standards; food and alcohol standards and restrictions; transport and pedestrians; pricing of harmful commodities, healthy products and essential and prevention services; environmental safety changes; policies for employment; policies for provision of high-quality early childhood education and adult learning and on training and learning; ensuring that public services are provided in proportion to need as part of a universal system.

Third, looking at individuals, the interventions suggested are that there should be equitable experience of socio-economic and wider environmental exposures and equitable experience of public services.

High-risk individuals should be targeted for support; there should be intensive, tailored individual support: there should be a focus on young children and the early years.

Effective actions include; training for the public sector workforce to ensure it is sensitive to all social and cultural groups, to build on the personal assets of service users; linking of services for vulnerable or high-risk individuals, e.g. income maximization welfare advice linked to healthcare for low-income families. 

There should be provision of specialist outreach and targeted services for particularly high-risk individuals such as looked after children and the homeless.

Services should be provided in locations and ways that are likely to reduce inequalities in access.

Addressing inequalities of income, wealth and power will require that Scotland has control of economic and welfare policies. And as McCartney says:

"If health inequalities in Scotland are to be reduced, this will require leadership at all levels to reduce the stark inequalities in the socio-economic circumstances prevalent today."

So what are our politicians doing?