Wednesday 26 November 2014

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?


  1. I have always considered that housing and poor housing has much to answer for the state of many people in this countries health. It isn't always the public sector either. I have lived in excellent public housing and really awful, but I have also bought housing which would have been rejected by those who have the standards in public housing to look after.
    Oh and a wee cry from the heart, please stop putting green spaces in the middle of Housing estates, they drive those who live beside them mad.
    I hate that we have got to the situation where so many people are sleeping out on the streets, stupidly I thought that the Blair Government might tackle this, their reaction, clear them out of sight.
    Things are improving slowly with housing, I am watching new social housing being built in Dunfermline, have to say once they build this quota, they want to look at some of the more elderly Orlets (sp) that are still standing, they will not stand for ever.
    I would say that education is definitely needed Sam but this must not be preaching, I get quite angry when I watch the young take up smoking, my generation should have been the last but sadly not. The number of people who die every year from smoking related illness be it Lung Cancer or anything else should have become non existent by now.
    I did have a flat in Livingston which was what was wrong with much, it was a single skin and after complaining about dampness I was told that it was built to the then minimum standard. We must have made an impact with the complaints because shortly after we were moved to a really well built maisonette. The other problem with housing is noise, and that can be as detrimental on people's health and not much is done about it. Oh I know you can complain, if you live in a Council House something will be done, but try this in either a bought house or a private rent. Sometimes it isn't that someone is going out of the way to be noisy either. Our flat in Edinburgh suffered from quite a bit of noise, doors which closed with a bang because people forgot they were on closures or even the wardrobe sliding door opening and closing at night, all could be an irritant. How much worse with the music which we had blaring from out off shore neighbour for two weeks out of four because he decided to put it in the wardrobe which back on to our Living room in another flat in Edinburgh.

    1. This is weird. I answered this post this afterrnoon and my reply has gone!

      Oh well, the sum of what I said this afternoon was that I pretty much agreed with everything you said.

      Bad housing is a disaster for people's health, whether it's because of damp, or crowding or bad insulation/noise pollution.

      We must tackle that, but at the moment they won;t give us the money, because they are too busy buying a replacement for trident, which even Scottish Labour wants rid of... that is the people rather than the management... according to Mr Findlay.

  2. Tris and fellow nat stirrers

    watched nicola on tv being interviewed about
    land reform ....,defo alternative to council tax
    defo......50p tax band if powers granted..defo

    alright she spoke well and i agreed with all
    she said 100%
    There i said it

    1. It could bring in a lot of money. Can't think of many downsides...

      Millionaires would want to sell up and go? Who is buying?

      Loss of jobs on the hunting and shooting estates? Yes, true there might be some. Maybe the money that it raises would make it possible for other uses of the land to be considered, creating other jobs?

      Maybe this kind of socialism is what you have been looking for and not getting from the likes of Lamont and Gray.

      50p band is a common purpose with Labour, although it will raise very little money to be fair. Still, better in our pockets than theirs I say.

      I read somewhere that the editor of the Daily Mail, Paul Dacre, right wing Thatcherite that he is, owns a fairly large estate in Scotland.

      I wonder what the Mail will have to say about the land reforms...

      :) :) :)