The scale of health inequalities in Scotland and what we can do about them

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Andrew Pulford on tackling Scotland's health inequalities

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6th February 2019 by TFN Guest 0 Comments

The population of Scotland is living longer – good news.  

However, Scotland’s health inequalities are some of the widest in Europe, meaning that many people live for fewer years than they should and spend a higher proportion of their lives in poor health.

Life expectancy has even stalled in some age and sex groups in recent years. 

The need to grow an understanding of the scale of the problem, and help to identify solutions, is great. That’s where our tools, the Scottish Burden of Disease (SBoD) study, and the Informing Interventions to Reduce Health Inequalities (Triple I) tool, can help.

Andrew Pulford

Andrew Pulford

Scotland’s health inequalities are some of the widest in Europe

The SBoD shows what we are living with and dying from. It highlights the scale of ill health, and because it shows this by area of deprivation, it tells us much about health inequality. 

We found that 25 diseases account for three in four years that are lost due to ill health or early death. It also shows that ill health is increasingly being defined by what makes us sick rather than what is killing us. 

It also shows that just seven diseases account for over half of socio-economic inequalities. 

These are a consequence of drug use, poor diet, smoking, alcohol and mental ill health – highlighting the role played by deprivation.

Importantly, SBoD has shown that a third of early deaths and ill health could be prevented if we all had the same life circumstances as those in the wealthiest areas.

This information is crucial because it allows us to set priorities and plan based on the current and projected scale of the problem. 

Coupled with this, we have a developed a tool that can help identify interventions that achieve a win-win situation where they make the population healthier and reduce health inequalities. 

Our Triple I tool allows decision-makers to estimate the impact of interventions before deciding whether to invest public money. 

Findings from Triple I show that:Interventions which aim to undo causes of health inequalities (eg redistributing income disproportionately to those on the lowest incomes) have the greatest potential to achieve this win-win situation. 

Interventions which aim to prevent health inequalities (eg increased tobacco taxation, access to jobs and increasing uptake of benefits) had a smaller impact but still achieved that win-win. 
Interventions to mitigate effects of things that are harmful to health (eg support for smokers) also had a smaller impact than those that aim to undo causes of health inequality. However, a win-win can be achieved by targeting more resources to those in greater need.

Using the Triple I can help decision-makers consider the best blend of these three types of action, and can contribute to a fairer, healthier Scotland. 

Helping grow our understanding of the scale of health inequalities can help everyone, including in the third sector, to promote the strongest response possible to improve health and reduce health inequalities.

Andrew Pulford is public health intelligence advisor at NHS Health Scotland.

NHS Health Scotland presents a session at The Gathering called on Thursday, 21 February, from 11.15am till 12.15pm.