Guest blog by Nick Hay – NHS Health Scotland
Sometimes it’s easy to get caught up in the rhetoric of why we want to live in a society that’s fairer and healthier. There hasn’t yet been someone to stand up and say that this would be a bad thing; we can all agree that these are good things to strive for. That’s been evident in the sheer number of recent debates, both political and cultural about why we need to bring in concepts of human rights and social justice into the mix. What we now need is agreement on what areas to prioritise to make a fairer, healthier Scotland a reality.
My colleague, Pam Duncan-Glancy, recently blogged about the need to thread human rights throughout health and social care and bring in a human rights based approach to all that we do. Working in the health field, we sometimes highlight statistics about the impact of inequalities and the inherent unfairness in how health different groups in unequal ways. Given that we’re all working to make Scotland fairer, and therefore healthier, we can all agree that it’s time to turn rhetoric into reality. But what does that actually mean? What can we do to turn words into action?
Recently, the Joseph Rowntree Foundation published their manifesto for a Scotland that’s free from poverty, highlighting figures showing that currently more than 200,000 children, 600,000 working age adults and 100,000 retired people live in poverty. That’s a staggering statistic. My own organisation, NHS Health Scotland, the national health board which works to reduce health inequalities and improve health, looks at a number of areas that have a profound impact on a person’s health and wellbeing to consider what we can do to make our system fairer and therefore healthier. These “social determinants of health” include; childhood experience; housing; education; social support; family income; work; the community in which we live; and access to services. We argue that health inequalities are avoidable because they are rooted in political and social decisions. They are caused by an unequal distribution of income, power and wealth and result in the poverty and marginalisation of certain groups. This is obviously not fair, nor is it socially just.
These National Conversations have been vital in bringing opinion together and highlighting the relationship between fairness and better health. We’ve already contributed to the Scottish Government’s Fairer and Healthier conversations. We think it’s time to start thinking about what our priorities should be to make this a reality.
If health inequalities are avoidable because they are rooted in political and social decisions, we need to change the structure in which these inequalities originate. That means that action is needed at societal, environmental and individual levels to undo, prevent and mitigate health inequalities to make this a fairer and healthier country.
NHS Health Scotland provides evidence to suggest that action is needed to ensure everyone has an adequate income. The introduction of a minimum income for healthy living and making sure that welfare system provides sufficient income for healthy living are two examples to do this.
We also need to empower communities experiencing inequalities, making sure their voices are heard in decisions which affect them in all aspects of their lives.
We’ve proposed that action should focus on reducing unemployment in vulnerable groups or deprived areas. What’s considered to be ‘good work’ should be available for everyone, with greater job flexibility and participation in workplace decision-making important areas for action.
We need action to address inequalities in the physical places that we live. Improving physical environments with better transport links, traffic calming schemes and a high standard of build that’s also affordable should be some of the areas that we focus on to improve the place in which we live. NHS Health Scotland has produced a “Place Standard”, a tool to improve the physical and social environment in supporting health, wellbeing and a high quality of life.
We also need programmes that target vulnerable groups by investing in more intensive services. Services that are proportionate to need would ensure that disadvantaged groups get a fairer share of resources.
We need to provide high-quality early childhood education and adult learning services. This could mean accessible support and advice for young people on life skills or training and employment opportunities.
Policies that use regulation and price are also effective at reducing health inequalities. Evidence has shown that policies which raise the price of harmful substances like tobacco and alcohol through taxation are practical examples of what works to change risky behaviours. At the same time we also need to reduce or eradicate the price barrier for healthy products such as healthy foods and essential services like water, education, healthcare.
These are some of the actions that we argue should be priorities for Scottish society as a whole. It’s heartening to see that more communities are having conversations about how we make Scotland fairer and healthier.
Ambitious it may be, but one we think worth striving for.
For more information about NHS Health Scotland and to explore the evidence around what would make a fairer, healthier Scotland, please visit our website.
Nick Hay – NHS Health Scotland
Twitter – @NHS_HS