Health inequalities: policy context
Since devolution, a number of policy documents have focused on the issue of health inequalities in Scotland. The influential 1999 White Paper, Towards A Healthier Scotland, recognised that health improvement action should encompass life circumstances as well as lifestyles and priority diseases, with all action underpinned by the need to reduce health inequalities. This foundation was built upon by subsequent policy documents such as the 2003 White Paper, Partnership for Care, the 'Challenge' document of the same year (Improving Health in Scotland: The Challenge, 2003), and the 2005 Delivering for Health report, all of which highlighted the need to reduce inequalities in health.
In 2007, the current Scottish Government set up a Ministerial Task Force on Health Inequalities. The report of the Task Force, Equally Well, was published in 2008 and outlined recommendations for tackling the underlying causes of health inequalities under a range of key headings including: early years & young people; poverty & employment; physical environments & transport; alcohol, drugs & violence; health and wellbeing. Alongside two other Scottish Government-COSLA joint publications - Achieving Our Potential: A Framework to Tackle Poverty and Income Inequality in Scotland, 2008 and The Early Years Framework - Equally Well is seen as the basis for cross-sector action on reducing inequalities in Scotland.
Equally Well was followed up in 2008 by the Equally Well Implementation Plan, 2008, and the publication of indicators to be used in assessing progress in tackling inequalities (as outlined in the Long-term monitoring of health inequalities reports). In addition, one of Equally Well's recommendations (concerning inequalities-related indicators and the Single Outcome Agreement (SOA) process agreed between the Government and local authorities) was met with the production of NHS Health Scotland's Tools for SOA Processes.
The Ministerial Task Force on Health Inequalities has been reconvened twice to review progress since the publication of Equally Well in 2008. The first Equally Well review report was published jointly by the Scottish Government and COSLA in 2010, and concluded that the three social policy frameworks listed above - Equally Well, the Early Years Framework and Achieving Our Potential - were the best mechanisms by which to reduce inequalities in Scotland and deliver long term improvements for the population. The report of the second Equally Well review was published in March 2014. As part of that process, NHS Health Scotland undertook a review of policy and the evidence regarding what works to address health inequalities: that Health Scotland report was also published in March 2014.
The reduction of health inequalities is recognised as a vital component of achieving the Scottish Government's overall purpose of sustainable economic growth. Their 'population' target is underpinned by a commitment to increase healthy life expectancy, while their 'solidarity' target aims to not only 'increase overall income' but also 'the proportion of income earned by the three lowest income deciles as a group by 2017'. Inequality-related indicators also make up some of the 50 national indicators being used to track progress towards the achievement of national outcomes (see Scotland Performs website): examples include decreasing the percentage of the population living in poverty (including - as a separate target - decreasing the numbers of children living in material deprivation), and reducing premature mortality.
The reduction of inequalities also lies at the heart of the proposed reform of the public sector, as outlined in the Scottish Government's response to the Commission on the Future Delivery of Public Services (the 'Christie report').
A number of bills included within the Scottish Government's current (2016-17) programme for government are relevant to inequalities generally and, therefore, health inequalities.