Health inequalities: policy context

The 1999 White Paper, Towards A Healthier Scotland, set the framework for current public health and health improvement policy. The White Paper recognised that health improvement action should encompass life circumstances, lifestyles, and priority diseases such as CHD and cancer, with all action being underpinned by the need to reduce health inequalities and the need for the NHS to work in partnership with others to achieve this. The most recent White Paper on NHS reform in Scotland, Partnership for Care (published in February 2003) built upon the 1997 reforms set out in the Designed to Care White Paper to increase the emphasis on the NHS for health improvement to be integrated more fully into NHS core business.

The Executive’s 2003 paper on improving health, Improving Health in Scotland - the Challenge, was produced in tandem with Partnership for Care to highlight the need for all of the NHS to work within a partnership context to improve health. The Challenge’s aims for health improvement was, and still is, to improve the health of all people in Scotland and to narrow the health gap. The paper proposed priority topics and settings for action and recognised that promoting positive mental health and preventing mental ill health are essential components of all health improvement work. It recommended the use of 23 indicators to monitor health inequalities, and had a specific objective to improve life expectancy and healthy life expectancy and also “to reduce inequalities between the most affluent and most deprived groups.”

Targets for reducing health inequalities are integrated with the Scottish Executive’s current social inclusion policy – Closing the Opportunity Gap. Related to this, the second of the Scottish Executive’s 2005-2008 spending review targets is to “reduce health inequalities by increasing the rate of improvement across a range of indicators for the most deprived communities by 15%, by 2008”. There are six health specific indicators (selected from the 23 originally set out in the Challenge paper):

• smoking during pregnancy  - 10.0% reduction in the most deprived areas between 2003 and 2008
• adults smoking (aged 16-64)  - 10.9% reduction between 2003 and 2008
• coronary heart disease mortality (for under 75s) - 27.1% reduction between 2003 and 2008
• teenage pregnancy (aged 13-15) - 33% reduction between 2000/02 and 2007/09
• suicides in young people (aged 10-24) - 15% reduction between 2001-03 and 2007-09
• cancer mortality rates (for under 75s) - 10.1% reduction between 2003 and 2008

In 2005 the Kerr Report ('Building a Health Service Fit for the Future - a National Framework for Service Change in the NHS in Scotland' - a review of the function and future of the NHS in Scotland, commissioned by the Scottish Executive) recommended, among other initiatives, "targeted action in deprived areas to reach out with anticipatory care to prevent future ill-health and help reduce health inequality". This was accepted in the Executive's response to the report, outlined in 2005's Delivering for Health report, and has resulted in the Prevention 2010 initiative. This aims to: target health improvement action and resources at the most disadvantaged areas; build capacity in primary care to deliver proactive, preventative care; provide early interventions to prevent escalation of health care needs. The project will be piloted in up to 5 Community Health Partnerships in 2006/07.

Scotland's Chief Medical Officer, Dr Harry Burns, has established an expert reference group to help inform policy on tackling Scotland's health inequalities. A report of their meeting and copies of presentations are available here.