Deprivation: policy context
Tackling deprivation has been a government priority in Scotland over a long period. In 1988 the Scottish Office launched its New Life for Urban Scotland Initiative which created regeneration partnerships in four peripheral housing estates: Castlemilk in Glasgow, Ferguslie Park in Paisley, Wester Hailes in Edinburgh and Whitfield in Dundee. After devolution in 1999, the (then) Scottish Executive committed itself to tackling poverty and disadvantage through its Social Justice Strategy. The Social Justice Strategy was supported nationally by the Social Justice milestones and locally by the establishment of 'Social Inclusion Partnerships (SIPs)' throughout Scotland (replacing what were formerly Priority Partnership Areas (PPAs) and Regeneration Partnerships (RPs). A key feature of these initiatives was their focus on regeneration and social inclusion in areas of high deprivation.
In November 2008 the Scottish Government launched Achieving Our Potential: A Framework to Tackle Poverty and Income Inequality in Scotland, 2008, which outlined a long-term approach to reducing levels of poverty and income inequality in Scotland. Among its key aims are to increase overall income and the proportion of income earned by the three lowest income deciles by 2017; to decrease the proportion of individuals living in poverty; and to increase healthy life expectancy at birth in the most deprived areas. Related to this, many of the health-related indicators set out in Scotland Performs(for example, on smoking, problem drug misuse and alcohol-related admissions to hospital) will particularly benefit people living in the most deprived communities in Scotland if their targets are achieved. The latest report on Long Term Monitoring of Health Inequalities was published in 2015. A report from the Independent Advisor on Poverty and Inequality to the First Minister, Shifting the Curve, was also published in January 2016.
The international context is set by the World Health Organization Commission on Social Determinants of Health (2008), which notes that: "the development of a society, rich or poor, can be judged by the quality of its population's health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantage as a result of ill-health." In 2010, the Chair of the Commission, Sir Michael Marmot, concluded a strategic review of health inequalities in England (Strategic Review of Health Inequalities in England Post 2010). Its analysis and recommendations remain relevant to Scotland.
All of the above illustrate the importance of deprivation within past and current government policy. It is also worth noting the existence of the NHS Scotland Resource Allocation Committee (NRAC). NRAC was established to ensure the Arbuthnott Formula (2000-2005) was still allocating resources to NHS Boards in a way that reflects local need for healthcare. The Arbuthnott formula included a Morbidity and Life Circumstances adjustment for deprivation. NRAC's 2007 report recommended (and it was accepted by Government) that in future there should be separate "additional needs" adjustments for different care groups. It did not recommend using SIMD as part of the revised Formula, since the SIMD indicators did not appear to be the best predictors of healthcare need. However, 30% of NHS Scotland funding (e.g. for dental practices in deprived areas) is allocated using the SIMD.
In 2016, the Joseph Rowntree Foundation published two relevant reports: