Experts have told a parliamentary committee that much of the power to eradicate health inequalities lies outwith devolved powers, as MSPs hear the ‘horrific’ impact of austerity on Scotland’s health and wellbeing.

The Scottish parliament’s Health, Social Care and Sport Committee has heard cuts to public funding and social security introduced by the UK government from 2010 onward is the single biggest contributor to health inequalities.

Dr David Walsh from the Glasgow Centre for Population Health (GCPH) told MSPs that the “scandalous” austerity programme has contributed to increasing death rates across UK, hitting the poorest hardest:

“I would again emphasise that this is not my personal opinion: this is me pointing to the published evidence.

“If you want to narrow health inequalities, you have to address the fundamental socioeconomic causes of health inequalities.

“If austerity had not happened at the UK level, I do not think that we would be having these conversations about the horrific scale of the increasing death rate in poorer communities. We would not have aspects such as food banks and homelessness. That is the reality.”

The committee heard evidence as part of its inquiry into health inequalities, which is to focus on the negative effects of covid-19 and progress made since 2015 when the predecessor committee published a report on the topic.

Professor Gerry McCartney from the University of Glasgow told MSPs that a place-based approach that solely focuses resources in more deprived areas will not be able to eradicate health inequalities alone:

“A place-based approach does not consider [the fundamental social and economic drivers of health] in any way, shape or form. I worry that a lot of energy and attention goes into the place-based approach and that, ultimately, we will look back in ten years’ time and it will be another failed specific health inequalities approach.

“We need an inequalities approach for Scotland that addresses inequalities in the round as well as health inequalities. An effective general inequalities approach would generate a narrowing in health inequalities.”

Dr Walsh added that Scotland will not be able to narrow health inequalities without additional economic powers, or without a UK-wide change of policy direction. 

The comments came just days before a report co-authored by the two academics concluded austerity is ‘highly likely’ to be the most substantial causal contributor to Scotland’s ‘stalled mortality’ rate.

Most recent statistics from the National Records of Scotland show life expectancy for men and women fell by 17.6 weeks and 6.1 weeks respectively in 2018-2020 – the biggest annual decrease since the series began.

The gap in life expectancy between the most and least deprived areas was 13.5 years for males and 10.2 years for females.

The stalled mortality report recommends all levels of government introduce policies to reduce wealth inequalities – such as rent controls, greater financial regulation and land value taxation – to reverse this trend.

All 40 recommendations in their report to address the crisis – actions to be taken by UK, devolved and local level government around social security, taxation, public services, financial regulation, obesity and covid-19 recovery – echo prior calls from organisations like Oxfam and Public Health Scotland according to the researchers.

At last week’s meeting of the committee, Claire Stevens from Voluntary Health Scotland also highlighted to MSPs the critical role played by voluntary organisations, which are often working in single communities to get into “the deep end and at the grass roots”:

“They are reaching the marginalised communities that are often the furthest away from public services for whatever reason, and they are gaining the trust and confidence of those people and working with them.

“That work is very place based, but there is not enough investment in it.

“Involving people in the co-design and the co-development of services and empowering people often has to be done at a place-based community level.”

At this week’s meeting of the Health and Social Care Committee, Bill Scott from the Poverty and Inequality Commission said a man in one of Scotland’s most deprived areas can expect to live 17 fewer years than his more affluent counterpart.

The Glasgow Disability Alliance described the pandemic as ‘supercharging’ existing inequalities, while the stalled mortality report recommends that all government’s covid-19 recovery plans prioritise actions to reduce inequalities.

A Care and Wellbeing Portfolio, with the responsiblity of health services recovery and redesign oversight with a focus on reducing inequality, is currently under development by the Scottish government.

Health Secretary, Humza Yousaf, said its work must be broader than just healthcare in order to meet its aims.

One area of strength for Scotland, according to Professor McCartney, is its quantitative data and health inequalities trend monitoring for which “Scotland has the best system in the world, bar none”.

The Scottish government publish annually a long-term monitoring of health inequalities, which the Glasgow University professor says provide “outstanding detail” in overall mortality trends and wellbeing measures for different groups.

However, Claire Stevens said data gaps in service provision, especially across the third sector, can cause problems:

“Although the third sector is a source of rich qualitative data, that is not taken up and used to the extent that it could be by any means.

“Another point is about who gets access to data and how that is used. If our sector had better access to data, we would be better able to develop responses, approaches and services,” she said.

 

Read more: Update: New portfolio to tackle inequality;  Consultation on Disability Commissioner Bill;  Review calls for breast screening overhaul

 

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