REDUCING health inequalities – closing the health gap between the richest and poorest people – is one of Scotland’s greatest challenges.
Inequality wastes human potential, and reducing the health gap will lead to less pressure on public finances and improve Scotland’s wellbeing.
It is important to note that Scotland’s health is improving, with people now living longer, healthier lives. Over the past year we have seen a number of indictors move in the right direction, with evidence of a narrowing health gap in the number of low birth-weight babies or admissions to hospital for heart attack. Yet there are still a large number of areas, such as cancer rates or healthy life expectancy, where there is no clear movement for the better.
So last month I chaired the first meeting of the reconvened Ministerial Taskforce on Health Inequalities. We want to look again at all available evidence and see if we can find new or better ways to reduce the difference in life expectancy and health among the whole population.
A key area of discussion and exploration will be the concept of social connectedness.
The Chief Medical Officer’s annual report, published last week, is compelling reading. Sir Harry Burns shows that Scotland’s life expectancy only began to fall behind our western European neighbours in the 1960s, pointing to factors such as drugs and the doubling of alcohol-related deaths.
Scotland is rightly seen as a world leader in public health legislation and policy, with great strides taken in recent years that have seen smoking rates decline and alcohol-related deaths reduce. So is better health education and delivery the solution? It is important, but the truth is that the causes of health inequalities are extremely complex, and concentrating solely on health solutions will simply not end the problem.
We need to shift the emphasis of our approach from dealing with the consequences of health inequalities to tackling the underlying causes such as poverty, support for families and improving our physical and social environments.
The impact of our environment on health is huge. Studies have shown time and again that early life conditions influence adult health. Adverse childhoods translate into higher risk of suicide, depression, alcoholism and obesity. So our Early Years Framework and Getting it Right for Every Child approach places a strong emphasis on giving children, particularly those who are most disadvantaged, the best possible start in life.
The UK Government’s welfare cuts will have a huge impact on vulnerable groups and are extremely worrying. In the current political and economic circumstances, we are doing what we can, alongside all of our partners, to tackle poverty and inequality and help those who want to work to get into work.
Physical inactivity accounts for one in 10 deaths worldwide, so making sure we give people safe access to recreation or physical activity facilities will improve the chances of regular exercise and its associated benefits, such as increased mental and physical wellbeing and life expectancy.
There is also emerging research on the impact of the environment on genes. It is common to believe that genes are inherited, but research now highlights how the physical environment in which we live can switch genes on or off, changing how they function. While these changes can be subsequently reversed, gene modification can have negative health effects for future generations.
This is a relatively new area of emerging research that needs much more work, but offers a glimpse of the complexities of the problem.
I know that our long-standing problems won’t be solved overnight, but we can make a difference. The Chief Medical Officer calls for a fundamental rethink based on a more complete understanding of the basis of health inequalities. That is an aim I fully support.
• Michael Matheson MSP is Minister of Public Health