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2. HEALTH IMPROVEMENT AND SOCIAL JUSTICE - CLOSING THE OPPORTUNITY GAP
WHAT WE WANT TO ACHIEVE
Since devolution in 1999, the Executive has been committed to tackling poverty and disadvantage and to promoting social justice. There are close links between poverty and poor health, and we are committed to strong action to change this. Closing the Opportunity Gap is the Executive's cross-cutting approach to tackling social exclusion and providing sustainable routes out of poverty and disadvantage. We have set targets for Closing the Opportunity Gap which range from access to rural services to educational achievement, employability and addressing health inequalities. These can be seen on our Closing the Opportunity Gap website. 5 We believe that sustained employment is the best route out of poverty for the vast majority of people.
Social exclusion can affect all aspects of people's lives and has a direct impact on their life chances. We must improve people's life circumstances - including housing, education, employment and health - to help close the opportunity gap. That is why Closing the Opportunity Gap aims to increase the rate of improvement in under 75 coronary heart disease mortality and under 75 cancer mortality in our most disadvantaged communities, and progress on these can be seen in the Annex to this report. Tackling poverty will improve health through a healthier physical environment, better diet, a more active lifestyle and healthier recreational choices, improved access to services (including health services and opportunities for physical activity), higher levels of confidence and self-esteem, and reduced stress and social fragmentation.
In tackling social exclusion and improving the health of the most vulnerable in our society we will reduce inequalities in health and help them to overcome the barriers that make it difficult for them to contribute to their communities whether through employment, voluntary work or formal training and education. We are already acting to combat cultural issues and the stigma associated with mental ill-health.
There is also a strong connection between drug and alcohol misuse and poor health, lack of employment, mental health problems and other aspects of social exclusion. We are actively addressing this with our partners in all sectors. Tackling drugs misuse reduces a range of economic costs to society - through reduced crime, less acute hospital treatment and less unemployment. For every £1 spent on drug treatment at least £9.50 is saved in crime and health costs. Tackling substance misuse through prevention, treatment, rehabilitation and enforcement helps people lead healthier and more productive lives.
WHAT WE ARE DOING
We are tackling poverty and disadvantage in Scotland through our Closing the Opportunity Gap approach, and working with the UK government on our target to eliminate child poverty by 2020. We want to:
- prevent individuals and families from falling into poverty;
- provide routes out of poverty for individuals and families; and
- sustain individuals and families in a lifestyle free from poverty.
Poverty is only partly about low income; it also encompasses a lack of opportunity, low aspirations, facing barriers to participating in social and economic life, and access to appropriate and affordable public services. We are more than on track to meet to our target to eradicate child poverty by 2020. We have seen a reduction of 34% against an interim target of 25% by 2004/5. We are promoting uptake of tax credits and benefits by providing £442,000 to a Child Poverty Action Group project with this aim. Through co-ordinated action across all of the Executive's departments and agencies, and working with our partners, we are making good progress - although we recognise that there is much more still to do.
Sure Start Scotland and Working for Families are providing children with a much better start to life and supporting parents back into employment, thereby providing the opportunities for improved health in both children and parents.
Limiting the impact and incidence of fuel poverty through the Warm Deal and the Central Heating Programme is also benefiting the health of the most vulnerable in the older population.
This year we launched the Executive's employability framework, Workforce Plus, 6 and More Choices, More Chances7 our strategy for those 16-19 year olds not in education, employment or training. Young people that are not in education, employment or training is an unacceptable waste of potential - economically and socially it makes no sense. Our objective is to eradicate this problem the length and breadth of Scotland. This is a national priority demanding a national effort.
The see me...8 campaign aims to combat the stigma and discrimination associated with mental ill health and mental health problems. People with a mental illness are among the most excluded in our society. 'see me' combines an award-winning national publicity programme with local and national anti-stigma action developed in partnership with a range of groups and individuals across all sectors of Scottish life. Individuals who have experience of stigma are involved in all aspects of the campaign, with some being supported to talk to the media about the impact stigma has had on their lives.
A number of community sentences have a specific focus on tackling health problems as a means of addressing offending behaviour, such as the Drug Treatment and Testing Order; the probation order with conditions of drug, alcohol or mental health treatment; and structured deferred sentences. We are also introducing a range of interventions at various points in the criminal justice system designed to encourage people into drug treatment - arrest referral, mandatory drug testing (to be piloted from 2007), and bail treatment and testing (from 2007).
We established the Community Regeneration Fund with £318m funding over three years from 2005 to help Community Planning Partnerships achieve the Closing the Oppor tunity Gap target "To promote community regeneration of the most deprived neighbourhoods, through improvements by 2008 in employability, education, health, access to local services and quality of the local environment". Community Planning Partnerships have developed 3-year Regeneration Outcome Agreements which provide the strategic and operational framework for Community Planning Partnerships to deliver better and additional outcomes for people living in the deprived communities. Health improvement is a key aspect of all Regeneration Outcome Agreements.
These are key strands we are taking forward in support of our Closing the Opportunity Gap approach, supported by our strategies for health improvement and in turn helping to improve the health of the client groups targeted by these initiatives.
CASE STUDIES
DELIVERING A HEALTHIER SCOTLAND
Turning Point Scotland - 218 Project - Mary's Story
The 218 Centre in Glasgow offers residential and day services to women subject to the criminal justice system and has a major focus on health improvement - in relation to substance misuse, but also mental health and general health and wellbeing. The Centre is run in partnership with NHS Greater Glasgow and Clyde. Mary's story illustrates the complex range of needs which people have - and which services need to address - in order to close the opportunity gap.
Mary is a 37-year-old woman with a 13-year-old daughter. Due to Mary's drug use and consequent lifestyle she was mostly estranged from her family. When Mary was referred to the 218 Project she was using a large quantity of illegal drugs and was involved in prostitution to fund her habit. She had convictions for shop lifting and other offences. Mary had been involved in a number of abusive relationships in the past and following the breakdown of her last relationship Mary had been homeless.
The 218 Project helped stabilise Mary's drug use and carried out a comprehensive health assessment. Once Mary settled into the unit she was soon fully engaging in the programme and re-established contact with her father and daughter and started to develop coping mechanisms. She was no longer self-harming and recognised she was now ready to exit prostitution. Mary had regular contact with a Routes Out of Prostitution service worker during her stay and her worker arranged for her to move into a temporary furnished flat.
Mary continues to receive support from the 218 Project through the day service and also from her worker at Routes Out. Mary attends the clinic at the 218 Project to receive her methadone. Mary is staying near her father and her daughter and is in regular contact with her family. Mary has no outstanding legal issues. Health wise, Mary has gained a suitable amount of weight and is not presently self-harming. Mary states she is feeling more confident and in control of her life.
The Scottish Centre for Regeneration
The work of the Scottish Centre for Regeneration is explicitly linked to the Closing the Opportunity Gap strategy, specifically the community regeneration target to 'promote community regeneration of the most deprived neighbourhoods, through improvements by 2008 in employability, education, health, access to local services and quality of the local environment'.
The Scottish Centre for Regeneration's New Ideas Fund provides grants of between £100 and £5,000 to help communities develop innovative approaches to community regeneration.
In 2005, the New Ideas Fund awarded grants to:
- the Mill of Haldane Regeneration group in West Dunbartonshire to support them to build inter-generational relationships across the community through bringing together different generations to develop and publish a new local calendar.
- the Mid Craigie Childcare study in Dundee to undertake a study for its Under 12s Project to assess the demand and feasibility for funding for childcare in the area.
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