MINISTERIAL TASK FORCE ON HEALTH INEQUALITIES - SUMMARY OF PROGRESS UP TO DECEMBER 2007
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1. The Task Force has met 4 times between October and December 2007. It has agreed its remit, which includes cross-Government activity to achieve both short and long-term outcomes, and the need to use existing evidence and have a clear and measurable impact through its recommendations.
2. The Task Force will draw on the Better Health, Better Care consultation. It has also agreed how to involve and communicate with external interests, including organisations that will be critical to putting its recommendations into practice. Further consultation and involvement will be carefully targeted, in order to secure commitment and buy-in.
3. The Task Force is considering factors that influence people's health, from individual characteristics, through people's lifestyles and behaviours, to wider influences such as education, employment, living conditions and other environmental influences. The focus is, however, on health outcomes. The most significant inequalities have been agreed as:
- Children's very early years, where inequalities first arise and may influence the rest of people's lives.
- The high economic, social and health burden imposed by mental illness, and the corresponding requirement to improve mental wellbeing.
- The "Big Killers" including cardio-vascular disease and cancer. Risk factors for these, such as smoking, are strongly linked to deprivation.
- Drug and alcohol problems and links to violence that affect younger men in particular and where inequalities are widening.
4. Scientific evidence is emerging of how deprivation and other forms of chronic stress lead to poor health, starting at the very early stages of life. The Task Force is basing its principles and approach on this evidence. It has set out key principles to drive its work, which include building the resilience and capacity of individuals, families and communities to improve their health and to reduce factors in the physical and social environments in Scotland that would otherwise perpetuate inequalities in health.
5. The Task Force's principles have been published in the Government's Better Health, Better Care action plan, December 2007. The action plan states the high priority that the Government attaches to reducing health inequalities. This is reflected in the Spending Review 2007 which prioritises spending on relevant current and new activities.
6. Professor Sally Macintyre has advised the Task Force about action that works in tackling inequalities in health. This includes structural changes in the environment, legislative and regulatory controls, maximising income and reducing price barriers, improving accessibility of services, prioritising disadvantaged groups, offering intensive support where people need it and starting young. The Task Force will test its recommendations for actions against this evidence.
7. Some NHS Chief Executives presented information to the Task Force in November, to enable it to contribute to the Better Health, Better Care action plan. As a result, the Task Force is on record in the action plan as identifying critical activity to: support particularly vulnerable children and families, realign resources and effort in primary care, extend anticipatory care approaches to preventing ill health, reach and engage with the most vulnerable groups of people to improve their physical and mental health more effectively, ensure that health is not a barrier to retaining or entering work, and improve the capacity of the third sector to reduce inequalities in health. The NHS itself plays a critical role as an employer, investor in local communities and as a community planning partner. More detailed delivery programmes are now being worked up to turn these recommendations into specific action.
8. The 4th meeting of the Task Force considered tackling health inequalities through action in children's early years and with young people. The Task Force's conclusions will feed into the Government's early years strategy due in 2008. This will also be taken into account in the More Choices, More Chances element of development and delivery of the new Curriculum for Excellence during 2008.
9. Key points for the early years strategy include the need for holistic support for children and families at risk of poor health and other outcomes, in all aspects of their lives and for sustained periods. Redesign of existing services is required, working through mainstream planning and delivery systems and joining up services effectively across statutory agencies. It should be possible to test out promising approaches from other countries quickly, to find out how to make these work in a Scottish context. A number of workforce factors will be critical, for example encouraging professions to work across organisation boundaries, fostering the key worker approach for more complex families and boosting the confidence and skills of staff to deal with issues such as sexual health and prevention of early pregnancy. The Task Force emphasised the importance of literacy and numeracy, which are vital for people's subsequent capacity to manage and improve their own health, as well as for other aspects of their lives.
10. The remaining Task Force meetings will address themes from the Government's Safer and Stronger, Wealthier and Fairer and Greener objectives. They will look at health inequalities that depend on gender, ethnicity, disability etc as well as on socio-economic status. Finally, the Task Force will look at delivering and managing implementation of its recommendations, making sure that the impact of these can be measured and evaluated.