Thursday, December 13, 2012

Audit Scotland on health inequality

Audit Scotland have published a report on health inequalities. I appeared on the BBC Call Kaye programme this morning to debate it.

Auditor General for Scotland, Caroline Gardner, summed up their findings:

“Health inequalities are long-standing and entrenched in Scotland. Tackling this has been a priority for successive governments but most indicators show the problem remains substantial. On average, people in Scotland’s poorest neighbourhoods die earlier and children in the most deprived areas have significantly worse health. Across the country, there are particular areas of poverty where people have higher healthcare needs. Resources should be better targeted at those who require them most.”

The report doesn't tell us anything new about the scale of health inequality in Scotland. As usual auditors want more data and targets, but not everything is measurable in the way they would wish. They do emphasise that the solutions are not just down to the NHS. This is certainly the case as the NHS Scotland long term monitoring report concludes "Inequalities in income are the most obvious point for action. Clearly, the economic recession and welfare reform are pushing in the wrong direction. Health policy is important, but it plays a 
minor part.”
The report therefore calls for action by Community Planning Partnerships. Chair of the Accounts Commission for Scotland, John Baillie, said:

“Reducing health inequalities is challenging and requires effective partnership working across a range of organisations. Community Planning Partnerships have a key role to play and need to provide strong and supportive leadership for local organisations. They should also ensure all partners are clear about their roles and responsibilities, and improve their evaluation and reporting of progress in reducing health inequalities.”

Well yes they do, but the solutions are wider than that. CPP's have limited powers to tackle inequality in society. As the Spirit Level shows us, more equal societies do better on almost every area of policy including health.

We should also recognise that it is not just physical but mental health that is impacted by poverty. This makes health education initiatives challenging. One in five people in the UK suffer from poor mental health compared to one in ten in Germany and Japan.

The response from the Tories and some others on the programme was to put the focus on behavioural factors. In essence blame the feckless poor even if, as one caller pointed out, that means the consequences fall on poor children. Behaviour issues are a factor and targeted programmes such as the Dundee smoking cessation scheme have a role to play. But the Tories need to move on from their 1980 position when they tried to block the publication of the Black Report. There have now been some 200 studies showing the link between income inequality and health.

Finally, we had the Tax Dodgers Alliance popping up to tell us that the solution is a low tax economy. Well they don't pay much tax in Somalia, but it hasn't done much for their health. More equal countries with better health are also countries with higher taxes to redistribute wealth and pay for public services. That's the way forward for Scotland.

Dave Watson

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