Health Inequalities

The latest Long-term Monitoring of Health Inequalities: Headline Indicators report has been published.

The gap in health outcomes between the most deprived and least deprived areas of Scotland is reported for a variety of indicators in both absolute and relative terms. The latest figures include data up to 2010 for most indicators.

The main findings are:

* The highest level of relative inequality continues to be seen in alcohol-related deaths among those aged 45-74. While there have been some improvements in recent years, death rates and levels of inequality were higher in 2010 than in 1998.

* Between 1997 and 2010 the death rate for coronary heart disease (CHD) among those aged 45-74 years fell 57%. The reduction was slower in the most deprived areas of Scotland than elsewhere, meaning that relative inequality has increased slightly over the long-term while the absolute inequality gap has narrowed. However there are signs that relative inequality has stabilised in recent years.

* There are also signs of recently improving trends (reducing or stabilising inequality in one or both measures) in Low Birthweight, Premature Mortality, and Alcohol Related Hospital Admissions.

* Over the longer term, inequalities have widened in one or both measures for All-cause Mortality (aged 15-44) and Cancer Mortality (aged 45-74).

THE extent of Scotland’s health inequalities is highlighted, showing that healthy life expectancy among men in the poorest areas of the country is just 47. Scotland’s health gap is now wider than anywhere else in Europe and that the poorest people can expect to die 20 years before the country’s wealthiest residents. Men in the most deprived areas have a life expectancy of 68. This is a year above the UK Government's proposed retirement age.

Scotland’s life expectancy and healthy life expectancy is going up with between two and three years more of healthy life than they did in 1999. However, the gap between rich and poor has failed to close and is now wider than 
in the rest of the United 
Kingdom.

David Walsh, of the Glasgow Centre for Population Health, added: “We are talking about extending working life, but we are seeing parts of Scotland where people are not going to get much time in retirement. These figures are shocking and they continue to be shocking.”

Dr Gerry McCartney, of the Public Health Observatory for Health Scotland, identified the key issues. He said:
"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.”

Political action on mental health

It is very welcome that Ed Miliband is speaking in such a public way about mental health. One of the last taboo subjects is getting the political attention it deserves. He made it clear that as a nation we had both a moral obligation to support the most vulnerable in our society and importantly also made clear the economic case for tackling it.

The Scottish mental health charity SAMH calculates that three in every ten employees will have a mental health problem in any year, making mental health the dominant health problem among people of working age. The business case for tackling this is overwhelming with output losses of over £2bn last year or £950 per employee.

Following Miliband’s announcement in his speech of a new taskforce on mental health, there are some key areas Labour must address if we are to properly tackle the mental health crisis he describes.

It is widely accepted that work is good for mental health, providing a source of contact with others, structure, meaning to the day and providing a sense of self-worth. The problem is not work itself, but the support provided by employers. According to a recent CIPD survey only a quarter of respondents felt their employer and colleagues encouraged staff to talk openly about mental health problems and just 37% thought their employer supported employees with mental health problems well. So employers need more help and we need stronger, not Beecroft weaker, employment rights to protect workers suffering from this condition.

GPs and other frontline health workers need a better training to identify mental ill health, then provide the services and support needed as swiftly as possible.The Westminster All Party Parliamentary Group on Mental Health has warned:

“GPs may not possess enough knowledge of mental health problems to commission mental health services effectively [whilst] there is a need to ensure mental health features prominently in local health plans, so that people with mental health problems are encouraged to play a part in local decision making processes, and that public health professionals understand that mental health sits in their remit.”

While that comment refers to the position in England, the same applies in Scotland. It is also unacceptable that waiting list targets rarely include mental health services. According to research by Mind, a partner is four times more likely to leave someone because they have a mental health difficulty as compared to a physical disability; and 27% of sufferers report facing discrimination.

Political action on mental health may not provide the kind of publicity opening a new hospital does. However, if we as a society are to be judged by how we treat our most vulnerable, we have a responsibility to provide the best possible care and support to those facing difficult times. Ed Miliband’s speech is a welcome start, but it must lead to something bigger and better for those who find themselves suffering in silence.

Occupational health and safety

As early as 2009, David Cameron called for an end to the ‘over-the-top’ health and safety culture in Great Britain. In January 2012, he pledged that, ‘one of the coalition’s new year resolutions is this: 'kill off the health and safety culture for good.’

In Scotland, the lethal combination of weak regulation and heavy industry caused endemic levels of occupational illness and disability. Through images, film and oral testimony this event highlights the lived experiences of Scots whose health has been affected by their occupation and illustrates both the risks of trivialising occupational health and safety and the complexities surrounding responsibility.

Understanding Occupational Health and Safety in Scotland since 1800
Saturday 10 November 2012
Summerlee Museum of Scottish Industrial life, Coatbridge
1.00pm to 4.00pm

Homeopathy on the NHS?

A recent rant on Labour List attacked the UK Social Health Association for its position on Homeopathy on the NHS. The author concluded:

"It’s bad enough to have a Conservative Secretary of State for Health that supports an utterly farcical and unsubstantiated form of treatment for patients but we are in no position to hold him to account unless our own Labour family is united. To have our own affiliated organisations support this position requires an immediate and decisive response, so that this issue does not distract us from our fight to ensure that we have a world class National Health Service."

The UK SHA response was “Homeopathy does no harm and its cheap. NHS wastes money in much worse ways”.

A number of SHA Scotland members asked what our position was in light of this debate. The last time this issue was debated was in our submission to the 2005 Scottish Labour policy review when we said:

"SHA Scotland believes that alternative and complimentary therapies have a significant role to play in NHS treatment. The success of the Glasgow Homeopathic Hospital is a good example of provision that should be supported including the retention of in-patient beds."

The debate on Homeopathy in Scotland has widened in recent weeks. As budget cuts impact health boards are beginning to question this provision. NHS Lothian is currently consulting on the issue and NHS Highland have come out firmly against. The debate is covered well in this BBC piece.

To sum up each side of the debate.

Against

The British Medical Association, believes there should be no further NHS funding for homeopathy, They argue that scarce resources are being spent on a treatment with "no scientific evidence base to support its use". The 2010 report by the cross-party House of Commons Science and Technology Committee, found there was no evidence beyond a placebo effect - where a patient gets better because of their belief that the treatment works.

For

The Faculty of Homeopathy says it is "not accurate" to say there is no evidence for homeopathy. They claim that the conclusions drawn from studies have been "cherry-picked" by opponents and that there is evidence for the effectiveness of its treatments. They also claim that homeopathy is a safe, cost-effective alternative which can actually save the NHS money.
 

What do you think?

Why Inequality Matters

The Centre for Labour and Social Studies have produced a booklet 'Why Inequality Matters". This builds on the pioneering work of Wilkinson and Pickett in The Spirit Level.

As the booklet points out the case against inequality is not an abstract, moral argument. With an abundance of evidence, The Spirit Level dramatically revealed that it actually has an impact on people’s everyday lives. And as the Nobel Prize-winning economist Paul Krugman has shown, there is a link between inequality and financial crises. As he pointed out, it is no accident that both major modern crises – the first beginning in 1929, the second in 2008 – coincided with historic levels of inequality.

The chapter on health highlights that there are now over 200 studies of income inequality and health. Life expectancy, infant death rates, low birth weight, the number of people badly overweight, the number of people with poor mental health have repeatedly been shown to be worse in more unequal societies. The UK has the fourth lowest life expectancy out of the 23 most developed countries. The three countries that have even lower life expectancy are those with even greater income inequality – Portugal, the USA and Singapore.

Put simply, and that is this booklets strong point, inequality kills. That is why it should be central to our thinking on health policy in Scotland in the coming years.

Reform Scotland and GP services

Dave Watson on Reform Scotland's report on GP services.


I was intrigued by the Sunday media warm up to today's launch of Reform Scotland's latest report on GP services. GP's should have better web sites, well that's probably true, even if perhaps not the greatest challenge facing primary care at present. Even a suggestion that all GPs should be salaried. Dangerous socialist thinking here, straight from the SHA policy manual. Certainly not what we expect from the right wing marketeers at Reform Scotland.

However, I needn't have worried. The report itself is full of the predictable market led solutions that you would expect from Reform Scotland. An organisation whose objectives are the apparently,  “traditional Scottish principles of limited government, diversity and personal responsibility". Translated this means- small state, privatisation and blame the poor!

The report's recommendations focus on extending GP catchment areas and allowing new GP practices to open. This will apparently create competition with better opening times and websites. And here was me thinking that patient care was the first concern of service users!

The wicked Scottish Government ban on commercial GP providers must of course be ended. After all are not GPs themselves private providers? Well yes they are, a hangover from the 1948 compromise, but that doesn't mean we make the position worse by importing rapacious privateers with profit as their only motive. I just wonder if Serco has made a donation to Reform? Not of course that Reform Scotland needs any encouragement to promote the influence of privatisation companies.

We can of course agree that GP practices should have a decent website and opening times could be more flexible. I don't in principle have a problem with a Scottish GP contract and I agree that health boards should be more democratically accountable. The SHA have strongly supported direct elections for this reason.

However, this report is very clearly focused on introducing a market approach to NHS Scotland on the Tory, English model. Planned services are the best approach to primary care provision, rather than wasteful competition that would lead to marketing managers replacing practice nurses. The relationship with a GP and their staff can be a very personal one and we dont want that compromised, any more than it already is, with the current commercial element. We have seen with privatised occupational health services the role commercial pressures can play.

SHA Scotland has long argued that we should indeed go in the opposite direction, through the introduction of salaried GPs. Many doctors working in primary care would welcome this as their focus, unlike Reform Scotland,  is on the patient not running a business.

Healthier Scotland - August 2012

The August 2012 edition of our E-Bulletin Healthier Scotland has been published.

Link here.