In December 2012, Scotland's Chief Medical Officer Dr Harry Burns told Parliament:
"Health inequalities are the biggest issue facing Scotland just now, because not only are health inequalities a problem, but they are a manifestation of social inequalities and social disintegration and a whole range of things we would like to be different."
The truth of this statement is reflected in all relevant health statistics: In 2012, there was a difference of 11 years in life expectancy between males born in the most and least affluent areas of Scotland, and 7.5 years for women. While Scotland's health is improving generally, recent evidence suggests health inequalities are widening along a socio-economic gradient.
People who are part of a lower occupational class, or have a lower level of income, with a lower level of education, have greater health problems, are sicker for longer and die at a younger age than more advantaged groups.
For children, this means their early life chances and experiences are already shaping their future prospects of a long and healthy life. The inequality gap between our most and least deprived communities is largely mirrored in children's health statistics: low birth weights (31% vs 13%), dental health issues (54% vs 81%) and obesity (25% vs 18%).
In Scotland, we have a range of policies and strategies in place to address these inequalities. There is also an impressive commitment across the public and voluntary sectors to improve children's early years and set them up to enjoy good health and wellbeing throughout their lives. Collaboration is under way to facilitate the necessary shifting of resources to tackle issues at the earliest possible stage when there is the most chance of lasting success.
NHS Health Scotland, which is charged with tackling health inequalities, recognises the complex combination of factors that cause inequalities and acknowledge this cannot be solved by health agencies alone. Factors such as housing, education and employment impact on people's life chances and help shape individual opportunities and responses.
Understanding what works in preventing, reducing and undoing health inequalities is growing as the debate widens but integrated action has been slow to follow. All agencies across all sectors need to work together to eliminate a social injustice that is unacceptable in 21st century Scotland. The Scottish Government's 20:20 vision of healthier, longer lives for all needs to apply to everyone.
Public Health Minister Michael Matheson's recent task force on health inequalities understood the need to empower and work with communities.
The evidence is some deprived communities are more resilient to health inequalities than others, with a key difference being higher levels of community cohesion, social and voluntary action.
The agenda of prevention needs far more traction and has to be shared across public, voluntary and private sectors, with communities at its heart. Working hand in hand with our communities needs to continue and be scaled up if it is to make a real difference.
The work of dedicated health and early years practitioners needs to be matched by the work of those working in economic regeneration; supporting local businesses; tackling inadequate housing, and addressing fuel poverty. The multi-dimensional problems faced by families and communities in our most disadvantaged areas need a multi-dimensional response. While early years must spearhead the long-term approach, we cannot give up on a generation.
We can keep talking about how appalling Scotland's health inequalities are and we can be proud of our strategies and policies, as well as how our practitioners working to improve health. However, we will not make a fundamental difference until our resources are focused on solutions that will take us to the top of the international health league tables rather than bringing up the rear.
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