The earnings gap between the richest and the poorest earners in Scotland has remained almost unchanged in 20 years according to researchers, undermining efforts to tackle the nation's health challenges.

Official figures released yesterday by the Scottish Government show that people living in the most deprived areas of the country are four times more likely to die early than those in the wealthiest and public health minister Joe FitzPatrick admitted there remain “entrenched and stubborn” issues which must be addressed.

Separate figures on schoolchildren in Scotland showed almost a quarter of primary one pupils are overweight or obese, but with wide differences between the most and least deprived parts of Scotland. Obesity is a predictor for a host of other health problems, and the figures show little change over the past 16 years.

But a new report from the Glasgow Centre for Population Health which says income inequality in Scotland is virtually unchanged in 20 years, and says this is a major factor in the nation's entrenched health problems.

Author David Walsh, Public Health Programme Manager said there was “absolutely no evidence of progress” over the last 20 years in tacking the gulf between rich and poor, and claimed attempts to tackle health inequalities are doomed to failure while income inequality remains unaddressed.

While improved incomes in the public sector, and the fact that more Scottish employers are willing to pay the real living wage have increased the lot of some people, and the gender pay gap has fallen considerably in the last two decades, change is not happening fast enough, he says.

Inequality in incomes widened in Scotland between 1997 and 2016, he said. While the gap between the highest and lowest earners has since dropped back to 1997 levels, this is largely due to the recession rather than a big improvement for the poorest Scots, Mr Walsh said, and half a million Scots continue to be paid below the real living wage, currently £9 an hour. Women are worst affected with two-thirds paid below the real living wage, and the pay gap is higher and growing worse for those in part time employment.

Mr Walsh added: "In real terms the lowest paid haven't seen much increase in their earnings over the last 20 year period, while even since the recession kicked in the top earners have seen their income continue broadly to increase."

"The fundamental causes of health inequlaities are broader socio economic factors such as income and welath. That is not opinoin, it is international evidence. We are the most unequal country in Western Europe and we must do more."

The report calls for a range of measures, such a freezing senior pay in the public sector to increase that of the least well paid,raising income or corporation tax or new welath and prpoerty taxes.

Mr FitzPatrick said: “Tackling the inequalities in health that the most deprived and vulnerable in our society experience is one of the most important challenges we face as a country.

“We have made significant progress in a number of areas such as healthy birthweight, alcohol-related hospital admissions and deaths from heart disease.

“But, as today’s report shows, there remain entrenched and stubborn issues that we must address. That is why we are taking decisive action on matters such as alcohol, smoking, physical activity and healthy eating.”

He said health inequalities are “very much a symptom” of wider income inequality, and insisted Scottish minister are working to mitigate the “devastating” impacts of UK welfare reform.

Cabinet Secretary for Communities and Local Government Aileen Campbell said:

“Tackling the inequalities in health that the most deprived and vulnerable in our society experience is one of the most important challenges we face as a country. We have made significant progress in a number of areas such as healthy birthweight, alcohol-related hospital admissions and deaths from heart disease.

She said initiatives included investing £12 million in intensive employment support for parents, launching anew Financial Health Check Service and increasing School Clothing Grants to at least £100.

“This is alongside investment in affordable housing and ensuring fair access to healthcare through policies such as free prescriptions, concessionary travel and free personal care.

“However, reaching our goals for a fairer Scotland are more challenging in the face of continued UK Government austerity. This year we will invest over £125 million in mitigating the devastating impacts of the UK Government’s welfare reform and protecting those on low incomes.”