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Chamber and committees

Meeting of the Parliament (Hybrid)

Meeting date: Wednesday, December 14, 2022

Agenda: Portfolio Question Time, Health Inequalities (Report), Urgent Question, Business Motions, Parliamentary Bureau Motions, Decision Time, Transforming Scotland’s Vacant and Derelict Sites


Health Inequalities (Report)

The Deputy Presiding Officer (Liam McArthur)

The next item of business is a debate on motion S6M-07198, in the name of Gillian Martin, on behalf of the Health, Social Care and Sport Committee, on tackling health inequalities in Scotland.


Gillian Martin (Aberdeenshire East) (SNP)

As convener of the Health, Social Care and Sport Committee, I am pleased to open the debate on the committee’s recent inquiry into health inequalities. We would argue that this is an issue that is relevant to all areas of life, all areas of Government and all areas of parliamentary scrutiny.

In 2015, our predecessor committee held an inquiry into health inequalities. We did not want to replicate that work; instead, we set out to explore what progress has been made in tackling health inequalities since its report and what effect additional current factors such as the pandemic and the spiralling cost of living have had on people’s lives.

Before setting out our findings, I thank everyone who was involved in our inquiry—every organisation, every professional and every individual who spoke to us and who responded to our call for views. I extend a special thank you to Voluntary Health Scotland; we collaborated with it on a series of informal engagement events involving people with lived and living experience of health inequalities to help us to understand how those inequalities have affected their daily lives.

What we heard during our inquiry was, sadly, not unexpected. Many witnesses pointed to deindustrialisation as having had a generational and decades-long impact on Scottish health inequalities way before devolution, but health inequalities also increased in the years leading up to the pandemic, and they have worsened since. Clearly, the pandemic affected everyone, but it had a disproportionate effect on some. That particularly includes people from black and ethnic minority communities, people from deprived backgrounds, people with disabilities and parents with disabled children, as well as carers—we know that women are impacted the most, as they shoulder most caring responsibilities and are more likely to be unpaid carers.

It is widely accepted that the fundamental causes of health inequalities are rooted in the unequal distribution of wealth and power. The pandemic exacerbated income inequalities, with 36 per cent of low-income households increasing their expenditure but 40 per cent of people with the highest incomes decreasing their expenditure. Then came a rapid rise in the cost of living, and of course that happened smack bang in the middle of our scrutiny. Again, although that has affected everyone to some degree, those with the least have been hit the hardest. Older people and those living with or caring for someone with disabilities or complex health conditions are among the more severely affected, and that is just not acceptable. Most shockingly, an increasing number of households have been forced to choose between eating and heating. How much inequality are we prepared to tolerate before taking collective and systemic action?

As a committee, we were very clear that we wanted to set out some tangible recommendations that could help to tackle health inequalities and improve people’s lives. For many years, a lot of the rhetoric around health inequalities has been focused on mitigating the outcomes, but we are clear on the need to tackle the underlying causes at their source and to align policy and decision making along those lines.

Our report found that there is a policy implementation gap, which may hold a lot of the blame for the stubborn persistence of health inequalities. We need to look at that implementation gap in relation to national policy as it is delivered locally. There are lots of policies out there, but are they landing? That point comes up time and again in discussions with experts in health inequalities. Are all the good policies that are out there having the effect that they were designed to produce and are they being deployed effectively?

Decisions made at every level, reaching far beyond health policy to every area of decision making, are having a major impact on people’s exposure to health inequalities; logically, the solutions must equally lie at every level and across every area of policy. We call for urgent action across all levels of government—local government, Scottish Government and United Kingdom Government—because they all have a significant part to play, and our report made recommendations to each level of government.

We did something quite unusual in our committee report, in that we made recommendations to other committees about further scrutiny opportunities in their portfolio areas, because many of the causes of health inequalities and the solutions to them are not in the health portfolio: they lie in housing, planning, energy, social security, education, justice, and many more areas. I am delighted that so many of the Parliament’s committees have acknowledged that and that members of those committees are taking part in the debate.

At the outset of our inquiry, Professor Sir Michael Marmot told us that no one policy measure on its own could fix the health inequality problem. If it were that easy, it would have been fixed by now. He memorably said that every minister should be a health minister, and that equity in health and wellbeing needs to be at the heart of all policy making. The Minister for Public Health, Women’s Health and Sport put it very well when she told us that, in her opinion

“the Parliament needs to be a public health Parliament in which all parties come together to consider how we work jointly to tackle issues.”

She echoed the committee’s view when she said that

“The answers to health inequality do not lie simply in my public health portfolio.”—[Official Report, Health, Social Care and Sport Committee, 28 June 2022; c 2-3, 4.]

How right she is.

There is currently no overarching strategy for tackling health inequalities in Scotland. There are arguments about whether that is needed; however, we are clear that, with or without a defined health inequality strategy, we need to redouble our focus on fostering collaboration across portfolios, so that all relevant policy areas and levels of government are pulling in the same direction and contributing actively and positively to tackling health inequalities. We would like to see a reinforced commitment to cross-portfolio working in order to explore preventative strategies for tackling health inequalities.

I am not just talking about the Scottish Government; the recommendations in the committee’s report are equally directed towards the UK Government and local government. I am aware that it is a considerable feat to align multiple governments and diverse areas of policy towards any shared goal of reducing, and ultimately eliminating, health inequalities. However, our report is very clear that if we are going to achieve that goal we need to break out of our silos.

I am grateful for the cabinet secretary’s extensive response to our report, which we received earlier this month. I note the Scottish Government’s commitment to strategic reform as part of its care and wellbeing portfolio, as well as the proactive cross-portfolio discussions that it is embarking on to prioritise a preventative approach that is aimed at tackling health inequalities. I hope that we hear more about that in the debate. I also look forward to seeing the results of the work that has been done by Scottish Government body Public Health Scotland to undertake health impact assessments in relation to the rising cost of living, with a view to identifying future actions to mitigate those impacts.

I end by thanking my colleagues across committees for their interest in the debate. I look forward to hearing their perspectives on how we can take forward a genuinely collaborative cross-portfolio approach to tackling health inequalities.

I move,

That the Parliament notes the conclusions and recommendations contained in the Health, Social Care and Sport Committee’s 11th Report, 2022 (Session 6), Tackling health inequalities in Scotland (SP Paper 230).

The Deputy Presiding Officer

I advise members that we are pretty tight for time. I would appreciate it if colleagues could stick to their allocated speaking time and accommodate interventions within that allocation.

I call Clare Adamson to speak on behalf of the Constitution, Europe, External Affairs and Culture Committee, for around four minutes.


Clare Adamson (Motherwell and Wishaw) (SNP)

I thank the convener and members of the Health, Social Care and Sport Committee for the deliberations that are contained in its informative and challenging report. The subject of the debate is relevant to us all, as Gillian Martin so rightly points out. It is relevant to all areas of life, all areas of government, and all areas of parliamentary scrutiny.

I will reflect on the work that the Constitution, Europe, External Affairs and Culture Committee has looked at in relation to the wellbeing society, which is something that we all aspire to, and cover three areas: the wider benefits of culture, mainstreaming and preventative spend. I will start with what University College London in its submission to the committee described as the “grade A evidence” on the impact of music to support infant social development, reading to support child social development, and the arts to support aspects of social cohesion, improve wellbeing, and reduce physical decline in older age.

The World Health Organization cited 3,000 studies that

“…identified a major role for the arts in the prevention of ill health, promotion of health, and management and treatment of illness across the lifespan.”

According to Creative Scotland, the challenges in fulfilling the arts role are multifold and involve funding, awareness, staffing, integration, reaching those who are the most compromised by inequality, building partnerships and evaluation, which touches on the question of how we measure what works in terms of preventative spend. Of course, inequalities of access to the arts play their part in those challenges.

We should not underestimate the severity of the cost of living crisis. Our pre-budget scrutiny found a perfect storm of financial pressure facing the sector, and I am sure that other subject committees will have heard similar evidence. However, those are challenges that we must overcome if we are to make the most of the transformational power of culture. Mainstreaming—as my committee and many others contend—is a means to do that.

Audit Scotland has made the case for

“different thinking about what we consider to be health funding, because health is much broader than the National Health Service.”—[Official Report, Constitution, Europe, External Affairs and Culture Committee, 17 March 2022; c 6.]

That is why, when we took evidence on the published resource spending review, we heard from the Cabinet Secretary for the Constitution, External Affairs and Culture and the Cabinet Secretary for Health and Social Care at the same time—such is our commitment to mainstreaming.

The Convention of Scottish Local Authorities called for “whole-system thinking” when it comes to addressing the social determinants of health, and the National Galleries of Scotland highlighted the

“many individual cultural projects and initiatives relating to health and wellbeing across Scotland”

but found those to be

“fragmentary and not joined up by any national strategy or framework”.

It described the ambition to embed culture in health and wellbeing as

“still rotating in mid-air in rhetoric”—[Official Report, Constitution, Europe, External Affairs and Culture Committee, 29 September 2022; c 45.] .

It is nearly 12 years since publication of the Christie commission report. Lest we forget, the report’s four pillars were: partnership working; prevention of negative outcomes; reducing duplication; and empowering individuals and communities.

SENScot told us that we

“need to start to think, act and spend differently, and see prevention within an ‘investment paradigm’”,

whereby we would invest now in order for a flow of benefits to be realised over time.

There are a lot of culture projects out there working to support health and wellbeing, such as storytelling workshops for children from disadvantaged backgrounds, dementia-inclusive singing networks and art-in-hospital programmes, and I am delighted that we have been able to see some of them in action. However, we need a better understanding of what works well, who it works for, and when it should be delivered. That understanding can then drive a greater use of cultural services in support of health outcomes.

I call Siobhian Brown to speak on behalf of the COVID-19 Recovery Committee.


Siobhian Brown (Ayr) (SNP)

It is a pleasure to speak as the convener of the COVID-19 Recovery Committee in this debate on such an important topic, and I commend the Health, Social Care and Sport Committee for bringing the debate to the chamber.

Health inequalities have featured in all of our work, but I will talk about one inquiry in particular. First, however, it is important to stress that, sadly, health inequalities existed before the pandemic and have been made much worse as a result of it. As we go through recovery, that issue has been concerning to the committee. Recently, in this chamber, we debated the cost of living crisis, which has also exacerbated health inequalities. Therefore, today’s debate is timely, and I look forward to hearing about other parliamentary committees’ scrutiny of this major issue and to potential collaborative committee work in the future.

In April this year, we wrote to the Cabinet Secretary for Health and Social Care on our inquiry into excess deaths in Scotland since the start of the pandemic. We wanted to look at the extent to which excess deaths were caused by Covid-19 as opposed to other issues, such as the indirect health impacts of the pandemic. It was a difficult inquiry because, when looking at the statistics, we were acutely aware that they represented the end of the lives of real people. I send my condolences to everyone who has suffered such a loss.

We heard of the pressures that the national health service faces, some of the health impacts that are being experienced by individuals and the level of demand that services face. Given the complexity of the inquiry, we found that it was too early to tell the exact impact that the pandemic has had on excess deaths. However, we heard some stark evidence of how the pandemic hit those from deprived areas harder and that that could have had an impact on excess deaths.

We were shocked to hear that the levels of excess deaths in the most deprived areas were twice as great as those in the least deprived areas and that people who live in deprived areas are more likely to get cancer, to be diagnosed later and to die because of it, which is simply unacceptable in this day and age. In making our recommendations, we highlighted that as a priority issue that must be addressed as part of Scotland’s recovery. We asked the Government to set out its response to the recommendations made by the primary care health inequalities short-life working group, which had looked into how primary care and communities could be strengthened and supported to mitigate health inequalities more effectively.

The group made five foundational recommendations, which are worth highlighting today. First, the Government should strengthen national leadership on health inequalities. Secondly, it should implement a national programme of multidisciplinary postgraduate training fellowships in health inequalities. Thirdly, it should create an inclusion-enhanced service that invests in the management of patients who experience multiple and intersecting socioeconomic inequalities. Fourthly, it should develop a strategy to invest in wellbeing communities through local, place-based action to reduce inequalities. Fifthly, it should commission an investigation into how barriers to healthcare can, inadvertently, contribute to excess deaths and premature disability that are related to socioeconomic inequalities.

The Government agreed that health inequalities is a priority issue that must be addressed as part of Scotland’s recovery and said that it had established a new development group to focus on driving forward responses to those recommendations. It will be interesting to monitor that work, and we intend to follow up the work on excess deaths when we look at the recovery of cancer services in the new year.

I will turn briefly to our work on the on-going vaccination programme. The committee has continued to monitor the vaccination programme, including the booster vaccination. We have looked at the reasons behind below-average take-up in some demographics, particularly among minority ethnic communities and in communities that experience higher levels of deprivation. We considered equity of access to vaccination programmes, as well as access to trusted and reliable public health information on Covid and vaccinations.

Presiding Officer, I have run out of time, so I will finish there.

I call Natalie Don to speak on behalf of the Social Justice and Social Security Committee.


Natalie Don (Renfrewshire North and West) (SNP)

I thank the Health, Social Care and Sport Committee for bringing this important debate to the chamber today.

The starting point for the health committee’s inquiry is that

“health inequalities are a symptom rather than the cause of the problem. Health inequalities arise from the unequal distribution of income, wealth and power and the societal conditions this creates”.

Addressing socioeconomic inequality is a priority focus for the Social Justice and Social Security Committee. We have been exploring support for people who experience low income and debt, investigating whether policies to tackle child poverty are achieving that aim and scrutinising the delivery of social security to ensure that it provides a vital safety net for those who need it.

Health inequality is a long-standing issue. Entrenched poverty can have a generational impact and it adversely affects every aspect of someone’s life. Child poverty impacts on children’s ability to enjoy their childhoods and achieve their aspirations. Low-income households spend more of their money on essentials and often have little or no disposable income to cover a rise in costs. Those extremely difficult circumstances have been compounded by the cost of living crisis.

As Gillian Martin said, certain groups are more likely to experience poverty and, therefore, experience worse health outcomes. Disabled people are disproportionately more likely to be living in poverty and make up 48 per cent of the total number of people in Scotland who live in poverty. Disabled people and families with disabled children face extra costs of more than £1,000 a month. Women are more likely than men to be in poverty. Their experiences of poverty are directly tied to their experiences of the labour market and social security and in relation to their undertaking caring roles.

With regard to lone parents specifically, the following example from our fuel poverty focus group details the punishing decisions that one lone parent faces daily:

“Heating is a no go. I use energy for cooking, washing and lights. I keep a note of the units I’m using, but the bills keep going up and up. The heating is on for a maximum of 30 minutes, and I stay under a blanket with a hot water bottle to keep warm. I’m living on an income of just over £7,000 for 3 people, without food banks we wouldn’t survive. I’m on 25 painkillers a day and eat one meal a day as I want the best for my kids. My mental health is getting worse, and my health is getting worse—I hate winter, the temperatures are dipping”.

That is just one example of the many people who are in crisis. Our inquiry into low income and debt underlined the strong links between poverty, debt and poor mental health. Social stigma is highlighted as a significant barrier to seeking support, which increases the impact on mental health. The Scottish Association for Mental Health explained that the drivers for suicide can include

“feelings of humiliation, entrapment and hopelessness, all of which are very common amongst people in problem debt.”

People living in poverty are more likely to live in disadvantaged neighbourhoods and in overcrowded or unsuitable housing, and homelessness is both a cause and the result of social inequality, health inequality and poverty.

Homeless people experience poorer physical and mental health than the general population does, and the complex needs and circumstances of many people who experience homelessness make accessing housing and other services, including health services, more difficult. The Health, Social Care and Sport Committee’s report highlights the essential connection between access to safe, secure and affordable housing and achieving positive health and wellbeing outcomes.

Key findings from our committee’s work also show the need for suitable, sustainable housing. Others include early identification of the threat of homelessness to enable prevention. Those actions, alongside better integration of support services, all contribute to minimising homelessness and its impact.

Social security can do some of the heavy lifting in the short term, but to tackle poverty and the symptoms of poverty, such as health inequality, there needs to be a comprehensive radical, long-term and targeted economic approach. My committee will continue to work to improve the lives of the most vulnerable in our society.

I call Audrey Nicoll to speak on behalf of the Criminal Justice Committee.


Audrey Nicoll (Aberdeen South and North Kincardine) (SNP)

I am very pleased to speak in this important debate on behalf of the Criminal Justice Committee. I thank the Health, Social Care and Sport Committee for bringing the debate to the chamber.

Inequality, poverty and health are threads that run right through many of the issues that the Criminal Justice Committee is considering. In “The Vision for Justice in Scotland”, the Scottish Government states that

“Crime and victimisation are intrinsically linked to deep-seated issues such as poverty and income and wealth inequality.”

It also states that 33 per cent of people in prison are from the most deprived areas of Scotland, which is a truly shocking statistic. I agree with the convener of the Health, Social Care and Sport Committee that more focus is needed on prevention and tackling the underlying causes of health inequality.

Last week, I attended a conference on policing mental health, and I listened to one contributor describe how

“prevention always loses in the backroom of power.”

That cannot, and does not, reflect our approach in Scotland. However, sectors, organisations and individuals must be supported with appropriate legislative and other structures to make preventative approaches succeed.

One area for improvement is ensuring that support is in place for people on their leaving prison. When people are released without a fixed address, little access to benefits or employment, and difficult access to health services such as a general practitioner, there is a high likelihood that they will simply return to prison.

As others have mentioned, the cost of living crisis and high fuel costs are disproportionately impacting the poorest people in Scotland. There is a real danger that, without extra support, those who are struggling to survive will simply turn to petty crime.

Recently, Chief Superintendent Phil Davison of Police Scotland warned that the force has noticed changes in the type of items that are being taken in shoplifting incidents, with people now stealing more basic necessities. That change in behaviour is causing the police service to become extremely concerned over the wider impact of the cost of living crisis.

An area of the Criminal Justice Committee’s on-going work is how to improve the policing responses to those who are experiencing poor mental health. Officers cannot take someone from a private place—normally their home—to a place of safety; therefore, in order to fulfil their duty of care, when someone is in mental health distress, one option is that they might have to arrest the person, regardless of the fact that they have committed no crime. That simply makes their situation worse, leaving people feeling criminalised by a system that is supposed to protect them.

A sensitive policing approach is very much needed when dealing with people whose issues are health related. We saw during Covid that a more sensitive, considerate and compassionate approach to policing was extremely effective and appropriate.

There have been a couple of welcome developments in ensuring that people with health issues are given the right support. The first of those is the collaboration between Police Scotland and Public Health Scotland to address public health and wellbeing in communities across the country. The second is that each health board in Scotland is now providing access to a mental health clinician 24 hours a day, seven days a week. I look forward to seeing the impact of those initiatives.

I thank everyone who has contributed to the work of the Criminal Justice Committee. I also echo the comments of the public health minister, who said that the answers to health inequality do not lie simply in the public health portfolio. Finally, I again thank the Health, Social Care and Sport Committee for securing today’s debate on this very important issue.


The Cabinet Secretary for Health and Social Care (Humza Yousaf)

I welcome the opportunity to open the debate on the Scottish Government’s behalf. I thank the Health, Social Care and Sport Committee for the comprehensive work that it has undertaken this year for its inquiry. I thank also the clerks, all those who gave evidence and my colleagues who were around the committee table. My colleague the Minister for Public Health, Women’s Health and Sport played a role by giving evidence to the committee, and she will sum up on the Government’s behalf.

That so many conveners and representatives of committees have already contributed to today’s debate demonstrates the importance attached to the issue at hand by not only the Parliament and the Government but the entire country. Natalie Don was absolutely right that we cannot look at health inequalities without looking at their root causes. I will pick up on points that have been made where I can.

The Government has a role to play in addressing the long-standing health challenges and health inequalities that exist but, equally, it is not a job that we can do alone. It is now more crucial than ever that we work collaboratively not just across the chamber—I think that everybody will agree to that—but across society. It is also important for the Government to work across portfolio boundaries, and I will say more about that in my contribution.

Members have been absolutely right to make the point, with which the Health, Social Care and Sport Committee’s convener started her contribution, that health inequalities existed pre-pandemic. There is no argument from me or the Government about that; we faced ingrained challenges in relation to health inequalities before the pandemic. The convener was equally right to say that those issues have undoubtedly been exacerbated by the pandemic and further impacted by the on-going cost of living crisis. The scale of the challenges that we face has never been greater.

The truth is that inequality has been exacerbated by years of austerity imposed by the UK Government. Recent evidence from the Glasgow Centre for Population Health and the University of Glasgow showed that a decade of cuts has damaged lives, made our communities more vulnerable and led to many dying before their time. Our poorest areas have undoubtedly been hit the hardest. An additional 335,000 deaths were observed across Scotland, England and Wales between 2012 and 2019. That is unacceptable.

We plead with the UK Government—we urge it—to change course from its current harmful policies. The Chancellor of the Exchequer’s most recent autumn statement does not go nearly far enough. In our view, the measures that he outlined are insufficient to help us deal with this crisis. Let us be clear that, at its heart, the cost crisis is a public health crisis. Natalie Don relayed just one testimony from one parent of having to choose between heating and eating. How can that not have an impact on public health?

Brian Whittle (South Scotland) (Con)

Does the cabinet secretary recognise that, if we are to tackle health inequalities, we must deal with the reality? He cannot say, on the one hand, that the Scottish Government is 100 per cent responsible for record investment in the national health service but, on the other, that health inequalities are a problem due to Westminster.

Humza Yousaf

I am not suggesting that the problem is all to do with Westminster. I am simply making the point, as others have done, that serious academics at the University of Glasgow and many organisations, including the Child Poverty Action Group and the Joseph Rowntree Foundation, have said that austerity has clearly been the driver of inequality over the past decade. There cannot be any argument about that, even if Brian Whittle is happy to argue the opposite.

I am coming to the important action that the Scottish Government can take. I am afraid that not all the financial levers are in our hands, although some of them are. John Swinney, the Deputy First Minister, will lay out our budget tomorrow as interim finance secretary.

Some of the levers are in our hands, and there is the possibility for us to take action. I am proud that the Scottish Government has provided £3 billion in this financial year to help the lowest-paid households, the most vulnerable and people in the areas of highest deprivation through the current crisis. Our “Best Start, Bright Futures: Tackling Child Poverty Delivery Plan 2022-2026” outlines the wide-ranging action that we are taking. When it comes to tackling child poverty, the transformative increase in the Scottish child payment will be a real “game changer”—those are not my words but those of many of our third sector partners.

Carol Mochan (South Scotland) (Lab)

The cabinet secretary will know that I agree that austerity has been the key driver of inequality. I have been positive about what has happened with the Scottish child payment, but a lot of organisations say that we need to go further. Does he agree that we should be going further at this stage?

Humza Yousaf

We will always engage with third sector organisations, Opposition parties and others to see whether we can go further. As I said, John Swinney will tomorrow lay out the budget for the next financial year, so I will leave him to say more about that.

Many committee conveners and other representatives have made the point that it is incumbent on the Scottish Government to work collaboratively. We are doing just that, in part, through the care and wellbeing portfolio that has been brought together. When the Minister for Public Health, Women’s Health and Sport was in front of the Health, Social Care and Sport Committee, she was absolutely right to say that public health is the responsibility of every minister. I give an absolute assurance that the good work that we are doing in our portfolio—and, more important, the Deputy First Minister’s work in bringing together cabinet secretaries and ministers across portfolios—is having an impact. Much of that work is inspired by the work of Sir Michael Marmot, who gave a helpful contribution to the committee, as Gillian Martin mentioned.

The committee’s report refers to racialised health inequalities, which Siobhian Brown talked about. We know that not everybody has been impacted equally by the pandemic or the cost crisis. We have heard from a number of members about the importance of recognising intersectionality. I give an absolute assurance that tackling racialised health inequalities and issues relating to intersectionality is at the forefront of our minds in the Scottish Government.

We need effective and collaborative leadership to tackle the issues robustly and to achieve the outcomes that we desire for our people and communities. I am committed to playing my role in that endeavour, using the powers that are available to us, and I promise to work not just across the chamber but with other Governments, including the UK Government, and local government. There is an appetite for change among all of us in the chamber, and I commit to working with anyone who wishes to reduce the health inequalities that, sadly, still exist in Scotland.


Sandesh Gulhane (Glasgow) (Con)

We have a serious problem in Scotland with health inequalities. The committee’s report makes for uncomfortable reading. Simply not enough is being done to improve health outcomes in the most deprived communities. According to Public Health Scotland, Scots die younger than our neighbours in other western European countries, and those who live in our poorest communities are three times more likely to die by suicide, twice as likely to have a mental health condition, four times more likely to suffer an alcohol-specific death and 15 times more likely to suffer a drug-related death.

The committee’s report homes in on the many factors that cause, impact on or exacerbate mental health and health inequalities, which include housing, education, access to social and cultural opportunities, employment, income and social security. We heard from the health convener, and in taking evidence, that the Scottish Government has no overarching strategy for tackling health inequalities. That is why the committee’s report calls on the Scottish Government to set out in detail what it is doing within its devolved competence to tackle poverty as a public health issue.

I take the opportunity to highlight areas that should be prioritised for action. On housing, the committee heard compelling evidence of the essential connection between access to safe, secure and affordable housing and positive health and wellbeing outcomes. However, the 2022-23 budget, led by the Scottish National Party, slashed £5 million from the core housing budget. More than 32,000 adults and 14,000 children are registered homeless in Scotland, and almost 100,000 children, as well as 230,000 adults, are on Scotland’s social housing waiting list. Despite strong SNP Government rhetoric in support of action to tackle inequalities, the evidence of what is happening in our communities tells a different story.

Emma Harper (South Scotland) (SNP)

I thank my committee colleague for taking an intervention. People who gave evidence to us said that the universal credit uplift should be reinstated—that is one of the things that came out in the report. If the member is saying that we should do more to help people in Scotland, that is one of the things that could help. I am interested in knowing why the Conservative members did not support the report’s recommendation on that uplift.

Sandesh Gulhane

It is clear that the UK Government put in an increase for the Covid times, which was quite right.

The committee recognises the benefit of giving local government the autonomy to innovate and explore new ways of tackling health inequalities through affordable housing and transport, improved town planning, access to green space, prioritising health in planning applications and investing in wellbeing communities. We should support councils with some of those areas, because local government knows what will work best for its communities.

Our committee recognises the important role of education in addressing societal and health inequalities. In 2016, the First Minister promised on the record to end the discrepancy in results between the richest and the poorest schoolchildren, which she said was her “defining mission”. Six years on, the attainment gap is wider than that in 2018-19. Grand statements and no delivery will not cut it. The SNP-led Government should be laser focused on delivering for Scotland—it has substantial powers and it is responsible for education, transport, health and housing.

We cannot discuss health inequalities without a focus on health. People in the most deprived areas are now expected to live a healthy life for 24 years less than people in the least deprived ones will, which is in part linked to higher levels of smoking, obesity and alcohol consumption in the poorer areas. In other words, Scots from our poorest areas are not as healthy, so they will rely more on our health services.

The poor stewardship of our NHS is exacerbating the health inequalities. Any figure that we look at has reached its worst-ever level. Cancer waiting times are the longest on record—a patient in Shetland waited almost two years for cancer treatment; the average number of delayed discharges is at its worst-ever level; and only two thirds of children are receiving mental health treatment within 18 weeks. The SNP-led Government has cut £400 million from the health and social care budget and cut £65 million from the primary care budget.

Will the member take an intervention?


Humza Yousaf

We had to reprofile £400 million across the budget because my budget is now worth £650 million less as a result of the economic incompetence of the member’s party. If he does not think that we should have taken money away from those services, where should we have taken it from to afford record pay deals? Those deals are the reason why nurses are not going on strike in Scotland but will do so tomorrow in England, which his party controls.

I also say to Sandesh Gulhane that he needs to come up with credible solutions—

No. Dr Gulhane, you can have some of that time back.

—on where we reprofile that money.

Sit down, please, cabinet secretary.

Sandesh Gulhane

Well, £1.5 billion from the national care service would be a fantastic start. Plus, let us be absolutely clear that we know that the Scottish National Party is not very good when it comes to statistics and telling us what is actually happening. The money to which the cabinet secretary refers is not the type of money that has been lost. The SNP-led Government has cut £400 million from the health and social care budget; £65 million from the primary care budget; £38 million from the mental health budget; £70 million from the social care budget; and £5 million from GP support.

Scotland has the highest drug deaths rate in western Europe. We have terrible rates of addiction. In 2021, there were 1,330 drug-related deaths in Scotland. Those drug deaths expose serious inequalities. People in the most deprived areas are 15 times more likely to die from drug misuse than those in the least deprived areas, and that gap has widened in the past two decades.

Let us consider some solutions. Our proposed right to recovery bill would give people the statutory right to addiction and recovery treatments. To make it easier for people in deprived areas to have health problems diagnosed, let us roll out mobile testing facilities and take healthcare to the people. For example, we could conduct computed tomography scans in areas with high deprivation levels to identify lung cancer earlier. The Scottish Government needs to up its game to reduce smoking, and it especially needs to look at e-cigarettes and heated tobacco products. We need to maintain funding for smoking prevention and cessation services. We reiterate our calls for community link workers to be embedded across all GP surgeries in Scotland.

The committee’s “Tackling health inequalities in Scotland” report is an important piece of work. We must ensure that it does not gather dust and that concrete actions are put in place as a matter of urgency. I thank the convener and members of the committee and all the witnesses who were invited to our meetings.

I declare an interest as a registered NHS GP.

I remind members that we are tight for time. I encourage interventions, but I also encourage members to make them as brief as possible.


Carol Mochan (South Scotland) (Lab)

I thank all my colleagues on the Health, Social Care and Sport Committee for the work that they put into the report, and I thank all those who gave evidence to the committee on the reality of health inequalities in our communities.

I am pleased to open the debate on behalf of Scottish Labour. My party and I fully support the recommendations of the report; indeed, I would go further and say that it is essential. We recognise that the issue of health inequalities is one of the most significant political issues that we can address in the Parliament. To allow health inequalities in Scotland to have such a detrimental impact is to prevent our country from growing, progressing and improving. Health inequalities hold back people and communities and, if the Parliament fails to recognise the scale of the challenge, they will hold back a nation.

Before I move on, I must speak about the scale of the problem that we face. In Scotland, women from more affluent areas are more likely to attend screening appointments than women in our most deprived areas. Suicide rates and cancer rates are higher in our most deprived areas than they are in our most affluent areas. As described in a recent report from the University of Glasgow, the gap in life expectancy between the most and least deprived areas has actually worsened. That is shocking and it should worry all of us in the chamber.

That gives a picture of a country whose Governments are letting it down and where the poorest pay the price of neglectful governance. I therefore welcome the recognition in paragraph 354 of the report, which states:

“The Committee considers that policy action to date has been insufficient to address health inequalities and therefore concludes that additional action is urgently needed across all levels of Government to resolve this.”

No one can speak about health inequalities without condemning the policy of austerity. It was widely accepted and acknowledged in the evidence that was given to the committee that austerity drives health inequalities and causes undue harm to our most deprived communities. The current attack on the poor by the Tories must be addressed if we are ever to make far-reaching changes to address health inequalities in this country.

Along with other members on the Labour benches, I will continue to fight Tory cuts and attacks on the poor. We will do that not only by attacking the abhorrent record of the Tories in power, but by highlighting the positive impact that a Labour Government could make in this country. However, the reality is that my job in this place is to ensure that the Scottish Government is meeting its responsibility to our citizens, and it is this Government’s responsibility to do all that it can to change the downward trajectory.

There are a lot of things on which the Scottish Government must act. If it fails to do that, it will let down many people who would benefit greatly from serious reform. In Parliament, we regularly hear plenty of warm words from the cabinet secretary and Government ministers, but we do not see enough action to seriously tackle health inequalities.

Having said that, I am confident that, with the right approach and good will, we can take into account the testimony of the experts who came to the committee. We heard from them about important matters such as access to safe and secure housing; whether we are efficiently using our housing stock; embedding community link workers in all our GP surgeries; maximising welfare; and eliminating barriers to employment. Those are just a few of the issues on which there are very necessary recommendations in the committee’s report—which, despite being far from exhaustive, is a positive step in the right direction.

The Scottish Government can and must do more. It is undeniable that we are facing economic challenges due to national and international pressures, but now is the time to stand up rather than hide behind excuses. It is perfectly clear—we received a detailed plan on the issue from the Scottish Trades Union Congress this week—that there are significant levers that the Scottish Government can use to increase pay, especially in the public sector. That is the most obvious and impactful contribution that we could make to improve economic outcomes and, with that, reduce health inequalities.

Roz Foyer, the general secretary of the STUC said:

“This isn’t a question of ability, it’s a question of ambition and political will. I’m fed up listening to the Scottish Government playing the Westminster blame game. Simply being better than the UK Government isn’t good enough.”

Roz Foyer is right. That is not good enough; that is a low bar with which to make a comparison. We in Scotland can do better.

I remind Parliament that the solution to health inequalities lies largely in widening opportunities and increasing the provision of services so that they reach every community in the land regardless of wealth or whether someone benefits from a postcode lottery.

We all accept that inequalities are complex and multifaceted, and they cannot be solved with a single policy or initiative. Health inequalities are everybody’s business. I support the committee’s call for cross-party and cross-portfolio engagement on the issue. If that can move us one step closer to eradicating health inequalities, which is what the report intends to achieve, my Labour colleagues and I will work with all parties to deliver that change.


Alex Cole-Hamilton (Edinburgh Western) (LD)

It gives me great pleasure to rise for the Scottish Liberal Democrats to support today’s motion. I am grateful to the committee for bringing this debate to the chamber. It is debates such as this one, in which we see the intersectionality of the issues that we are here to discuss—given that health inequalities manifest in the work of every committee of this Parliament—that show Parliament at its best. I commend each of the conveners for their remarks.

Martin Luther King said:

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman”.

It is also, largely, the most preventable. We in this country are rightly proud of our national health service and we rightly celebrate and reaffirm its ethos of high-quality care that is free at the point of need. We should be proud of that, but we must never be complacent, for although much of our health system might be envied around the world, there is not always equality of access to healthcare for everyone in this country. Health outcomes are certainly anything but equal.

Last year, National Records of Scotland revealed that those who are born in the most deprived areas can expect 24 fewer years of good health than those who are born in the least deprived areas. It also revealed that disadvantaged people spend around a third of their lives in poor health and that the most deprived groups face barriers when booking medical appointments and seeking treatment.

As members will know, I represent Muirhouse in Edinburgh, which is one of the most deprived communities in Scotland—it is regularly in the top five according to the Scottish index of multiple deprivation. Muirhouse Medical Group is the highest ranked of the deep-end GP practices in the country. I am proud to represent that dynamic and beautiful community.

I make a point of going to Muirhouse Medical Group every six months to hear about health inequalities. On my last visit there, I was struck by a question that the lead partner asked me. He asked, “In a practice that serves roughly 10,000 people, how many patients with dementia or Alzheimer’s do you think we have?” I hazarded a guess of a couple of hundred. He said, “It’s a handful—it is barely 50.” That is because nobody really makes it to dementia age, because of the manifest co-morbidities and the grinding poverty that is faced by so many people in that part of the community. That is a stark example.

For the most alarming evidence of health disparities, one need look no further than some cancer outcomes. Those in the most deprived areas are more likely to get cancer, more likely to be diagnosed later and more likely to die. A Public Health Scotland report that was published just last month found that cancer mortality rates in the most deprived areas are a staggering 74 per cent higher than those in the least deprived areas, and there are almost 5,000 extra cancer cases each year as a direct result of socioeconomic deprivation.

There is even inequality when it comes to accessing NHS treatments. If we take NHS dentistry as an example, we have seen the emergence over time of a two-tier system of those who can afford private dental work and those who cannot. Disinterest and inaction have allowed that problem to fester, and now one person in five who are unable to get an appointment are turning to do-it-yourself dentistry. Imagine how horrific that must be. That is a shocking state of affairs in 21st century Scotland, and it is why my party voted at its conference in October to reform the NHS dentistry funding structure in order to incentivise dentists to take on and treat NHS patients.

We must not forget the postcode lottery that, sadly, still exists in maternity services in the north of Scotland. Expectant mothers in Moray and Caithness are forced to endure a dangerous and nightmarish journey to Raigmore, sometimes in the snow and in the dark, to give birth. That means an incredibly anxious car journey over icy roads during winter. Despite repeated calls from my colleague at Westminster, Jamie Stone MP, the Scottish Government has yet to conduct a safety audit of that huge change in service to Caithness patients. That audit will come too late for the newborn who suffered brain damage after travelling three hours by car between Wick and Raigmore in October, when an ambulance was never even offered to the family. The health board in that case was forced to apologise to the family, and rightly so.

It goes without saying that nobody should have to face that level of increased risk simply because of where they live. Everyone should have equal access to high-quality, localised maternity services.

At the root of that problem is the asset stripping of local communities that we have seen this Government commit. The Government has continued to prove that it prefers to spend money on huge centralised bureaucracies rather than take the decisive action that will make a difference to people’s outcomes today.

As we heard in committee, there is a huge link between health and poverty. Income inequality often leads to health inequality, and the knock-on impact on mental health cannot be overstated. Those in financial difficulty are more likely to suffer poor mental health, and the mental health of parents has a significant impact on the wellbeing and life chances of children and adolescents in their care. I fear that the longer that Scots are forced to endure the cost of living crisis, the more obvious and tragic the impacts of poverty will become. Those people join the longest waiting lists for care in our NHS.

The Government must redouble its efforts to tackle rising poverty. It must treat that as the public health issue that it is, and give people the treatment that they need when their mental health fails them. Shamefully, all the evidence suggests that health inequalities in Scotland are continuing to grow.

I am coming to the end of my time. I finish with the words of the former Prime Minister of Barbados, Owen Arthur, who once said:

“he who has health, has hope; and he who has hope, has everything.”

We need to give the people of Scotland some new hope.

We move to the open debate, and I remind members that speeches will be five minutes, rather than the usual four or six minutes.


Evelyn Tweed (Stirling) (SNP)

As a member of the Health, Social Care and Sport Committee, I would like to thank all participants for sharing their time and expertise throughout the inquiry.

Our committee found that unjust and avoidable health inequalities are widening across Scotland. They are systemic and intertwined with other forms of inequality and, as we have heard today, poverty.

Dr Sharon Wright from the University of Glasgow, along with 74 other respondents, told us that poverty drives health inequalities. Poverty has wide-ranging and dire consequences for health, and the Westminster cost of living crisis is having a disproportionate negative impact on those who are already experiencing health inequalities.

Marie Curie shared stories of terminally ill people in Scotland who are struggling with bills and having to “rough it” through the winter. A terminal illness comes with extra use of energy for heating and specialist equipment. Dr David Walsh of the Glasgow Centre for Population Health told our committee:

“You can ... trace the effects of austerity through well-understood pathways to—ultimately and tragically—early death.”—[Official Report, Health, Social Care and Sport Committee, 24 May 2022; c 12.]

As the cabinet secretary has highlighted, the most damning statistic of all is that life expectancy has fallen as a direct result of the UK Government’s austerity policies.

Will the member take an intervention?

Evelyn Tweed

Not at this time—I might do later on.

Research that was led by the Glasgow Centre for Population Health and the University of Glasgow shows that austerity has led to almost 20,000 excess deaths in Scotland and that people who live in the poorest areas are hardest hit. In fact, the study found that there was a total of 335,000 excess deaths across Scotland, England and Wales between 2012 and 2019. Conservative policies have helped to shorten life expectancy for people across the UK, as well as diminishing the quality of their lives.

During our evidence gathering, we heard from multiple experts that the most effective method of relieving poverty and thus improving health outcomes is putting money in the hands of those who need it. Scotland is making huge progress on that. As the Joseph Rowntree Foundation said,

“The full rollout of the Scottish Child Payment is a watershed moment for tackling poverty in Scotland, and the rest of the UK should take notice.”

The Child Poverty Action Group said:

“If the Scottish government can make this kind of serious investment in protecting our children from poverty then so too can the UK government.”

Much is being done to mitigate health inequalities, but there is one clear fact that is driven by the data, not politics, which is that the most effective remedies for tackling poverty remain outwith the control of the Scottish Government.

Will the member take an intervention?

Evelyn Tweed

No, not at this time.

Many of the experts we spoke to were unequivocal in their view that Scotland’s ability to remedy health inequality is extremely limited while we remain part of the UK. For example, the experts told us that benefits that are under the control of Westminster—

Will the member take an intervention?

Evelyn Tweed

No, not at this time.

The experts told us that those benefits are among the most effective ways of delivering support to low-income families.

I am tired of the Labour Party’s continual attacks on the Scottish health service, when Scotland’s health service is clearly performing better than that of Labour-controlled Wales. Now, Labour and Sir Keir Starmer are enthusiastic backers of Brexit, which, as well as doing so much to damage our economy, is depriving the health and care sectors of desperately needed staff.

Will the member take an intervention?

Evelyn Tweed

No, I will not—I have more to say.

We have heard that poverty and health inequalities are inextricably linked. The Scottish Government will continue to support people in poverty, but we could do so much more with independence. The result of the most recent Holyrood elections demonstrated, and all the recent polls confirm, that the people of Scotland recognise that. If the Opposition parties in the Parliament were really serious about working collaboratively to tackle health inequality in Scotland, they should be joining us to demand that Scotland’s people have the right to choose their own future.


Brian Whittle (South Scotland) (Con)

Okay. It is back to reality.

I am pleased to have the opportunity to speak in the debate and I do so as the co-convener of the cross-party group on health inequalities.

Health inequalities are a tremendously important topic to me and I welcome the chance to discuss the work that I, five of my MSP colleagues and nearly 100 external organisations—including third sector organisations, health boards, other public bodies, academic institutions and royal colleges—have done to raise awareness of the causes of health inequalities, promote evidence-based actions that reduce them and avoid legislation and policies that make health inequalities in Scotland worse.

Over the past year, the cross-party group has met to consider a range of topics, including the inverse care law, socioeconomic impacts on children’s activity levels and mental health. Despite our work to draw attention to the needs of the underserved and marginalised groups and their evidence-based solutions, we are all aware that the Covid-19 pandemic has starkly brought attention to the realities of the gap in health outcomes between different population groups, particularly the rich and the poor.

The NHS rate of recovery from the pandemic, twinned with the cost of living crisis, is alarming. Both of those risk widening the health inequalities gap further.

When we discuss health inequalities, it is important to ensure that we are not focused entirely on the outcomes of health inequalities but also look at the broader reasons for those inequalities outside of healthcare. We should also recognise that there have always been and always will be inequalities. The question is, at what level are inequalities acceptable and what can we do to tackle the societal inequalities that we are able to address?

With that in mind, I will talk once again about the significant role that the preventative health agenda could and should play. For example, housing people with respiratory conditions in damp, poorly insulated housing will inevitably lead to them spending more time in hospital, with that cost coming out of the NHS budget rather than the housing budget. In fact, housing anyone in damp, poorly insulated housing will lead to more people with respiratory conditions.

That highlights where the Scottish Government has failed to think and act across portfolios. We either invest in better-quality housing, heating and insulation or we spend the money on the healthcare of people who do not have that quality housing. It all comes out of the same Scottish Government budget. It is just a question of what page in the ledger the investment will appear on.

The Scottish healthcare system is funded to provide healthcare on demand rather than on need. It is reactive more than proactive and preventative. It must be encouraged to change and evolve.

I absolutely agree with everything that Brian Whittle says about good-quality housing. Is he supportive of the moves to build more social housing in Scotland? Does the Conservative Party support that?

Brian Whittle

Of course we do. It is crucial that we do that but, if we cut the budget to social housing, we will build less. Therefore, the cost will come out of the healthcare budget. That is what I am trying to say.

Scotland is the unhealthiest country in Europe and the unhealthiest small country in the world. That is a major reason why we have such stark health inequality data. We have such a poor record on conditions such as obesity, levels of which in Scotland are among the highest in the developed world. That condition is likely to result in rising levels of type 2 diabetes, colon cancer and hypertension.

Declining levels of physical activity and sedentary lifestyles were highlighted in a report as a factor in the rising obesity levels in Scotland, affecting the lower SIMD areas more acutely. That report also talked about changes in diet—including the availability of cheap, energy-dense food—as a factor. It also said that people were walking less, car use was up and people’s jobs were less active. According to Obesity Action Scotland, the average body mass index of the Scottish population has been rising steadily since 1995 and gone from 26 to 28. More than half of children in Scotland living with obesity are at risk of severe obesity, which costs the health budget billions.

Those conditions are certainly exacerbated by poverty, with life expectancy varying hugely in Scotland. Even within the city of Glasgow, life expectancy can vary by more than 20 years within just a few miles. However, those conditions are preventable. That is why I am passionate about ensuring that physical activity should play a much bigger part in our education system. It is why nutritional education should play a much bigger part.

Will the member take an intervention?

No, he is winding up.

Brian Whittle

When we discuss free school meals, we should ensure that pupils have a much greater part in the development of the menu.

The Scottish Government health strategy, education strategy and housing strategy are some of the reasons why health inequalities persist. We must join up the dots and think across portfolios. That is the only way we can improve Scotland’s report card.


Emma Harper (South Scotland) (SNP)

I thank everybody who was involved in the inquiry. I am a member of the Health, Social Care and Sport Committee. The health inequalities inquiry, as we have heard, has involved numerous parliamentary committees and it has shown us one crucial factor—that the Scottish Government is doing everything that it can to tackle the root causes of poverty and associated poor health. However, it has one hand tied behind its back in not having control over the relevant reserved powers.

Tory policies at Westminster are having negative and long-lasting consequences that directly impact on the health of low-income households here in Scotland—that is clear and it is based on evidence. Game-changing policies such as the £25 per week Scottish child payment can only do so much when the Tories continue to inflict harm on the most vulnerable people in our society—namely, those who rely on the state safety net. That safety net is being systematically dismantled by the Westminster Government.

Brian Whittle

Does the member accept that the Scottish Government has total control of the biggest tools in the toolbox to tackle health inequalities, which are health and education? The SNP is failing in both those areas. [Interruption.]

Emma Harper

The member is still trying to intervene from a sedentary position. The bottom line is that we dinnae have control of the budget. We need the finance to deliver what we need in order to tackle poverty and address health inequalities.

The committee’s report shows that successive UK Conservative Governments, particularly in the 1980s and from 2010 onwards, insisted on austerity agendas and slashed welfare payments and public services. It is important to state that austerity is

“difficult economic conditions created by government measures to reduce public expenditure.”

It is caused by policy choices.

Will the member take an intervention?

Emma Harper

I have only five minutes.

The report reflects that the austerity agenda has caused continued and immense damage to the health of the poorest and most vulnerable. Austerity has been an economic failure and a health failure. During our inquiry, we heard how experts from the Glasgow Centre of Population Health showed that nearly 20,000 excess deaths in Scotland were likely to have been caused by UK Government economic policy. Tory austerity policies have likely caused more deaths in Scotland than Covid-19. [Interruption.]

Here is the evidence that members might want tae listen tae. Dr David Walsh from the Glasgow Centre of Population Health said:

“we must remember that these are more than just statistics: they represent hundreds of thousands of people whose lives have been cut short, and hundreds of thousands of families who have had to deal with the grief and aftermath of those deaths.”

Will the member give way?

Emma Harper

I am continuing with my evidence; I will run out of time if I take another intervention.

The United Nations poverty envoy, Olivier De Schutter, has warned that another wave of austerity might violate UK human rights obligations and increase hunger and malnutrition. Matthew Taylor, chief executive of the NHS Confederation, said:

“The country is facing a humanitarian crisis. Many people could face the awful choice between skipping meals to heat their homes and having to live in cold, damp and very unpleasant conditions.”

Since Matthew Taylor stated that, we have seen the reality of eating versus heating. It is not a choice any more, because folk are not heating their homes and they are missing meals—families are omitting their meals.

Gillian Martin mentioned that the inquiry shaped the committee’s many recommendations in employment, education, housing, social security, public services and health—many portfolios are covered. Fundamentally, the recommendations call for urgent co-ordinated action across all levels of government in the UK to tackle health inequalities in Scotland.

The committee was particularly concerned that the rising cost of living will have a more negative impact on those groups that are already experiencing health inequalities, including those living in poverty and those with a disability.

One of the key findings is that there is no overarching, national strategy for tackling health inequalities in Scotland, but the evidence submitted to our inquiry showed many instances where the design and delivery of public services may exacerbate inequalities rather than reduce them.

It is clear from our report that many causes of health inequalities lie with policies made at Westminster, so I welcome the Government’s commitment to accept the majority of the committee’s recommendations, and we will work together to tackle health inequalities in Scotland.

I remind the chamber that it is up to members whether they take an intervention, and if they do not take one, it is not an invitation to shout the intervention from a sedentary position.


Rhoda Grant (Highlands and Islands) (Lab)

Health inequalities are a symptom of an unequal society rather than a cause—a point that many members have made during the debate. There are inequalities in our health service, but those are because of the underlying societal issues.

I live in Inverness, and from my home I can walk 15 minutes in one direction and then 15 minutes in the other direction and, sadly, the difference in life expectancy between those two communities—which are separated by a 30-minute walk—is almost two decades. Those in the wealthy area live nearly 20 years longer than those in the less affluent community. Those people were born in the same hospital and educated by the same council, and they live in the same city; the only difference is their access to wealth.

People with a reasonable income can live in warm homes, enjoy nutritious food and focus on the education of their children as well as their own opportunities. People who do not have a reasonable income live in cold, damp homes and eat a poor diet, and the education of their children is secondary to their survival. They have no opportunities, and they are therefore more liable to become unwell and to suffer harms that damage their mental and physical health. Therefore, they have a shorter life expectancy. It is absolutely unfair that those people also have poorer health services.

General practitioners who work in our most deprived areas tell of the challenges that they face while working in those communities. Lack of money and opportunity also diminishes people’s expectations of their health services. They do not expect to be able to access services, and they often cannot afford to access services due to the cost and availability of transport. That lack of expectation of a reasonable outcome can cause mental health issues and lead to self-medication and addiction.

Drugs and alcohol also shorten lives. Women are more likely to earn less due to the gender pay gap and have greater caring responsibilities. Therefore, in order to deal with health inequalities, we need to deal with societal inequalities, which are the root cause. It is often easy to see those divides in cities by identifying postcodes where low incomes and poor health outcomes are prevalent, but it is much more difficult to do that in rural communities where the wealthy live side by side with the poor.

The Highlands and Islands Enterprise report “A minimum Income for Remote Rural Scotland” points out that a minimum income for a reasonable standard of living is between a tenth and a third more in rural areas than it is in urban areas. The report tells us:

“The additional costs come from a range of sources. In particular, the costs of travelling, heating one’s home and paying for goods and their delivery are much higher for many residents of the areas under review, especially those in the remotest areas.”

Therefore, interventions that target geographical areas do not work for the rural poor and the Scottish Government passes the buck to the UK Government. Its policies have, of course, made the situation worse, but the Scottish Government continues to ignore its own responsibilities.

With regard to heating, the Scottish Government now insists that all new heating boilers that are off the gas grid and funded under Government schemes should be heat pumps. In order to use a heat pump, people need to invest tens of thousands of pounds in the insulation of their home—which is money that people simply do not have. I spoke to someone who had recently had a heat pump fitted in an old house. They said that putting on the heating was pointless because it was hugely expensive and did not provide any warmth at all. The Scottish Government needs to take responsibility for that and design its policies accordingly, because it is now responsible for people freezing in their own homes. It is also responsible for potential interventions that could lift people out of poverty.

The Scottish Labour Party proposed improvements to the Good Food Nation (Scotland) Bill that would have enshrined the right to food in the act, but that was voted down. We also tried to make the Scottish Food Commission responsible for realising that right, but—again—that was voted down. The Scottish Government is directly responsible for that.

We all aspire to live in a country where those basic human rights are met, and it is to our shame that they are not. So, I welcome the committee’s report and I hope that it pushes the Scottish Government to act to make Scotland a fairer country. If it does that, it will begin to tackle health inequalities.

The Deputy Presiding Officer

Thank you, Ms Grant.

I remind members that those who are participating in a debate are expected to be in the chamber for opening and closing speeches and that, if you have made a speech, you are required to be in the chamber for at least two speeches after that. I notice that that has not been adhered to by a couple of colleagues, which is disappointing.


Fiona Hyslop (Linlithgow) (SNP)

As we have heard throughout the debate and in the evidence of experts to the committee’s informative inquiry, health inequalities are symptoms, not causes, and we must tackle the causes. As expert witnesses to the committee said, devolution policies have helped to tackle those inequalities but much more needs to be done, and the finding in the report that a decade of austerity is behind stalling improvements in life expectancy must make us all angry.

Health inequalities reflect the values of the state, and we currently have a state that enables the likes of Michelle Mone and her family to make millions from Covid contracts during a pandemic that laid bare the health inequalities for all to see and many to suffer from. Poverty does not recognise a person’s age or that they are a child. No child should suffer health inequalities as a result of living in poverty, but life chances, health, and cognitive, linguistic and childhood development are all affected by a person’s start in life.

When giving evidence to the committee, Professor Gerry McCartney said:

“We know that health inequalities are a result of inequalities in income, wealth and power in society and it is because those inequalities have continued to widen that health inequalities have continued to widen.”—[Official Report, Health, Social Care and Sport Committee, 24 May 2022; c 3.]

Jaki Lambert, the director of the Royal College of Midwives in Scotland, recently commented that she is now seeing heath inequalities starting to be the cause of increasing deaths of mothers who have recently given birth and that countries such as Denmark, which are better at tackling inequalities, are not seeing that. The worst start in life for someone must be to lose their mother.

The Scottish Government continues to drive to reduce childhood inequalities. Introducing the Scottish child payment and increasing it to £25 per week for all eligible under-16s is a long-term measure but one that will be a lifeline to many families this winter. In West Lothian, 7,105 applications for the Scottish child payment have been submitted from families as of 30 September this year, and many more families will be eligible with the extension of the payment to under-16s. The new parental employability support and the best start grant—which are also available only in Scotland—are also increasing household incomes in order to improve family wellbeing.

Children need access to safe, secure, affordable housing, as that leads to more positive health outcomes. That is why I welcome the Scottish Government’s affordable housing supply programme, which prioritises tackling child poverty and will deliver 110,000 more affordable, energy-efficient homes by 2032.

Early years stimulation, development and resilience at nursery can help children in later years, but it also enables parents and carers to work, which leads to the imperative to tackle in-work poverty and the need for a decent living wage. I welcome the Scottish Government’s recent announcement that it will introduce measures to ensure that businesses and organisations that receive public funds pay the living wage.

The voluntary sector also plays an important role, and, with estimates that 8,740 children were living in relative poverty in 2019-20 in West Lothian, the pioneering West Lothian school bank and the West Lothian financial inclusion network, with a Christmas present shoe box appeal, also help families.

However, it does not have to be that way. It is clear that the Scottish Government is using the limited resources and powers that are available to it to take a wide and connected approach to tackling inequality and dealing with child poverty in Scotland. The majority of powers that are required to address economic inequalities are reserved to Westminster, which presides over one of the worst levels of inequalities in the G20. As long as economic inequalities continue to widen, so too will health inequalities.

Craig Hoy

Before the Covid pandemic, the Institute for Government said that an independent Scotland with full powers over every area of policy in Scotland would immediately face an £8 billion black hole. What will it be: £8 billion in spending cuts—SNP austerity—or £8 billion in tax increases?

Fiona Hyslop

Mr Hoy should be ashamed of the state of the UK and its economic experience, which put Scotland in the position of having to deal with any problem whatsoever in its economy. The UK Government’s recent stewardship leaves a lot to be desired. I am sincerely concerned about the impact of that and how it will affect inequality among my constituents.

The UK Government should use its powers over employment law and many work-related benefits to reduce inequalities. The committee’s report quite rightly states that health inequality cannot be viewed in isolation, which has been echoed in the debate. In order to reduce health inequalities in Scotland, we must work to ensure that no child in Scotland lives in poverty. I want a Scotland that can use the powers of independence with a value system that tackles and does not perpetuate inequalities.

We cannot—we must not—rest until there is no child in Scotland who is living in poverty. Only by working to make that a reality will we end health inequality and give the children of Scotland the health, equality and life chances that they deserve.


Gillian Mackay (Central Scotland) (Green)

I thank committee colleagues, clerks, the people who gave evidence and all those who sent in briefings ahead of the debate. The committee’s report is hugely wide ranging and covers many more issues than I can do justice to in five minutes.

I know that colleagues across the chamber will—as I do—have numerous constituents who are faced with overlapping and intersectional health inequalities. Inequalities do not exist in a silo and I am pleased by the steps that have been taken in the chamber to acknowledge health inequalities holistically. As we heard, wealth inequality is the biggest factor that impacts on health outcomes; given the current cost of living crisis, it is likely that that will be made worse, in the short term.

As many other members have said, we cannot get through a debate on health inequalities without mentioning austerity. The Scottish Greens would like to see implementation of a universal basic income; however, given the powers that are currently available to Parliament, we welcome the work that is being done to implement a basic income guarantee. I would welcome an update from the minister, in closing, on what, in addition to that, is currently being done to support low-income households to maintain their health and wellbeing.

As the convener of the cross-party group on stroke, it would be remiss of me not to mention the important statistics related to deprivation and stroke prevalence. There is a strong relationship between deprivation and stroke mortality. That is particularly true in the under-65 age group, in which the standardised mortality rate is over four times higher for the most deprived 10 per cent of the population than it is for the least deprived 10 per cent of the population. The death rate in 2020 for cerebrovascular disease in the most deprived areas was 43 per cent higher than it was in the least deprived areas, which was consistent with the figures for the previous five years.

The association between mortality and deprivation was stronger in the under-65 age category than in the over-65 age category. In the under-65s, there is a clear pattern of correlation between the SMR and the deprivation decile. The SMR in the under-65 age category was 86 per cent above the Scottish average in the most deprived 10 per cent of the population, whereas the SMR in the under-65 age category in the least deprived 10 per cent of the population was 61 per cent below the Scottish average.

As noted in Engender’s briefing on women’s health inequalities, women and girls still face significant and distinct barriers to having adequate mental and physical health in Scotland. Health inequalities that disproportionately affect women have historically lacked adequate funding and the professional focus that is needed to address them.

Women’s health has not historically been understood and respected as it should have been. I have touched already on intersectional equality issues having a significant bearing on health outcomes, and the same is true of the effect on women. Important examples include historic ableism, racism and homophobia, which have contributed to there being unmet health needs for women of colour, disabled women and LGBT+ women. A 2017 study found that women in the most deprived areas of Scotland experience good health outcomes for 25 years less than women in the most affluent parts of the country. Inequality has also persisted across gender divides in terms of health outcomes.

A 2020 report by the Health and Social Care Alliance Scotland highlights that women consistently raise their experiences of their healthcare concerns not being listened to or not being taken seriously, and say that they are not actively involved in treatment or in planning prescription choices. As a result of that, women wait longer for pain medication than men, wait longer to be diagnosed and are more likely to have physical symptoms ascribed to mental health issues, as well as being more likely to have heart disease misdiagnosed or to become disabled after a stroke.

We must remember that each and every portfolio across Government has an impact on health in one way or another. The impact of poverty and the added pressure of the cost of living crisis on mental health cannot be understated.

In its briefing, the Mental Health Foundation said that,

“In November, new evidence emerged on the negative mental health effects of the cost of living crisis, in a poll conducted for the Foundation by Opinium. The Foundation found that when they were asked about the past month, one in nine ... adults in Scotland were feeling hopeless about their financial situation, four in 10 ... were feeling anxious and one third ... were feeling stressed. This research on a representative sample of 1,000 adults in Scotland is worrying and shows the early signs of the negative mental health impact of the ‘cost of living crisis’ ... The effects of adversity are cumulative; those who have already experienced stress due to the recession of 2008, prior poverty, other adversity and/or the COVID-19 pandemic will be at higher risk if they also experience financial stress due to the Cost of Living Crisis.“

Today’s debate is on the committee’s report, but it is actually about how we switch to a preventative health agenda, thereby reducing the ill health that people experience and increasing their ability to stay well. We have a way to go to move to truly preventative health approaches that reach as many people as possible, and more work needs to be done to ensure that people in low-income households attend appointments, such as those for cancer screening and vaccination. We need to ensure that, for carers, there are flexible appointments, and that the time spent at and cost of getting to those appointments are not barriers.

However, we should not underestimate the ability of preventative approaches to make a difference. We know the impact they have had on mortality rates.

You need to wind up now, Ms Mackay.

I apologise, Presiding Officer. There is a lot more that I could have got through, but I will end by again thanking committee colleagues and those who gave evidence.


Craig Hoy (South Scotland) (Con)

I thank the Health, Social Care and Sport Committee for its wide-ranging and impactful report. The report was published by that committee, but the debate goes way beyond the realms and remit of public health. The causes and implications of health inequality are spread over a far broader public-policy canvas that covers housing, communities and planning, access to social and cultural opportunities, education and early years development and, of course, employment and the need to secure a growth-based economy in which everyone has access to skills development and well-paid employment. If we fail in those areas, we will fail to tackle the underlying causes of health inequality. As the Scottish Parliament information centre notes,

“the fundamental causes of health inequalities lie largely outside the health system; health inequalities are a symptom rather than the cause of the problem”.

The Health, Social Care and Sport Committee is concerned by evidence that, despite

“strong rhetoric in support of action to tackle them, the level of health inequalities in Scotland remains higher than in England”

The responsibility for the failure to combat poverty in Scotland rests with all political parties over decades; my Conservative Party, the Labour Party and now the Scottish National Party. However, we cannot escape the simple fact that the SNP has been in government here at Holyrood for 15 years. This is happening on its watch, so I say to the minister that blaming Westminster simply will not wash.

Can Craig Hoy touch on how austerity affects communities? There are lots of reports on the issue; a recent one from Glasgow is clear that austerity is driving most of the health inequalities that we have.

Craig Hoy

Scotland has the largest settlement from Westminster that it has ever had, and has control over welfare powers and employment, and the way to tackle austerity and poverty in the long term is to ensure that we get people in a position—

So, austerity has had no impact.

The cabinet secretary is saying that austerity has had no impact—

Austerity has had a major impact.

Craig Hoy

I remind him of the fact that he is advocating independence, which would lead to £8 billion-worth of austerity.

We must remember that the Covid pandemic has shone a light on the severity of health inequalities in Scotland today. Death rates among people from deprived backgrounds and among the south Asian community were around double the rates in the general population. Rightly, the data prompted the committee to look into the issue.

The social and economic costs of inequality are immense and are very real costs. People are living in poor health, in chronic pain, in poverty, in poor housing and with poor diet, and they face higher mortality rates.

For too long, we have written off the existence of severe pockets of deprivation in our communities as a problem that is too entrenched and tough to fix. The problem is often hidden within our communities in pockets of deprivation, which are shut away from sight, so we must shine a light on them.

The committee recognises the benefit of giving local government the authority to innovate and explore new ways to tackle health inequalities. It also notes that a lack of strategic co-ordination could exacerbate inequality, in some instances. However, if local government has a major role to play in combating inequality, it is vital that our councils be properly funded.

Will the member take an intervention?

Craig Hoy

No, I will not.

I have very real concerns that year after year of SNP cuts to housing and council budgets will have exacerbated many of the social determinants of health inequality.

To break that link, it is vital that we work across the parties in Parliament to end the depressing cycle of intergenerational poverty, because only by doing that can we set out on a different path that, as the committee knows, will save lives.

Let us take the example of cancer. Cancer-related deaths are 74 per cent higher in the most deprived communities than they are in the least deprived communities in Scotland.

Will the member take an intervention on that point?

Craig Hoy

I will not give way, because I am short of time.

Around 4,900 extra cancer cases each year in Scotland are attributable to deprivation, which is equivalent to a staggering 13 extra new cancer diagnoses in Scotland per day.

A recent report from Cancer Research UK sets out some clear recommendations. It calls on the SNP ministers and the NHS to fund and roll out interventions that tackle the known drivers of inequalities. It calls for

“bold action to diagnose cancers earlier”

and to ensure that everyone has access to the right treatments for them.

Deputy Presiding Officer—

I am sorry, I mean Presiding Officer—you snuck in without me seeing you.

Poverty remains a scar on the face of modern Scotland, and tackling it remains one of the greatest priorities that must be addressed if we are to reduce health inequalities.

We need a Scottish Government that focuses on tackling the inequalities of place across Scotland, not a Scottish Government that is obsessed with dividing the country on the constitution. We need a Scottish Government that is truly committed to reversing the in-built disadvantages that hold urban and rural Scotland back. To achieve that, we need a Scottish Government that is truly committed to improving health outcomes for everyone across Scotland today.


Foysol Choudhury (Lothian) (Lab)

I pay tribute to the committee members and staff for their work in producing the report, which covers a very wide range of issues across Scottish society, under the umbrella of health inequalities. I also thank the witnesses who gave evidence to the committee, to allow it to develop the report on such an important subject.

I will focus my attention on the very welcome recommendation from the committee to treat the elimination of poverty as a public health measure. As a member of the Social Justice and Social Security Committee, I am grateful that the health committee considered our recent reports as part of its report. The report introduces itself with a history of the failed actions to reduce health inequalities in Scotland.

I am glad that the committee clearly lays out the gravity of the health inequalities that are faced in Scotland, because we do not do ourselves any favours by sugar-coating the situation. As Scottish parliamentarians, it is incumbent on all of us to find a way to tackle the distinct problem that we face.

To that end, as a co-convener of the cross-party group on improving Scotland’s health, I am grateful to colleagues from the CPGs on diabetes, heart and circulatory diseases, lung health and stroke for agreeing to participate in a joint inquiry into non-communicable diseases.

I am also grateful to the British Heart Foundation for supporting that work. Although NCDs are only one aspect of the health inequalities in Scotland, I am hopeful that by pooling the resources of our CPGs, we will be able to come up with recommendations to help the situation.

These inequalities are close to home. In 2018, a report found that a boy born that year in Muirhouse or West Pilton had a life expectancy that was 13 years shorter than that of a boy born in neighbouring Cramond. That is shocking, and it was so before Covid-19, which the committee’s report tells us has made health inequalities considerably worse across the board.

The most recent report from the National Records of Scotland shows that in the past 10 years, improvements in life expectancy have stalled and, most recently, have started to reverse. That reverse is put down to Covid, but the stall was not. Decreases in deaths from heart disease have slowed; deaths from drugs have risen. It is important for us all to find ways to halt and reverse those trends and to improve life expectancy in Scotland. Perhaps greater use of organisations such as the fantastic Pilton Community Health Project, which is a community wellbeing programme in north Edinburgh, can bring to bear local expertise where it might help.

The committee makes clear that, sadly, there is no magic bullet to fix those issues. It will take systemic change across a variety of systems. For example, the report highlights the way that systemic racism creates poverty, and we know that poverty leads to poorer lifelong outcomes.

In 2020, Hannah Lawrence produced a comprehensive report for Edinburgh & Lothians Regional Equality Council—ELREC—which detailed the barriers of poverty and inequality for ethnic minorities in Scotland. I draw members’ attention to my entry in the register of members’ interests—I am co-chair of ELREC.

Ethnic minorities in Scotland often face multiple overlapping disadvantages that cannot be fixed by any single initiative. As I said earlier, it is incumbent on us all to work towards fixing those problems. I thank the committee for guiding us in that work.

David Torrance will be the final speaker in the open debate.


David Torrance (Kirkcaldy) (SNP)

Before I begin, I put on record my thanks to everyone who played a part in this inquiry and brought us to where we are today. There are far too many to mention, but I pay particular thanks to every single individual and organisation who took the time to contribute to our evidence sessions. Those sessions provided us with an opportunity to hear first-hand accounts of individual experiences and were invaluable to the work of the committee.

We all recognise the effect of inequality on individuals, families and communities and that a number of communities are disproportionately affected by inequality. Health inequalities are commonly understood to be unjust and avoidable differences in people’s health across the population and between different groups. As noted in the report,

“It is internationally accepted that the fundamental causes of health inequalities lie largely outside the health system; health inequalities are a symptom rather than the cause of the problem”


“arise from the unequal distribution of income, wealth and power and the societal conditions this creates.”

Through the inquiry, the committee sought to focus on

“what progress has been made ... in tackling health inequalities”

in Scotland since the 2015 report;

“what impacts additional factors ... have had on health inequalities and action to address them”;

and what opportunities exist to reduce such inequalities and

“increase preventative work to tackle”


“before they impact on individuals’ health and wellbeing”.

Over the seven years since the previous report, Scotland has also faced considerable new challenges and pressures that have intensified pre-existing inequalities. Back in 2015, no one could have predicted what was around the corner and how devastating an impact, both directly and indirectly, the Covid pandemic would have on certain sections of our population. The disproportionate effect on our ethnic minority communities, people with learning disabilities, those with severe mental illness and our most vulnerable cannot be overstated.

Now, as we slowly continue the difficult recovery, we are faced with a Tory cost of living crisis that threatens to push households into vulnerable positions, increasing health inequalities and worsening health and wellbeing. Yet again, the greatest negative impact will be felt by the groups who are already experiencing health inequalities, including those living in poverty and those with disabilities.

Matthew Taylor, chief executive of the NHS Confederation, has said:

“The country is facing a humanitarian crisis. Many people could face the awful choice between skipping meals to heat their homes and having to live in cold, damp and very unpleasant conditions. This in turn could lead to outbreaks of illness and sickness around the country and widen health inequalities, worsen children’s life chances and leave an indelible scar on local communities.”

In my constituency, I see the wide and varied impact of these inequalities every single day on the communities that I represent. In the past, people attending my surgeries came, in the main, to discuss general issues or to seek advice and help. That has now changed—now they come because they are scared. They come because they have very real fears about how they are going to keep their families safe and healthy. In the face of inflation that has risen out of control and astronomical energy prices, they are terrified about what the future holds.

I will touch on one of the findings from the committee’s inquiry, which urges the Scottish Government to ensure that the impact on inequalities is a primary consideration in the future design and delivery of all public services. I was extremely interested to see a Fife initiative being praised and used as an example of good practice in the written response received by the committee from the Royal College of Occupational Therapists. It noted that the benefits of local-level working have been seen in Fife, where the children and young people’s occupational therapy service is a key stakeholder in collaborative work to develop a new community play experience that offers invisible inclusivity. The goal is to create an environment that has no boundaries and that supports participation in play in every sense of the word.

There are so many local examples of good practice, across all our constituencies, that have a massive impact on what we all hope to achieve. I, for one, am eternally grateful to each and every one for their contribution.

Statistics consistently show that poverty and inequality impact a child’s whole life, affecting their education, housing and social environment, and in turn affecting their health outcomes. The Joseph Rowntree Foundation reported that

“Boys born in low-income communities can expect, on average, 47 years of healthy life, girls, 50.”

That is two decades of quality of life being taken from people solely because of where they were born.

The committee agrees that urgent action is needed to address health inequalities. However, it is clear that the UK Government’s action to date to tackle health inequalities in Scotland simply has not been enough. By enforcing austerity and slashing welfare payments and public services, the Tories have caused immense damage to the health of the poorest and most vulnerable in our society.

Today I call on the Westminster Government to follow the lead of the Scottish Government, which has used the powers that it does have to ensure that people in Scotland benefit from the most generous social contract in any part of the UK. We must continue to drive national and local action through partnerships with local government, public services, the voluntary sector and our local communities. Our policies and approach must be shaped by lived experience, and they must tackle the root causes of health inequalities, because lives literally depend on it.

We move to closing speeches.


Martin Whitfield (South Scotland) (Lab)

It has been a fascinating debate—one of perhaps two halves. It is a great pleasure to follow David Torrance, and I would encourage members, both those in the chamber and those who were unable to be here today, to read Mr Torrance’s speech afterwards. I found it very powerful, as it drew on the personal experiences of what happens in his constituency, and raised the fact that there is phenomenal good practice happening around Scotland. If we had a way of pooling and sharing those practices, many of the areas that face challenges might indeed find answers from other areas. I thank David Torrance for that speech and also for his festive greeting for the holiday period when it comes, which I received during his speech.

As I said, it has been very much a debate of two halves. I would like to concentrate on the opening contributions, because to have so many conveners in the chamber speaking on a committee report is, to me, unprecedented in the 18 months that I have had the pleasure to serve here. I will also do so because of how powerful all those contributions were. Like others, I must thank the committee and the convener for the report that it produced, which makes truly frightening reading but also provides tangible recommendations, which I think and hope that the Government will find very helpful.

I will concentrate on Gillian Martin’s contribution and the committee’s request for an overarching strategy. The cabinet secretary talked about the Government group that is addressing the issue, but the report is looking for something that is more formal, better understood and more wide reaching, so that the Government can be held to account. There is a difference between cabinet secretaries rightly gathering together to discuss the issue and a strategy that people outside the Parliament can see, so that they can hold the Government to account.

In Clare Adamson’s powerful contribution, she talked about the role of the arts in fighting inequality. That area is frequently considered almost as an afterthought, but the art and culture of a society speak volumes about the mental wellbeing of the members of that community. Art and culture can be used to find simple answers to problems that are a challenge for individuals and to find community-wide solutions to problems. I found her contribution incredibly useful.

Siobhian Brown, the convener of the COVID-19 Recovery Committee, gave powerful testimony on the effect that Covid has had on our deprived areas. Although some of the statistics still need to be finalised, the impact that the Covid period has had on some of our poorest communities is concerning.

Natalie Don talked about child poverty and the strategies that are successful. I very much welcome her comments about disabled people.

Alex Cole-Hamilton

Does Martin Whitfield agree that, if people in more affluent communities are able to live longer, that will exacerbate the strain on our NHS and could make health inequalities worse? I am not arguing that we should not be helping people to live longer, but we need to accommodate that in our planning for the NHS.

Martin Whitfield

It is true that these problems are sometimes made worse by the benefits that certain people in our communities get. Obviously, we should not seek to curtail communities, but people at the other end of those communities have suffered historically for so long and continue to do so. If time allows, I will come back to that issue with a question for the minister to address in summing up the debate.

Audrey Nicoll made a powerful point about the change in the items that are shoplifted. People are now stealing to live and to feed their families; they are not stealing to make money or as a job. There is a relatively simple solution—I say that in anticipation of many emails to come—with regard to people leaving our prisons without an address and without having a GP surgery or a dental surgery to go to. Casting people back in that way to the area where they came from merely invites them to recommit crime in order just to live.

I thank the cabinet secretary for his contribution, because I feel that he recognised the challenge. We should agree on that, because the challenge that we face is huge. He mentioned the £3 billion that is being provided to help households, but Natalie Don spoke about a mother who gave evidence to her committee having to live on merely £7,000—

Will the member take an intervention?

I am conscious of time, but I will take an intervention if it is very quick.

Brian Whittle

I am very grateful for the member giving way again. Does he agree that the two big tools that we have in our toolbox for tackling health inequalities are our education portfolio and our health portfolio and that we are not leveraging those enough at the moment?

Martin Whitfield

That intervention leads me to the issue of education. Why does the Government feel unable to agree to the committee’s recommendation to conduct a survey relating to families who are unable to access early years entitlement? I recognise that the issue rests with local authorities, but the Scottish Government is best placed to establish the picture across the whole of Scotland and to find out why some families feel excluded from the system. I would like the minister, if possible, to comment on that.

Scottish Labour supports the findings of the committee’s report, which is a damning indictment of the state of health inequalities across Scotland. It is a travesty that, today in Scotland, people in our poorest areas die 10 years before those in our wealthiest areas do. That outcome is not fixed when someone is born; it is not inevitable. Responsibility rests at the door of those who offer to lead our communities. A key driver of health inequalities has, undoubtedly, been 12 years of Tory austerity, but the lack of a Scottish Government strategy for tackling health inequalities is simply unforgivable.

Please conclude, Mr Whitfield.

Martin Whitfield

The Scottish poverty and inequality research unit, which is based at the University of Glasgow, published a report that states that, although we talk about these issues a lot, we do not build solutions to address them.

The debate has been fascinating, Presiding Officer, and I thank you for your indulgence.


Sue Webber (Lothian) (Con)

Although I was not a member of the Health, Social Care and Sport committee at the conclusion of this inquiry, I am pleased to have the chance to speak in the debate today. I thank the convener, members of the committee and all invited witnesses who came to our meetings.

We have heard extensively from a range of other committee conveners today, who outlined the complex nature of issues and solutions that are needed to tackle health inequalities. According to Public Health Scotland, Scots die younger than our neighbours do in any other western European country, and Scots in our poorest areas die 10 years earlier than those in our wealthier areas do.

The committee report recognises the effect of inequality on individuals, families and communities, and inequality disproportionately affects a number of communities.

The report states:

“it is internationally accepted that the fundamental causes of health inequalities lie largely outside the health system; health inequalities are a symptom rather than the cause of the problem.”

Many members have said that today. The cabinet secretary highlighted some of the scientific legacy issues that we face, which contribute to premature illness and death among our many diverse communities.

Unfortunately, the SNP Government is failing to tackle health inequalities. In 2018 to 2020, males in the most deprived areas were, on average, expected to live 23.7 fewer years in good health than those in the least deprived areas; in 2020-21, the drug-related hospital admissions rate in Scotland’s most deprived areas was more than 21 times greater than the rate in the least deprived areas. Cancer incidence is 33 per cent higher in more deprived populations in Scotland; cancer mortality rates are a staggering 74 per cent higher in the most deprived populations than they are in the least deprived ones.

I could continue, but we have heard contributions about those worrying statistics across the chamber this afternoon. Make no mistake: the Scottish Government has the levers at its disposal to tackle those health inequalities but, instead, it blames the UK Government or, as Rhoda Grant put it, passes the buck.

When the UK Government addresses some of the points that have been made in the report, that is not often acknowledged. Let us recall some of the most recent UK Government announcements from November. The Chancellor of the Exchequer announced that the national living wage would increase to £10.42 for over-23s, which will benefit more than 2 million of the lowest-paid workers across the country; disability and working age benefits will increase in line with inflation; across the UK, people will receive much-needed help next year—for example, a family on universal credit will benefit by around £600; and new workforce legislation will allow people to access flexible working, which will go a long way to tackle economic inequalities.

Decisions that the SNP is taking now will continue to directly impact the level of inequality, such as its recently announced £400 million cut to health and social care and £38 million cut to mental health services will have an impact.

Is the member saying that we should not have given that pay increase to health staff from the £400 million?

Sue Webber

The Scottish Government gets the money from the UK Government to make its decisions, and it has every right to do so—[Interruption.] I would like to carry on, if the cabinet secretary, who is heckling from a sedentary position, does not mind.

Thanks to Audit Scotland, we learned the truth about this cash-strapped Scottish Government—an Administration so short of money that in the past year it could afford not to spend just under £2 billion of its £51.2 billion budget.

Through incompetence or choice, the SNP has wasted millions of pounds—whether on Prestwick airport, Ferguson Marine, BiFab or the Lochaber smelter—and the budget for the constitution remains untouched. Those are its choices and its priorities.

As an ex-smoker—I am changing the tone here—I have always believed passionately in the need to tackle smoking. I applaud many of the universal measures that are in place to help people to stop smoking, but we need to be far more targeted in our interventions. We should remember that, in Scotland’s most deprived communities, one in three people smoke, compared to one in 10 in the least deprived communities. Reaching into and working specifically with marginalised communities can be done. We have shown that to be the case with our targeted community outreach vaccine programmes, so let us learn from that and do more of it.

As the report clearly states, and as we heard from Sandesh Gulhane and Fiona Hyslop, safe, secure and affordable housing is critical to tackling inequalities. Mr Whittle presented a compelling case for investment in more warm and dry homes to tackle costs that ultimately sit with the NHS in dealing with respiratory illnesses. He also referred to the critical role that nutrition and sporting activity play in the prevention agenda.

Craig Hoy accepted that the blame for the failure to combat poverty in Scotland rests with all political parties over decades. However, we cannot escape the simple fact that the SNP has been in government here at Holyrood for the past 15 years and more, and that this is happening on its watch. The blame cannot be laid at the door of anyone other than the SNP. Its lack of a credible strategy does nothing to address the widening health inequalities that our society is facing. As the convener of the Health, Social Care and Sport Committee stated in her opening remarks, it is time for “collective and systemic action”. Inaction is not an option.


The Minister for Public Health, Women’s Health and Sport (Maree Todd)

I thank members for contributing to what has been a lively debate on an issue that I know we all care deeply about.

I have stressed in previous debates and meetings that this Parliament needs to be a public health Parliament where all parties come together to work jointly to tackle the key challenges to population health and wellbeing. I view the committee’s inquiry and the debate as important steps in that process. Only by combining and strengthening our efforts will we be able to reverse the worrying trends in life expectancy and reduce health inequalities.

Craig Hoy

I thank the minister for reaching out and saying that we should all, across the Parliament, focus on policies. Does she therefore share my regret and, no doubt, the regret of the people who are watching at home, that a succession of her party’s back-bench members decided to talk about process rather than policy? Does she see that that constitutional smokescreen is wearing thin in respect of hiding the SNP’s failures?

Maree Todd

No, I do not. I have found Craig Hoy’s tone during the debate to be frankly astonishing—it is austerity denying. We have had evidence from academics—most recently in Scotland, but also from across the UK—that has absolutely laid bare the fact that the political choices that were made by the coalition Government of the Conservatives and the Lib Dems in 2010 had the most devastating impact on our population. Those choices not only had a devastating impact immediately on our most vulnerable citizens—I witnessed that when I was working as a mental health pharmacist among people with severe and enduring mental illness—but are still having an impact. They were life-shortening policies that were brought to us by the Tories and the Lib Dems, but there has been complete denial from the Tories in the chamber today.

Will the minister take an intervention?

Maree Todd

We all acknowledge the impact of the pandemic, which has shone a light on pre-existing inequalities and exacerbated them. I now believe that the scales have fallen from Scotland’s eyes. We will not tolerate this injustice any longer. Poverty is the driver of health inequalities. Like other inequalities, health inequalities are about inequality in power, wealth and status.

Will the member take an intervention?

Yes! I will take an intervention.

Finlay Carson

Perhaps the minister will comment on the inequalities in rural health that have been overseen by the SNP over the years. We have had closure of our cottage hospitals and downgrading of our maternity units, which has resulted in people giving birth at the side of the road. That is the SNP’s problem and responsibility.

Maree Todd

Perhaps one of the Conservative members would like to explain why they supported the UK Government’s mini-budget, which wiped £64 billion from our economy in one day.

If the Conservatives are asking me whether I think that we in the Scottish Government in an independent Scotland could have spent that money better, the answer is yes—absolutely. [Interruption.]

Thank you, members.

Maree Todd

I will tell members what we in the Scottish Government are doing to tackle child poverty. Fiona Hyslop eloquently set out the appalling lifelong impact that poverty has on our children. In this financial year alone, we have allocated almost £3 billion, through a range of measures, that will help to mitigate the impact of the cost of living crisis on households.

Sandesh Gulhane rose

Maree Todd

That includes support with energy bills, childcare, health and travel, as well as social security payments that are either not available elsewhere in the UK or are more generous than those elsewhere in the UK. They include the Scottish child payment and the related bridging payment.

Brian Whittle rose

Maree Todd

The Scottish child payment has been extended to include eligible six to 15-year-olds and has been increased to £25 per child per week. About 400,000 children are potentially eligible for it.

All the Conservative speakers have said that they want to hear what the Scottish Government is doing to tackle poverty. I am setting out what we are doing to tackle poverty. In addition, we are supporting families in a variety of other ways, including massive expansion of provision of fully funded high-quality early learning and childcare; provision of free bus travel for under-22s; provision of free school meals to about 545,000 pupils; and provision of child winter heating assistance.

Sue Webber rose

Brian Whittle rose

Maree Todd

Let us listen to what the Child Poverty Action Group report notes. It says that Scottish policies are making a major contribution to helping families to cover the cost of bringing up children, yet many of the factors that are causing families to risk deep poverty in the coming months and years are well beyond the Scottish Government’s control.

Sue Webber rose

Maree Todd

We will continue to urge the UK Government to use all the powers that it has at its disposal to tackle the cost of living crisis on the scale that is required, including access to borrowing, provision of benefits and—

Will the member take an intervention?

No. I will not take another intervention from the Conservatives. They are simply austerity deniers; they are refusing to listen to what the Scottish Government is doing to tackle poverty.

Will the minister take an intervention?


Clare Adamson

Does the minister agree with the United Nations poverty expert Philip Alston, who compared the Conservative Party’s welfare policies to the creation of 19th century workhouses, and warned that unless austerity is ended the UK’s poorest people face lives that are

“solitary, poor, nasty, brutish, and short”?

Maree Todd

Absolutely. I could not agree more.

On a number of occasions, we have seen that, when the UK Government has had an opportunity to tackle poverty by increasing wealth, welfare and the pay that working parents earn, it has instead punished poor people more.

Will the minister take an intervention?

Yes, certainly.

Carol Mochan

The minister knows that there is much on which we agree on this issue. However, given the extent to which people are living in poverty, which she has just noted and which other members, including Natalie Don, mentioned, will the Government agree to do everything that it can do to ensure that people do not continue to live like that? Will the Government take into account—I hope to see this in the budget tomorrow—some of the levers that the Scottish Trades Union Congress has suggested it could use?

Please conclude with this response, minister.

Maree Todd

Absolutely. Our budget will be set out tomorrow by John Swinney, and I know how carefully he is considering the STUC’s suggestions.

I reiterate that, in everything that we are doing, both hands are tied behind our back. Every additional percentage point on a pay deal and every pound that we spend on measures to deal with rising costs must be funded from reductions elsewhere, given our largely fixed budget and our limited fiscal powers.

Scotland is, once again, at the mercy of UK Government decisions. For me and for many other members in the chamber and many people in this nation, that reinforces the urgent need for independence.

I call Paul O’Kane to wind up the debate on behalf of the Health, Social Care and Sport Committee.


Paul O’Kane (West Scotland) (Lab)

I am pleased to be closing this extremely important debate on behalf of the Health, Social Care and Sport Committee. What we have heard most clearly throughout the debate is that health inequalities exist, are pernicious and continue to widen. That has to be a matter of shame for us all, and we have to recognise the scale of the challenge that lies before us.

Of course, this is not the first time that we have debated health inequalities and it will not be the last, because it is an enduring problem. The challenge that lies before us is that things are not improving. Instead, the evidence that the committee saw suggests that things are getting worse. We must all, across the chamber, resolve to do much more to tackle the issues.

From our inquiry, the committee is clear that health inequalities are a symptom of wider challenges. We have heard that echoed across the chamber by many colleagues, along with acknowledgment that we have to get to the root causes. The inequalities are the result of wider socioeconomic inequality and systemic racism and discrimination—in particular, discrimination against women and LGBT+ people. They are also a result of how our public services are sometimes organised in a way that focuses on what is convenient for administration, rather than on providing the support that is most effective for the people in our communities. It is fair to say that, very often, they are also a result of siloed working and a lack of joined-up action across services at local and national levels.

Brian Whittle

Does the member agree—despite what the minister said about all the money that the Scottish Government is putting into health inequalities—that until such time as the Government accepts that Scotland is still the unhealthiest nation and has the lowest life expectancy in Europe and starts doing something about it, we will get no further forward?

Paul O’Kane

I was just coming on to make the point that, along with the causes that I have just outlined, we cannot get away from the fact that problems are often rooted in political choices that are made in whatever sphere of government, including here. We have to acknowledge the many deep reasons behind all the issues that we have discussed today.

The hard choices that are needed to tackle the issues are everyone’s responsibility. Saying that they are everyone’s responsibility can often lead to issues becoming no one’s responsibility, so it is incumbent on all spheres of government to find a way to work together to change things. If we do not address the underlying causes, we will be treating symptoms, not tackling root problems. I add my voice in support of the very powerful evidence that the committee heard from Professor Michael Marmot, about how we can empower local government in particular to deal with many of the root causes on the ground.

I echo what the convener said: that our report calls for urgent action across all spheres of government—local government, the Scottish Government and the UK Government—and prioritisation of actions that are aimed at tackling the underlying causes of health inequality.

The challenge is enormous, as we have heard being reflected all across the chamber today, but it is one that we must aspire to address collectively. We have heard many important contributions today from committee colleagues and colleagues representing areas that are affected by health inequalities. We heard particularly powerful contributions from Alex Cole-Hamilton, about what is happening locally in Muirhouse; from Rhoda Grant, about neighbourhoods that sit side by side in Inverness; and from Fiona Hyslop, about the actions that are being undertaken in West Lothian as we start to tackle some of the issues at community and neighbourhood levels. We would do well to listen to those experiences and to see how we can continue to push forward the policy agenda.

Colleagues have mentioned Covid and the current cost of living crisis. We cannot escape those challenges; they continue to affect everything that we do. The cost of living crisis became acute during our work on our report.

As we seek to rebuild and renew following the pandemic, and to navigate our way through the rising cost of living and its effects, there are opportunities for us to reframe our thinking and to tackle some of those really difficult issues. If we are to meet the challenges effectively, we need to think in radical and innovative ways; I am hopeful that the committee’s report sets that out and helps colleagues to begin to think about all those things.

I want to highlight, in particular, the contributions that other committee conveners made to the debate. Martin Whitfield reflected on the fact that it has been good to have so many committees contributing to the debate and to the wider work of the Health, Social Care and Sport Committee.

From Clare Adamson, who spoke on behalf of the Constitution, Europe, External Affairs and Culture Committee, we heard about the wider societal benefits of culture in tackling health inequalities and about the importance of mainstreaming preventative spend. I thank her for highlighting the four pillars of the Christie commission report, which are still highly relevant today, 12 years on from the report. We must ask ourselves some serious questions about how far we have come on Christie’s vision and how far we still have to go to achieve it.

In speaking on behalf of the COVID-19 Recovery Committee, Siobhian Brown laid out shocking statistics on the excess deaths that were recorded in the most deprived areas during the pandemic. I recognise that as someone who, in part, represents Inverclyde, which had very high levels of death during the pandemic. She spoke about the on-going work on vaccination and the determination to make tackling health inequalities a priority to be addressed as part of Scotland’s wider recovery. I think that that chimes with many of the recommendations in the Health, Social Care and Sport Committee’s report.

Natalie Don, on behalf of the Social Justice and Social Security Committee, set out that committee’s recent work on low income and debt, its scrutiny of policies to tackle child poverty, housing issues and homelessness, and its work on social security policy, all of which bear on health inequalities. We agree that there must be a joined-up preventative approach that enables people to thrive rather than just to survive.

When Audrey Nicoll spoke on behalf of the Criminal Justice Committee, she highlighted the link between crime, victimisation and inequality, and she mentioned the growing number of people who are having to turn to crime to survive. It was stark to hear about that. We must acknowledge that that is a current and persistent problem.

I could mention a number of other colleagues, although I am conscious of the time. I thought that what Brian Whittle said in his speech on behalf of the cross-party group on health inequalities was very helpful, as was what Gillian Mackay said about the work of the cross-party group on stroke. I know from what the cabinet secretary has said in the chamber and in response to the committee that there will be more discussions and debates about how we will move forward.

I again thank everyone who contributed to the report. I thank the clerks and everyone involved with the committee for their work. It is my hope—which I know is shared by many members—that by addressing the challenges that have been identified we can start to tackle health inequalities and, in doing so, improve the lives of people in Scotland.