The next item of business is a debate on motion S4M-12769, in the name of Duncan McNeil, on behalf of the Health and Sport Committee, on health inequalities.
I call Duncan McNeil to speak to and move the motion. [Interruption.]
Can Duncan McNeil’s microphone be switched on, please? Mr McNeil, is your card in the console? [Interruption.]
He has got his Tesco card, his Morrisons card, his concessionary bus pass—[Laughter.]
Order, please.
15:06
I was going to begin with a question, and it should not have been, “Where the heck is my card?” [Laughter.] As well as the question, I have a speech, but I begin by asking, “Can a society be too tolerant?” That is members’ starter for 10. Is Scotland too tolerant? Whatever the colour of our political rosettes, whatever our habits and hobbies outside the Parliament and whatever we had for breakfast, are we too tolerant?
Tolerance is not a bad thing. It is a good thing. It is the mark of any civilisation that is worth the name, but at what point does it lapse into complacency, dereliction, or even fatalism and the acceptance of the unacceptable? I am talking about an indifference to the suffering of others—what Nye Bevan called “social blindness”.
NHS Health Scotland has produced a graphic—I am waving it about now—that takes us on a journey eastwards along the Argyle line from Jordanhill to Bridgeton. Each stop of the train represents a drop in life expectancy of 1.7 years for men and 1.2 years for women. Some people call that the Glasgow effect, but the effects of inequality can be felt in all corners of Scotland and across all social classes, for inequality diminishes us all.
But then, some are more unequal than others. In William McIlvanney’s 1975 novel “Docherty”, he wrote:
“Everyone ... had failed in the same way. It was a penal colony for those who had committed poverty, a vice which was usually hereditary.”
Harry Burns’s name will probably come up in other speeches this afternoon, but I want to be the first to make Burns’s ears burn. His and Michael Marmot’s evidence to us on the Health and Sport Committee was impassioned and compelling. It was some of the most powerful that we have heard in this Parliament in 16 years.
Our former chief medical officer was evangelical about the early years. He told the committee about his daughter’s gap year, teaching in Spain. Each morning, the five and six-year-olds queued up when the bell went and each one would give her, the teacher, a kiss and a cuddle before going into class. No apples changed hands but it is fair to say that, in that context, we do not always show our children such love and care. Perhaps we should, if we want the next generation to be compassionate, imaginative, resourceful, spirited and happy—to be masters of circumstance and not its servants, and to be resilient when things do not go their way and purposeful when they do.
“You’re not going to be able to fix this”, Sir Harry told us, pointing his surgeon’s finger. Sir Michael joined in, asking us what sort of society we thought we were running. That is a good question. For more than 40 years, health inequalities have been driven by a growing disparity in income, power and wealth. Not one of the successive Governments in Edinburgh and London—ours, the SNP’s and that of the Conservatives and the Lib Dems—has dealt with that successfully.
The Institute of Health and Wellbeing outlined three key domains: employment, earnings and education. That hat trick of factors is outwith the Health and Sport Committee’s remit, hence this afternoon’s debate and the committee’s desire to draw others into the discussion.
We knew that the topic would be difficult when we began to consider an inquiry in 2012. Sir Harry Burns told us:
“The issue is much more complex than you think”,
and added that the story of health inequalities was
“bedevilled by people who knew the answer”.—[Official Report, Health and Sport Committee, 22 January 2013; c 3156.]
We will not add to that bedevilment. We do not have an answer, but we have lots of questions.
Why do more equal societies enjoy better health outcomes? How important is community and quality of housing? Are the latest teenage pregnancy figures a sign of progress? What emphasis should we give to lifestyle drift, the inverse care law or proportionate universalism? When do a family’s stress levels become intolerable? Is a zero-hours, poorly paid, low-skilled job better than no job at all? Where does the molecular biology of a hug come into all this? Do not panic, Presiding Officer. We will leave Sir Harry to explain that one to you.
Sir Michael Marmot told us that
“a health service for the poor is a poor health service”.—[Official Report, Health and Sport Committee, 13 May 2014; c 5370.]
As Campbell Christie told us, the allocation of funds is important but cash alone cannot resolve this. Through good times—times of plenty—and through austerity, we have not resolved these issues. We need leadership, and to have the right policies in place and the courage to see them through, beyond a single term of government—beyond even the lifetime of this Administration and the next one, because, in the words of a 2008 report:
“Social injustice is killing people on a grand scale.”
Some would say that that is overblown and overstated, but not according to the World Health Organization’s commission on social determinants of health. Sir Michael chaired that commission and his stance certainly has not softened. It is a political choice, he told us, that the worst-off should suffer more. Poverty is not down to people shirking, he said. It is because, he said in a stage whisper, people “are not paid enough”.
There were some hints of hope. Sir Harry enthused about the early years collaborative, the family nurse partnership and the positive parenting plan. If a policy is shown to work and make a difference to people’s lives, we should pursue it. If not, we move on. If that sounds easy, members obviously have not been listening.
Sir Michael cited the example of Sweden, where leadership at a local level has been encouraged. Targeted services could make a difference but tackling health inequalities has to be “a corporate issue”, at the heart of local and national government. He talked about breaking down barriers in Norway to the extent that its Minister of Foreign Affairs could declare, “I’m the Minister for Health.” That principle is important. With no slight to Shona Robison, or to the previous cabinet secretary, I say that responsibility for this issue should extend to all her Cabinet colleagues—to each and every portfolio.
Ours was a lengthy inquiry. The committee learned that inequality is complex and multifarious but far from inevitable, and that it is of concern to everyone. I cannot conceive of a single committee in this place that it does not impact upon. It is on that Parliament-wide basis that we want members to take part today.
In a recent Scottish Government debate on tackling inequalities, I said that aspirations were fine, but that we must first win the argument, which is one that was ably articulated by Sir Harry and Sir Michael, and by many others who are not of the knighted realm. Earlier this month, the actor Michael Sheen told a St David’s day rally:
“We only say we’ve crossed the finish line when the last of us does. Because no one is alone. And there is such a thing as society.”
Of course, it is not just luvvies who say that; it is popes, presidents, economists and even trade unionists. I finish by quoting a clarion voice—a compassionate voice. It is more than 40 years since Jimmy Reid gave his rectorial address at the University of Glasgow, which was described by The New York Times as the greatest speech since the Gettysburg address. Harry Burns was a medical student there at the time—Glasgow, not Gettysburg—and I have heard him say that the comparison was rather over the top, as it flattered Abe Lincoln.
You must draw to a close, Mr McNeil.
I am just finishing, Presiding Officer.
Jimmy Reid’s theme of alienation rings as true today as it did then, as does his belief in the spirit and values of common humanity. Jimmy Reid said:
“Reject the insidious pressures in society that would blunt your critical facilities to all that is happening around you … This is not simply an economic matter. In essence it is an ethical and moral question”.
That is why I ask again whether a society can be too tolerant. Can Scotland be too tolerant? Are we too tolerant?
I move,
That the Parliament notes and welcomes the Health and Sport Committee’s 1st Report 2015 (Session 4), Report on Health Inequalities (SP Paper 637); recognises the wider causes of health inequalities, and welcomes the innovative approach that allows a wide range of parliamentary committees an opportunity to contribute to the debate.
Before we move on, I must impress upon members that they must stick to their time if possible.
15:17
I thank Duncan McNeil for making such a stirring opening to the debate. I welcome the innovative approach of the Health and Sport Committee and the unique format that it followed in challenging other committees to consider what they can bring to the work of reducing health inequalities and ensuring social justice.
Scotland’s health continues to improve and people are living longer and healthier lives. However, for too long, the benefits have not been shared fairly. Duncan McNeil showed us his railway map, which started in Jordanhill. It usually starts in Bearsden, which is in my constituency—I think that that is because people like the alliteration in the phrase “Bearsden to Bridgeton”. From my constituents’ perspective, I can say that I absolutely get the issue of health inequalities and the gap that exists. The difference in life expectancy between that of a man who is born in Strathkelvin and Bearsden and that of one who is born in Glasgow is 7.5 years. However, the issue of health inequality does not just involve differences such as that between my leafy suburb of a constituency and the great city of Glasgow; within my constituency, between the areas of most affluence and those of the least, the life expectancy gap for men is 6.5 years.
Driven by social inequality, boys who are born in the 10 per cent most deprived areas will die 12.5 years earlier than their counterparts in the most affluent areas. For girls, the difference is 8.5 years. Those people will also suffer more years in poor health, often with multiple health conditions.
I will immediately start quoting Sir Harry Burns, as Duncan McNeil did. Sir Harry has made it absolutely clear to us that health inequalities are not inevitable, they are not irreversible and
“There is nothing inherently unhealthy about the Scots.”
Sir Harry said that when he was the chief medical officer. He went on to chair the Standing Literacy Commission, and he is now on the Council of Economic Advisers. That shows the cross-cutting approach that is taken to tackling health inequalities.
The problems are complex and they require a long-term approach involving complex solutions from the widest range of policy areas. As a Government, we are determined to make tackling health inequalities a focus across portfolio areas. As the First Minister stated at the launch of our economic strategy:
“Scotland is now leading the way in putting the quest for greater equality at the heart not just of our social strategy but at the heart also of our economic strategy.”
We recognised the need for that cross-portfolio work way back in 2007, when the ministerial task force on health inequalities had and maintained a cross-cutting group of eight ministers. It recognised the role that the wider public sector and others play with representatives from local authorities. “Equally Well: Report of the Ministerial Task Force on Health Inequalities” was jointly endorsed by the Convention of Scottish Local Authorities and representatives from health, the third sector and academia.
From the outset, our shared approach combined “Equally Well” with “The Early Years Framework” and “Achieving Our Potential: A Framework to tackle poverty and income inequality in Scotland.” Those three social policy frameworks recognised that a child’s start in life, cycles of poverty and poor health are all interlinked. The position that they advocate underpins our thoughts on pursuing early intervention, moving to prevention and breaking cycles of poor outcomes in people’s lives.
We must recognise that, in 2008, the external environment changed. The global recession and an austerity programme have increased the risks of negative impacts being shared unequally across our population.
Just last week, the Minister for Sport, Health Improvement and Mental Health and I were at the launch of Voluntary Health Scotland’s report, “Living in the Gap—a voluntary health sector perspective on health inequalities in Scotland.” It was shocking to hear someone there talking about our children growing up with a food bank diet. That illustrates the rise of the food banks. However, it is important that we recognise the action that the Scottish Government has. We have committed £104 million during 2015-16 to mitigate welfare reform. The Health and Sport Committee’s report covers benefits. Logically, we should all demand that power over benefits comes to this Parliament.
I welcome the Health and Sport Committee’s interest, particularly its examination of health inequalities and the early years. I will take a few moments to give some examples of the significant work that we are doing in the early years.
The early years collaborative has a number of key change themes. I will mention a few of them. For early pregnancy and beyond, we set a stretch aim of reducing stillbirths and infant mortality by 15 per cent by 2015. We have met that target, and we are working on how we can further stretch that aim.
We are investing £1.5 million to change health visitor education and to create 50 new health visitor posts this year. By 2018, we will have invested £41.6 million over four years for additional health visitors to grow the workforce by 500.
I will also talk about attachment, child development, support for learning and—this is one the early years collaborative’s key themes—addressing child poverty through income maximisation. A wealth of evidence shows the importance of our work with young people on attachment at the earliest years. We are looking at that, as members know, through the 600 hours of free childcare, which we hope to increase to 30 hours a week by the end of the next session of Parliament. We know that that is good for the child, and it is also good for the parents. It is especially good for the mothers and their employment opportunities and, therefore, for increasing and maximising their income.
Members will not be surprised to hear that I wanted to talk about bookbug and the play talk read campaign, but I fear that I may not have enough time to do that.
Duncan McNeil mentioned the molecular biology of a hug, as described by Harry Burns. We see huge progress in attachment when parents read to their children. Just think of that physical attachment—heads together while reading a book. That, and how that helps children’s language, has an incredible amount of biological research behind it.
I look forward to hearing from the committee conveners. I reiterate that collaboration, co-operation and close working are needed if we are serious about our shared ambition to close the health inequalities gap.
15:25
I thank the Health and Sport Committee for its long and tireless work on this extremely important topic. I also thank my colleague Duncan McNeil for one of the best speeches I have heard since being elected to Parliament. I feel a bit inadequate following some of the questions that he has raised this afternoon. I was struck by his very honest assessment: that none of our Governments of any hue has really been able properly to tackle health inequalities in our communities.
I know that every member of Parliament across the chamber sees health inequalities in their constituencies and in their surgeries. We also see health inequalities in our everyday lives as we are going about our business. There are many questions. The minister has just alluded to some of the initiatives that her Government has tried to take forward, which we very much support and welcome. However, the questions on health inequalities are complex and multifaceted, and they link to analysis of our economy: to the availability of work, including well-paid work, to good wages, to the state of housing, to the strength of our communities, and to facilities in our communities, such as community centres and sports facilities.
While I am on that point, I was very struck by a conversation that I had with a constituent just last week. He was telling me about facilities for young women’s football. The example is particularly pertinent because we know that facilities for access to sport are integral and fundamental to addressing health inequalities in our communities. We know how important sport is in keeping people healthy and in giving our youngsters, especially, the facility to exercise regularly and to keep that habit for the rest of their lives.
My constituent was telling me that, as the cabinet secretary knows, 1,200 girls in the Dundee area—in which I and the cabinet secretary both live—play girls’ football. However, the team that he takes in Carnoustie has to travel all the way into Dundee—at least 10 miles—to access an AstroTurf pitch to train on at night. That lack of facilities in our communities—that lack of access—is a problem. We know that having such access impacts more on deprived communities than it does on affluent communities. That is one example—it is only one of many—of how the lack of facilities can hold us back.
I want to touch on one of the findings from the committee’s inquiry into the availability of primary care and community-based services. Lorna Kelly of Greater Glasgow and Clyde NHS Board said:
“The money that is available for primary care and community-based services is limited.”—[Official Report, Health and Sport Committee, 1 April 2014; c 5166.]
I know that everyone across the chamber who has engaged in health debates will know how important that is. We know that the national health service is integral to our achieving our aims on health inequalities. It is about the services that it provides. Our primary care teams must be available to deliver for people.
Earlier this week, Macmillan Cancer Support released figures showing that we are more than 10 years behind other countries in Europe in cancer survival rates. There is, as we all know, a clear link between cancer survival rates and poverty; we know that if we reduce health inequalities, we can help more people to deal with their cancer and to live longer. We must make the case that it is in the interests of all of us that we ensure that people who are in poor health are given the support that they need to lead better lives and to improve their health. The statistics from Macmillan Cancer Support—our being a whole 10 years behind other countries in Europe—show that we have a long way to go.
If nothing else, the Health and Sport Committee’s report reminds us of the scale of the challenge that we all face in closing the gap between people who have good health and those who are in poor health. However, I am optimistic that we are committed to it as a Parliament and in partnership with other Parliaments across these islands. I am optimistic that, armed with the wealth of knowledge that exists among all stakeholders who come to Parliament and lobby us, and which exists among the health experts, we can make serious inroads into health inequalities. However, the services that our NHS provides are integral to the solutions to the problem.
15:30
The scoping exercise that the Health and Sport Committee carried out with the intention of defining the terms of reference for a possible full-scale inquiry into health inequalities soon indicated that such inequalities are rooted in much wider social and other issues, many of which are outwith the remit of the committee—or, indeed, of the NHS—and that such an inquiry would be unlikely to reveal much beyond what many previous studies had already found. That is why we decided to proceed with shorter in-depth investigations into specific areas that bear on health inequalities, including teenage pregnancy, and to ask other parliamentary committees to consider where their work might be relevant to dealing with that serious blight on our society.
Successive Governments have wrestled with health inequalities. However, a boy who is born today in East Dunbartonshire can still expect to live for 82 years while a contemporary from the east end of Glasgow is likely to die up to two decades earlier. What is more, the latter will probably spend more of his life dealing with poor health.
That difference exists not only between local authority areas; it also occurs between councils’ least-deprived and most-deprived areas. As NHS Health Scotland has pointed out, even in my city of Aberdeen, which is widely acknowledged to be prosperous, there is between the affluent parts and the areas of greatest deprivation a six-year gap in life expectancy for men and a four-year gap for women.
It is now recognised that the best way to tackle health inequalities is to do so upstream, to use the jargon, by intervening early in life—indeed, even before birth—rather than by taking action downstream to deal with problems that have already developed.
The oft-quoted former chief medical officer, Sir Harry Burns, who is renowned for his work on health inequalities, emphasised to the committee the importance of early interventions and pointed out that
“Children who experience adverse events in early life are far more likely to have mental health problems and are far less likely to succeed at school. That creates a generational cycle of failure in a number of domains of living.”
He concluded that
“unless we break”
that
“cycle by radically changing conditions of nurture, attachment and support for babies and their families, we will not be as effective as we can be.”—[Official Report, Health and Sport Committee, 22 January 2013; c 3151.]
That is where health visitors come in, and it is why the Conservatives were delighted when Alex Neil, as Cabinet Secretary for Health and Wellbeing, decided to fund 500 more of them. We have always thought that primary care practice based health visitors are in pole position to help families right through from pregnancy, into the child’s early years and on into school age, by which time lifestyle patterns have been set. They are ideally situated to pick up early on problems of development and nurture so that the problems can be tackled before it is too late. They can give support to, or enlist help for, parents who are struggling to bring up a family in poverty, with poor physical or mental health and with other conditions, including alcohol or drug addiction, that are often found in deprived and disadvantaged communities.
Although the health sector has a major role to play, it must play it in conjunction with other policy areas including education, housing, environment, work provision and income. The matter clearly cuts across many of the policy areas that are in the Parliament’s remit. As the British Medical Association says in its briefing, if real progress is to be made,
“significant efforts will have to be made across a raft of policy areas outwith health, and by different agencies collaborating and working more effectively together.”
Many children who are born into deprived communities are in households where up to three generations of the family have no work experience. Education is the key to breaking that cycle, so that future generations can learn the skills that they need in order that they can become part of the workforce.
Coming from Aberdeen as I do, where we face significant skills shortages in an area that has near full employment, it grieves me that there are parts of Scotland where significant numbers of people have no access to jobs but could, with appropriate education and training, achieve successful lives in well-paid employment in, for example, the oil and gas industry—I appreciate that there are difficulties in that industry just now, but I hope that they will be temporary—or in other sectors including fish and food processing and hospitality, in which Scottish people seem to be reluctant to become involved.
Difficult though it may be, I would like the Scottish Government to explore ways of linking areas of mass unemployment to areas where there are labour shortages, because that could provide opportunities to people who have previously been written off as having no real chance of earning a living and improving their lifestyles. It seems to be so unfair that that is still happening in this day and age.
Much work is being done by third sector and other organisations, which are all important in the collaborative approach that is so necessary in overcoming health inequalities. Organisations such as the Royal College of Nursing and Voluntary Health Scotland have important examples of achievement at community and personal levels. I would also like to mention Sistema Scotland, whose big noise centres have been hugely successful in Raploch in Stirling and Govanhill in Glasgow. Work is under way to establish a centre in Torry in Aberdeen. Through music making, they help with the development of personal and community confidence, which it is hoped will have a knock-on effect on health.
I hope that I have given just a little insight into what the Health and Sport Committee has been aiming for. If we are eventually to overcome health inequalities in Scotland, there is a need for co-operation across all sectors and all policy areas. That is what we all want, and I hope that we can achieve it.
This afternoon’s debate is slightly unusual in that most of the contributors will be the conveners of the Parliament’s committees speaking on behalf of their committees. Unfortunately, speeches must be of only four minutes.
I call the convener of the Education and Culture Committee, Stewart Maxwell.
15:36
The Presiding Officer is right—I am speaking in the debate as the convener of the Education and Culture Committee.
Our committee is acutely aware of how inequalities can affect pupils’ performance and participation in school, college and university. Indeed, we are in the middle of a year-long piece of work to consider how the educational attainment gap in schools could be closed.
As members are aware from recent debates, many different approaches have been proposed to bring about change in our schools, but there is a commendable unanimity in the view that more effort is needed to ensure that disadvantaged pupils do much better. No one is willing to accept that the current stark divide in attainment is inevitable.
The differences between the outcomes for our most-advantaged pupils and those for our least-advantaged pupils have been well aired recently, and members will be very familiar with some of the key statistics. Rather than simply restate them, I want to highlight specific aspects of our on-going work that we hope will help to turn around those statistics.
We have just held an evidence session on how the third and private sectors can help to raise attainment—in particular, for the pupils whose attainment is lowest. Next week, we will consider how parents and schools can best work together to raise attainment—again, in particular for those who perform least well.
Members will have picked up that questions about inequality were built into our work from the outset. As a committee, we think that that is the best means of ensuring that such issues are given the prominence that they deserve. We will also examine how the attainment levels of pupils who have hearing or visual impairments could be improved. There are significant inequalities in respect of outcomes for those pupils and we want to understand how they can be addressed. In theory, there is every reason to suggest that, with the right support, visually impaired and hearing-impaired students could do just as well as their peers, but up to now that has not happened.
Of course, this is not the first time that our committee has considered the corrosive impact of inequalities on the education system and children’s life chances. Earlier this session, we held a major inquiry on the educational attainment of looked-after children in recognition of the fact that, comparatively speaking, that group’s performance was particularly poor. That was especially the case for the group that was described as being looked after at home, whose results in school were the poorest of all.
Members will not be remotely surprised to hear that looked-after children also tended to have poorer school attendance records and were less likely to go on to employment or further or higher education after leaving school. In addition, they went on to experience poorer health and lower life expectancy. That is the thing about unequal outcomes—they tend to come in a package.
Our remit asked, in part, why since devolution more significant progress has not been made on improving the educational attainment of looked-after children. That remit might have suggested a certain weariness—a feeling that some problems might be just too difficult to solve. Over the years, many committee inquiries will have run up against the same hard ground. Despite all the efforts, all the legislation and all the funding, why are our schools, our hospitals and our criminal justice system not performing as well as we all want? Very often, the response is that inequalities can be so deeply entrenched that they act as a brake on progress.
Although it is important to be realistic, we should never be defeatist. We spoke to many children and young people who had experienced care, and we were struck by the enormous potential and ability that they showed. With the right support and investment and, on a human level—harking back to Duncan McNeil’s speech—with the love and care that those children and young people deserve, the damage can be undone and they can flourish.
Of course, we are the Education and Culture Committee, and it would be remiss of me not to mention briefly that we have considered inequalities on the cultural side of our remit too.
You must be brief, because I must ask you to draw to a close.
The two sides are not, of course, mutually exclusive. Members will be well aware of initiatives such as Sistema Scotland, which has already been mentioned today.
I welcome the debate, and I hope that I have assured members that the Education and Culture Committee is as committed as everybody else in Parliament to tackling the many inequalities that continue to bedevil our society.
I call the convener of the Public Petitions Committee, John Pentland.
15:40
I thank you, Presiding Officer, for inviting me to speak as the convener of the Public Petitions Committee. Although it is not a policy committee, we deal with policy issues that people raise because they feel that those issues have not been given the attention that they deserve. In that respect, the committee has been successful and has helped to fulfil the Scottish Parliament’s aim of engaging more effectively with the Scottish people.
Many petitions that the committee has received relate to health matters and inconsistent access to services and medicines. At the heart of health inequalities are often wider inequalities. I am sure that many members recall the petition on access to insulin pumps, which highlighted the different policies that health boards had adopted. The committee was effective in ensuring improved access to and consistency in the provision of such pumps.
The petition on the treatment of rare—or orphan—diseases was referred to the Health and Sport Committee, and on the back of that the Scottish new medicines fund was established. The petition on chronic pain resulted in the Scottish Government setting up a national service for sufferers.
We recently received two health-related petitions that raise more fundamental concerns about fairness. Jeff Adamson, on behalf of Scotland against the care tax, told the committee about how current care charging affects him and outlined the inconsistencies between local authority areas that lead to inequality. He said:
“Community care is needed to eliminate discrimination, promote equality of opportunity and protect human rights. Without it, many disabled people cannot participate in society on an equal basis with others. We believe that charging breaches at least seven different rights. Is this the way in which a fair and just society should treat disabled people and their carers—by taxing them to live a normal life?”—[Official Report, Public Petitions Committee, 11 November 2014; c 18.]
As members will know, at the heart of the petition is a health inequality, which the Public Petitions Committee agrees must be carefully considered.
The other petition is by Amanda Kopel, whose husband Frankie was diagnosed with dementia before his 60th birthday, before he sadly passed away at the age of 65. Mrs Kopel told the committee that dementia
“is no respecter of age, creed or colour or how much money you have ... Frankie did not ask to be diagnosed with dementia, but I find that he is discriminated against by having to pay for personal care because he is under 65. Free personal and nursing care was introduced in Scotland in July 2002 for people over 65. We pay almost £350 per month for his personal care, which covers 45 minutes’ input each day ... I would love to have been able to continue to carry out my husband’s personal care, but his dementia has progressed to the point at which that is no longer possible. It should not matter whether someone is 55 or 75”.—[Official Report, Public Petitions Committee, 17 September 2013; c 1649.]
The issues have been under discussion for some time, and I am sure that the committee and the petitioners would like rapid progress.
Although our committee is not a policy committee, I am sure that members would agree that we have a major role to play in ensuring that, where appropriate and with foundation, health inequality issues can be dealt with and flagged up for action. I welcome the debate and I hope that it will make us think more carefully about how we as a Parliament tackle health inequalities.
15:44
In his eloquent opening speech, Duncan McNeil was right to tell us that inequality diminishes us all. I commend him and the Health and Sport Committee for the valuable work that they have undertaken in scrutinising health inequalities.
As convener of the Infrastructure and Capital Investment Committee, I will talk about areas in that committee’s remit in which opportunities exist to address health inequalities through infrastructure improvements. The committee keeps under close scrutiny Government support for sustainable and active travel. Numerous studies highlight the obvious health benefits associated with walking and cycling, which contribute to a more active and healthier lifestyle. We should not forget the further health benefits that can arise from reducing the number of cars on the roads, reducing carbon emissions and improving the quality of the air in our communities.
The committee has heard from a range of stakeholders, including Cycling Scotland, Sustrans and the Spokes Lothian cycle campaign, about the need for further and sustained investment in active and sustainable travel and the need for all communities to have access to the appropriate infrastructure that is required, such as dedicated cycle paths and good public transport links.
The levels of health inequalities that exist in our more deprived communities highlight the importance of doing all that we can to improve the infrastructure to support active travel and ensure that everyone can benefit from the associated improvements to health and wellbeing through regular physical activity.
We asked the Scottish Government to re-evaluate the level of investment in sustainable and active travel. I therefore welcomed the announcement in February by the Deputy First Minister and Cabinet Secretary for Finance, Constitution and Economy, John Swinney, of an additional £3.9 million for cycling and walking infrastructure from the money coming to Scotland through the Barnett formula, and I very much welcomed the announcement yesterday by the Minister for Transport and Islands, Derek Mackay, of a £10 million boost for walking and cycling from the future transport fund. I am glad that the Government is listening to the committee.
There is much more still to be done, but that is a good start to the financial year and it will, as the national director of Sustrans, John Lauder, has said,
“build on the solid momentum that has been gathering pace over the past three years to create better conditions for people to walk and cycle for their short, everyday trips.”
We asked the Scottish Government to consider how it could benefit from the success of a number of trial projects, such as the provision of enhanced cycling infrastructure in Edinburgh and Glasgow, projects that have been delivered through smarter choices, smarter places initiatives and projects that are under way in Edinburgh to make city roads safer for cycling and walking.
Improvements in housing quality standards can have a significant and positive effect on the health and wellbeing of tenants and householders. To tackle health inequalities that are associated with poor-quality housing, everyone should have access to a home that is appropriate to their needs, provided with modern facilities, energy efficient and free from serious disrepair. Such standards, particularly in assisting with energy efficiency, can help to alleviate fuel poverty and therefore free up family funds for essential purchases such as better-quality food to help to maintain a healthy lifestyle and improve health outcomes.
We have therefore asked the Scottish Housing Regulator to keep the committee informed of social landlords’ performance against Scottish housing quality standards. Where they fall short, we will ask serious questions about what action is being taken to improve matters.
The provision of appropriate housing adaptations can allow people to stay in their own homes and continue to lead independent, healthy and active lives, rather than going into hospital or to a care environment.
Far more serious health inequalities befall homeless people. The committee has monitored and will continue to monitor closely the implementation of the 2012 homelessness commitment, which appears to be delivering tangible improvements.
Our committee welcomes and takes seriously our responsibilities in seeking to identify policy and funding interventions within our remit that will contribute to a reduction in health inequalities and close the health inequality and life expectancy gaps, which all of us in the Parliament wish to see happen.
I call the convener of the Welfare Reform Committee.
15:48
With so many conveners speaking in the debate, it is understandable that we each have a limited time. I will therefore restrict myself to a single point. It is a point that some may find uncomfortable, but my committee has received considerable evidence on it, and the majority share my view on it.
Welfare reform is having a significant impact on health inequalities. It is increasing them and making people sick. Much of the welfare reform affects people with disabilities, who are all in the process of being reassessed. Some argue that that is so that they are not left to rot on benefits; others argue that it is about saving the state money, as all those reassessments are resulting in fewer people qualifying for disability benefits.
Either way, one thing that appears incontestable is that the reassessment process is making people sick. It is increasing the stress on already vulnerable people, making the sick sicker and increasing health inequalities.
Welfare reform is making people sick, but members should not take my word for it. Instead, they should listen to ordinary people who have had the courage to share their experiences with the Welfare Reform Committee. Murray Grant from Arbroath, who has multiple sclerosis, wrote to us last year to say:
“Yesterday I received a letter from ATOS with a Limited capability for work questionnaire. I was a bit shocked when I received this as I thought I would not be reassessed until at least 2015 and this could possibly affect my mobility, DLA and ESA payments. The strain and stress of going through all this again is not doing my health much good and I fear for my future ... I am concerned about what effect this may have on my health as I have a degenerative condition that there is no cure for and stress does not help.”
Members should listen to John Lindsay from Carfin, in my constituency, who said:
“My depression can sometimes go away for periods of time, but it always comes back and, when it does, it hits me hard and floors me. I have always had a certain degree of anxiety, but since 2011 it has got worse due to my horrific experiences of jobseekers allowance and ESA. Now my anxiety is much worse than my depression”.—[Official Report, Welfare Reform Committee, 9 December 2014; c 5.]
Members should also listen to Jane McGill from East Kilbride, who is on dialysis three days a week and awaiting a double organ transplant. She said:
“I received a letter from Department for Work and Pensions advising me they now consider me capable of work and I have been moved from the Support Group to the Work Related Activity Group which means I have to prepare for work. I had to go for an interview to the Jobcentre last week, which takes a great deal of effort, not to mention stress to get to. I am now expected to take part in other activities, if I do not it will affect my benefit.
The bottom line to this is I had a job with the Government, they deemed me unfit for work, and I had to leave through ill health. I therefore claimed the benefits to which I am entitled, and now the UK Government want me off benefits and say I am fit to work. I have copies of all the relevant medical reports (all independent) which says I am unfit to work and will be for the remainder of my life, this is why I was retired through ill health from HMRC.”
Most people accept that some sort of reform of the welfare system is necessary, and that includes the assessment system, but the process does not have to be that way. The transfer of responsibility for disability living allowance and personal independence payments to this Parliament gives us an opportunity to create a scheme that respects the dignity and humanity of the people with disabilities who will rely on us for support. That is an opportunity to stop welfare reform making people sick.
15:52
It is with pleasure that I speak on behalf of the Finance Committee. The Health and Sport Committee concluded that
“most of the primary causes of health inequalities are rooted in wider social and income inequalities ... such as low income and poverty, economic disadvantage, poor housing, low educational attainment and industrial decline.”
The Finance Committee has considered a number of those issues, and I will focus on our work on prevention and on developing stronger scrutiny of outcomes.
The Government and COSLA defined preventative approaches as
“actions which prevent problems and ease future demand on services by intervening early, thereby delivering better outcomes and value for money.”
In 2011, the Government committed to a decisive shift to prevention to bring about
“a step change in the way ... we fund and deliver public services.”
It announced funding of £500 million for three change funds to
“support a transition across public services away from dealing with the symptoms of disadvantage and inequality towards tackling their root causes.”
That would be achieved by leveraging funding from existing budgets to invest more in preventative approaches. The three change funds covered the early years, care for older people and reducing reoffending. Guidance on single outcome agreements also states that SOAs should aim to
“promote early intervention and preventative approaches in reducing outcome inequalities”.
In our scrutiny of draft budgets, the committee has monitored progress in delivering that decisive shift. In evidence to the committee, Sir Harry Burns spoke passionately of his belief in the importance of early years investment and the numerous benefits that it could bring. However, we also heard evidence from those responsible for the delivery of front-line services about the problems that had arisen in maximising the impact of the early years change fund. To invest more in one area, one must disinvest in another, and the committee remains concerned that we have seen little evidence of any budgetary shift towards prevention.
The reshaping care for older people change fund was introduced to
“improve the way that public, private and third sector organisations work in partnership to deliver health and social care services.”
The approach was intended to reduce unnecessary hospital admissions and increase the capacity of community-based care through health and social care integration and joint working. Again, however, we heard of the challenges faced in disinvesting and the slow pace of progress in achieving our ambitions.
Another important part of our scrutiny is how we link financial inputs to the successful delivery of outcomes. We accept that showing links can be challenging, given that the spending in question is cross cutting. Seven of the 16 national outcomes in the Scotland performs framework are identified as contributing to a healthier Scotland, so developing a better understanding and analysis of the information that we have is vital to discovering what is working and—as important—what is not working.
The Government made it clear that community planning partnerships would “play a decisive role” in the shift towards prevention. To do that, our public sector organisations must work effectively together. Again, the committee heard evidence that, although things are moving in the right direction, progress has been slower than hoped. One CPP told us:
“We are now on the precipice of the next step”.—[Official Report, Finance Committee, 8 October 2014; c 44.]
Clearly, there is a long way to go before we have truly joined-up, long-term planning that is aligned to prevention.
Health inequalities are a complex issue for which there is no panacea. However, it is encouraging that the problem’s cross-cutting nature has been recognised in this and previous debates and that so many committees are represented this afternoon. Prevention is important in attempting to reduce health inequalities and, notwithstanding some of the issues that I outlined, the Finance Committee recognises that some progress has been made and supports the Government’s approach to prevention.
I call the convener of the Local Government and Regeneration Committee.
15:56
I welcome the opportunity to contribute to the widening discussion of health inequality issues. I commend Duncan McNeil and the Health and Sport Committee for securing the time for the debate.
The Local Government and Regeneration Committee’s remit has afforded us a number of opportunities to look at health inequality and at inequality in general. In recent times, we have published reports on public service reform and regeneration that have highlighted inequalities. As the debate today is short, I will look at some of our current work on the Community Empowerment (Scotland) Bill and the Air Weapons and Licensing (Scotland) Bill.
The Community Empowerment (Scotland) Bill seeks to address inequality by empowering communities. However, a number of submissions and witnesses have suggested that communities with sharp elbows will end up with the lion’s share of what is available, with outcomes being improved for one community perhaps at the expense of another. Many of our recommendations focused on building the capacity of communities that are less able to take advantage of the bill. We recommended that public authorities should report on the measures that they take to address inequalities between communities in their areas, which would underpin the shift in focus to assist those with less capacity.
The bill will place a duty on local authorities to provide a sufficient number of allotments, to ensure that waiting lists are below a specified target. In response to our video on allotments, we heard how allotment growing could contribute to mental and physical wellbeing. One allotment holder told us:
“My mental health has improved greatly—I’ve had my medication reduced three times this year and am nearly back to the licensed dose. I’m stronger and healthier than I have been in years. I’m eating well of fresh, organic produce. I’m getting exercise. I’m making friends—something I haven’t been able to do for a very long time, if ever.”
In our engagement with people through the course of our work, we have heard their stories—which otherwise we often would not hear—about how small things can make a huge difference to people’s lives. We should take cognisance of the level of engagement that there has been.
I turn to the Air Weapons and Licensing (Scotland) Bill. In its wide scrutiny of alcohol licensing provision, the committee found that boards have not addressed the overconsumption of alcohol particularly well, and there seems to be little communication between health boards, alcohol and drug partnerships, the police and the boards to highlight exactly where the difficulties lie.
Just this week, we published our report on the bill, which recommended a clear role for health boards and alcohol and drug partnerships in providing evidence to licensing boards to assist in their determinations. We made it clear that we expect all health boards to be proactive in presenting and championing health inequalities issues to licensing boards. The committee also made other recommendations in that regard.
Duncan McNeil can rest assured that the Local Government and Regeneration Committee will continue to look at all inequalities and to take into account health inequalities in all its work.
16:01
I am pleased to contribute this afternoon as convener of the Economy, Energy and Tourism Committee. I welcome the debate and the innovative approach that has been taken.
I also have another role—I am the co-convener of the cross-party group on health inequalities. Before I talk about the work of the Economy, Energy and Tourism Committee, I want to highlight “Living in the Gap”, the new report from Voluntary Health Scotland, which Fiona McLeod has already mentioned. Last week, I hosted the report’s launch in the Parliament. At that event, we heard about the voluntary sector’s vital role in tackling health inequalities. We were also given a number of examples from different parts of the country of voluntary projects that are absolutely vital to those who are most vulnerable as a result of health inequalities. The minister, Mr Hepburn, was also present and addressed some of the points that were raised. I hope that as we take the debate forward, not just this afternoon in the chamber but in general, we bear in mind the voluntary sector’s vital role in helping us to address the issue.
I want to look at the interrelationship between health inequalities and economic performance, which is an issue that comes under the Economy, Energy and Tourism Committee’s scrutiny. I am sure that none of us has to go back terribly far in our family trees before we discover what can be called “poor circumstances”; indeed, during the Health and Sport Committee’s inquiry, Sir Harry Burns asked committee members to do that very thing. The point that the former chief medical officer was making was that poverty need not condemn a person to failure. However, people will find somewhere on their family tree—however many generations ago—the moment at which enterprise or education made a difference.
Sir Michael Marmot, who is the experts’ expert on health inequalities, put it another way when he said, “Poverty is not destiny”. Sir Michael chaired the commission on social determinants of health, which was a WHO initiative, and the findings of its 2008 report set out the economic benefits of reducing health inequalities in terms of productivity, tax revenues, welfare spending and health costs. The Organisation for Economic Co-operation and Development came to a similar conclusion in research that it published last December, which found that countries where inequality was decreasing were growing faster. That view has been taken up by the managing director of the International Monetary Fund, Christine Lagarde, who last May made a similar point at a conference in London on inclusive capitalism. Such conclusions are not universally accepted—nothing ever is in the field of economics—but at least a lively debate is being had, and will no doubt continue to be had, on the link between inequality and economic performance.
I thank Duncan McNeil and his committee for their work on health inequalities. It is absolutely right that it should be not just a matter for the Health and Sport Committee but a matter that all parliamentary committees should be aware of. Two years ago, the Economy, Energy and Tourism Committee undertook an inquiry on underemployment, and we have agreed to do a new piece of work that will examine the progress that has been made on that issue and take a broader look at work, wages and wellbeing. The Scottish Government has made fair work and tackling inequality central to its refreshed economic strategy; as Mr McNeil said, aspirations are one thing, but we need to see more detail than we have seen so far.
Four minutes is far too short a time to address many of the key points that we need to talk about. It is too short a time to cover the statistics from the recent Scottish Parliament information centre briefing on fuel poverty. It is too short a time to talk about the Glasgow Centre for Population Health research on the quality of employment and its impact on wellbeing. It is too short a time to outline the work that the David Hume Institute commissioned on the effectiveness of policies that are intended to redistribute income and wealth more equally.
Today we have merely scratched the surface. I hope that we can return to the issue, which is of such importance.
16:05
On behalf of the Rural Affairs, Climate Change and Environment Committee, I am delighted to take part in a health inequalities debate. It is hugely relevant to many of the issues that are manifest in a rural setting and in fragile communities.
There are four parts to what I wish to say. I will talk about climate change; access to the outdoors and Scotland’s natural environment; life in rural areas; and service delivery in rural areas.
Fundamental to our life in future is the ability to protect ourselves against rampant climate change. Parliament has taken a united view that we have to tackle that seriously. There are equalities issues within that, and people have to be protected. Poverty is created by things such as flooding, and research is looking at how to avoid flooding. The committee has dealt with issues around the disruption to families that can occur as a result of floods in our communities. The climate change adaptation programme looks at getting people clued up. Issues such as how to deal with heatwaves and the cardiovascular and respiratory diseases that can arise from them need consideration and much more research.
Access to the outdoors and Scotland’s natural environment is perhaps the good-news story. However, unfortunately not enough of our people get out of doors—they do not even get on to the Forestry Commission land that is close to the estates on the edges of our cities. We are trying to create a central woodland and forest network and the means by which people can use that for recreation. That is part of our concerns. The Scottish Government should familiarise itself with the work of organisations that seek to ensure that the outdoors is accessible to all groups in society, so that disabled people can also get outdoors. Only 64 per cent of disabled adults use the outdoors compared with 80 per cent of non-disabled adults.
Service delivery in rural settings has a huge bearing on health inequalities. The committee has done work on broadband provision in rural areas. There can be an impact on health issues if telehealth is not made easily available to people who live in the most remote areas—areas where broadband should have been installed first. During the budget process, the committee highlighted concerns about rural areas in Scotland that had little, no or poor broadband provision. We must make sure that that is rectified.
Living in a rural area can damage people’s health in a lot of other ways. Living in temporary accommodation, such as caravans that are let seasonally, or having no access to land on which to build a house can have a huge bearing on life in rural areas. We wish to see many such issues tackled.
Life in rural areas can be dangerous. Agriculture is the riskiest occupation by industry sector in terms of fatal injuries. Mental health issues are also a concern. Problems such as dyslexia, which has recently been debated in Parliament, are prevalent among farmers, raising stress levels and affecting people’s health.
We should all have some watchwords that are important to us, and I quote Nye Bevan, who said that, in a capitalist society,
“either poverty will use democracy to win the struggle against property, or property, in fear of poverty, will destroy democracy.”
That is as true in rural areas as it is in the cities.
You must close, please.
We must make sure that a more explicit link between the national performance framework and equalities issues is made in the Government’s programmes.
16:09
I welcome the opportunity to speak in the debate on behalf of the Justice Committee. Our committee has a strong track record on considering health inequalities and inequalities at large as part of our work. There are a myriad of examples in our penal system, involving drugs, alcohol abuse and so on.
We considered health inequalities during our 2013 work on the transfer of prison healthcare from the Scottish Prison Service to the NHS. In “healthcare”, I include care for those with mental health problems, and the prison population has a disproportionate number of people who suffer from such problems. That work led to a series of fact-finding visits to prisons. One key issue that came through during those visits was the problem that offenders had in gaining access to a general practitioner immediately upon release. Many of them simply did not have a GP, so they quickly lost the benefits of prison healthcare, particularly the work that removed their drug and alcohol addiction.
Next week, the Parliament will debate the Prisoners (Control of Release) (Scotland) Bill at stage 1. The bill provides, inter alia, that the Scottish Prison Service will have greater flexibility to bring forward the date of release by up to two days. Why should that matter? It matters because that will allow the SPS to improve throughcare for prisoners on release. If prisoners are released on a Friday, they find that everything is closed: the housing department, the benefits system and even general practices. They will now be able to access those services on release. The hours after someone comes out of prison are very important. That is a positive step, and I call on the Prison Service and the NHS to ensure that people who are released from prison can be registered with a GP in their home area as quickly as possible.
We also considered health inequalities during a one-off round-table evidence session in August 2014 on the link between brain injury and the criminal justice system. That led to a brain injury and offending workstream being tasked by the Government to look into issues that were raised during our evidence session, and the work will be reported on in summer 2015. Often, the behaviour of people with a brain injury may give rise to criminal prosecutions, but the link is not made.
Imprisonment itself leads to health and other inequalities. It is apposite that we have Families Outside, which represents the families of prisoners, because families are affected by having someone in prison.
Much of the remainder of this parliamentary session will, as usual, be devoted to scrutiny of bills. We carry out that scrutiny well aware of the impact of justice reforms on other matters, such as health inequalities and human rights. I hope that the health impact on individuals who are trafficked, for example, will be addressed when the Human Trafficking and Exploitation (Scotland) Bill comes into force—if the Parliament votes to pass it—by identifying victims earlier and by protecting them from the traffickers, who are often the reason why people do not say that they are being trafficked.
The Parliamentary Bureau might refer to the Justice Committee the community justice bill, in which there will be opportunities to address health inequalities. Of course, not all legislation lends itself to a consideration of health inequalities but, when a bill does so, the committee makes every effort to deal with the issue.
The last thing that the convener of the Health and Sport Committee would want is tokenism from other committees but, when the issue of health inequalities is relevant, we certainly build it into our programmes.
16:13
As convener of the Equal Opportunities Committee, I welcome today’s debate on this very important topic.
The issue of health inequalities has been highlighted during our evidence taking in a variety of areas. Last year, we examined how the budget affected both older and younger people, and the evidence pointed to the difficulties in tackling multiple illnesses. In that context, Professor Stewart Mercer, professor of primary care research at the University of Glasgow, raised concerns about enduring health inequalities. Referring to people with multiple illnesses, he suggested that those from deprived areas
“may, at the age of 50, have the same amount of multiple morbidity as somebody in one of the most affluent areas who is 70.”—[Official Report, Equal Opportunities Committee, 13 November 2014; c 7.]
The committee is currently pursuing an inquiry into age and social isolation. Although we are still taking evidence and have yet to reach our conclusions, a number of key themes have already been repeated in scoping sessions and in evidence taking, and health has come to the forefront.
We have heard about the impact of social isolation on the health and wellbeing of a range of people. Evidence received to date touches on the health aspects of social isolation and the related equality issues.
The chief executive of the Food Train, Michelle McCrindle, told us:
“Research has found just over 10% of over 65’s are often or always lonely with that figure rising to 50% for the over 80 age group. Similarly, research has also found that just over 10% of over 65’s are at risk of or are malnourished (for the purposes of the research this means a Body Mass Index <18.5).”
The Food Train believes that it
“is not mere coincidence that the same number of older people are affected by malnutrition and loneliness.”
In the Food Train’s experience,
“the two are interlinked, which also means they can be successfully tackled together.”
It points out that
“Food and eating are hugely social activities”
and that it sees
“tremendous improvements in older people when they are supported with food access.”
They eat more, eat better and find motivation for food again. When we add additional socialising support, such as befriending services, the opportunities for improving food intake increase even more. The feedback from older people who use the Food Train’s services is that
“they eat more than they would have previously, enjoy food more ... and are feeling better physical and mentally as a result.”
The committee has heard about similar important projects that are essential to tackling the health problems that are associated with loneliness.
On young people, we have heard from a range of groups including Home-Start UK and Scotland’s Commissioner for Children and Young People about the crucial nature of early intervention and health considerations.
The mental health of younger people in vulnerable situations has been drawn to our attention formally and informally. Pauline McIntyre, from the office of Scotland’s Commissioner for Children and Young People, told the committee about the recent experience of a young person with severe mental health problems. Ms McIntyre said:
“Some of the delays that arose in the course of accessing appropriate support for them led to their condition deteriorating significantly. Even a delay in providing a service can have a massive impact on that child or young person’s wellbeing.”
She continued:
“If we do not put in the support at an early stage for a young person in a situation like that, or if we do not pick up on an issue, it spirals out of control, and we potentially end up with a much worse situation for that young person further down the line.”—[Official Report, Equal Opportunities Committee, 5 March 2015; c 42.]
I wish to highlight the work of the Equal Opportunities Committee on the subject of female genital mutilation. That practice against women has a severe and enduring impact on their physical and mental health and is one of the greatest inequalities that the committee has encountered.
You must close, please.
The committee is monitoring the work that the Scottish Government is undertaking and awaits the report of the short-life working group that has been set up to consider ways of tackling the practice in Scotland. The debate offers me the opportunity to highlight the need for health services to work towards prevention and to respond to the on-going emotional and physical difficulties that are faced by women who have undergone the practice.
The final convener to speak in the debate will be Christina McKelvie, after which we will move to the open debate.
16:18
I hope that I am last but not least, Presiding Officer.
Absolutely.
I will give another quote from that wise man, Nye Bevan, who said:
“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.”
It will not surprise members that, as convener of the European and External Relations Committee, I will speak about some of the work that is carried out by the European Commission and the World Health Organization on health inequalities. Often, when I speak at events in my capacity as convener, I find myself responding to questions that in effect ask, “What has the EU ever done for us?” I will talk about some of the international work that it has done.
First, what has the EU ever done in relation to health inequalities? It has worked on specific initiatives in relation to health inequalities for more than a decade. In 2003, it published a report entitled “The health status of the European Union: Narrowing the health gap” and, in 2006, the European Council attached such importance to the issue that it identified an overarching goal of reducing health inequalities across the EU.
More recently, in 2009, in response to increasing unemployment and uncertainty arising from the economic situation in the European Union, the European Commission published a communication entitled “Solidarity in Health: Reducing Health Inequalities in the EU”, because it regarded
“the extent of the health inequalities between people living in different parts of the EU and between socially advantaged and disadvantaged EU citizens as a challenge to the EU’s commitments to solidarity, social and economic cohesion, human rights and equality of opportunity.”
In 2009, when the European Commission published that communication on health inequalities, it acknowledged that, while the average level of health in the EU had continued to improve over the decades, the gaps in health between people living in different parts of the EU, and for the most disadvantaged sections of the populations, remained substantial and in some cases had increased.
That brings me to the second area that I would like to look at in relation to the EU, which is how average life expectancy in Scotland compares with average life expectancy in EU member states. In 2012, life expectancy at birth in the EU was 83.1 years for women and 77.5 years for men. In Scotland today, based on statistics from NHS Scotland, average life expectancy is 80.8 years for women and 76.6 years for men. If we included Scotland in a comparison table with EU member states, it would therefore sit below the average, in the company of the central and eastern European countries that joined the EU after the fall of the Berlin wall.
Maybe we need to look at the work that the European Commission is doing on promoting best practice and policies to address health inequalities and examine what has worked in other EU member states that have been more successful in tackling health inequalities or which face similar challenges to those that Scotland faces.
I turn to the work of the World Health Organization. In 2005, it set up a global commission on social determinants of health, and in 2008 it published a report entitled “Closing the gap in a generation: Health equity through action on the social determinants of health”. In 2009, the World Health Assembly passed a resolution on reducing health inequalities and urged its member states to take action. Since then, there has been a series of initiatives, ranging from discussion papers to the development of handbooks and from conferences to regional reports on progress. Again, there might be value in looking at the work that has been done under the World Health Organization’s framework to see what we can learn from it.
I think we agree that, for Scotland to flourish as a nation, more effort needs to be directed at tackling health inequalities, and there are valuable lessons that we can learn from both near and far on what can work. I conclude by encouraging those who work in the area to look at the work of the European Commission and the World Health Organization.
16:22
I would like to look at a completely different aspect of this multifaceted problem, but my starting point is paragraph 66 of the Health and Sport Committee’s report, which mentions Sir Harry Burns’s comments on a comparative analysis of Glasgow, Liverpool and Manchester. He said that the difference between the three cities was
“related to empathy and connectedness”.
The report states:
“Part of the challenge, he said, was ‘about not just pulling a set of policy levers, but creating a sense of community and of compassion for people’.”
I have absolutely no doubt that he is right, but when I saw the reference to Glasgow, Liverpool and Manchester, my mind immediately went to some unpublished research of which I have seen a draft, which indicates that there are dietary differences between those populations.
We might reasonably ask whether diet matters. We probably know that it does, but how much might not be quite so obvious. I would like to quote from the Journal of Public Health of 11 May 2011. The paper is “The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs” by Peter Scarborough and others. If I may quote selectively from the abstract, it says:
“Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health ... In 2006–07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.”
The conclusion is:
“The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.”
I will also refer to a report that was published in the past month in the journal Public Health Nutrition, “Trends in socio-economic inequalities in the Scottish diet: 2001-2009”, by Karen L Barton and others. Again, I will quote selectively from the abstract, which says:
“Daily consumption of fruit and vegetables ... brown/wholemeal bread ... breakfast cereals ... and oil-rich and white fish ... were lowest”
and the consumption
“of total bread highest ... in the most deprived compared with the least deprived households, respectively, for the period 2007-2009.”
The conclusion is important:
“There was no evidence to suggest that the difference in targeted food and nutrition intakes between the least and most deprived has decreased compared with previous years.”
We know the effects of these things. The depressing thing is that, despite the best efforts of everybody involved, we have not made much progress. The point that I will leave members with is simply that diet-related illnesses are hugely important and hugely expensive, which is why I wanted to ensure that that aspect of our communities’ life was raised in the debate.
16:26
Labour’s first Scottish health white paper, in 1997, emphasised the primacy of social circumstances as a cause of health inequalities, as had the Black report 17 years previously. It is fair to say that, since then, under Labour and the SNP, there has been a bit of the lifestyle drift in Scotland that Duncan McNeil talked about.
Although downstream lifestyle factors are important, it is vital to reaffirm the significance of upstream societal factors and action in combating health inequalities. There is plenty of general evidence, from Richard Wilkinson and others, that creating a more equal society is fundamental for combating health inequalities. It seems that the majority of health inequalities researchers agree with that perspective.
Katherine Smith, who is a brilliant researcher and writer on health inequalities at the University of Edinburgh, published an article in the Journal of Public Health on 30 August last year that described how she had contacted a large number—up to 100—experts in health inequalities throughout the United Kingdom. The top three actions that they proposed to deal with the problem were: number 1, a more progressive system of taxation, benefits, pensions and tax credits; number 2, a minimum income for healthy living; and number 3, progressively focused early years expenditure.
The words “progressively focused” are very important because they echo the words “progressive universalism”, which were used by Michael Marmot when he gave evidence to the Health and Sport Committee. That is a central concept for combating health inequalities, although I accept that it is a classic chameleonic idea that can mean different things to different people and take different forms in different circumstances.
Michael Marmot’s other central concept, which he also articulated to the Health and Sport Committee, was the idea of a health gradient, based on his classic study of different grades of the civil service in London. It is important that we think of the problem of health inequalities not in terms of health gaps, which is the common way of articulating the problem, but in terms of a health gradient.
I believe in initiatives to help the most vulnerable and disadvantaged. However, if we only do that, we will simply flatten the gradient at the bottom. We need to have upstream, population-based initiatives that affect the whole gradient. That has to be the context in which we take specific actions that are focused on the most disadvantaged individuals and communities.
I want to emphasise some initiatives that I strongly support. For decades, I have been well aware of community development initiatives in my constituency. The Pilton community health project is one example. I wrote to the Cabinet Secretary for Education and Lifelong Learning this week about an issue there. The actions that it takes in the community are very important and, as Murdo Fraser emphasised, there are many other similar projects in the voluntary sector more generally. Let us support such initiatives in disadvantaged communities.
However, let us not forget the NHS and, for example, the work of the GPs at the deep end. I initiated a debate on 7 January about nursing at the edge, which involves nurses leading action to help the most disadvantaged and vulnerable individuals in society. We should strongly support that kind of action by the health service, often in community settings rather than in hospitals and wards.
Although we must take action for the most disadvantaged, unless we also deal with the upstream societal issues and create a more equal society, we will never solve the problem of health inequalities.
16:30
I begin by commending Duncan McNeil for his excellent speech, which set the tone for this debate. In doing so, I say that I think that all the conveners have taken on board their respective portfolios and considered how they can look towards the health inequalities that exist.
I want to focus on a few measures that I think make a difference. I believe that free eye tests make a difference to health inequalities. They are a preventative measure that can prevent people from suffering trips and falls and enable people to get about their daily business, which they might not have been able to do before the test.
Before the introduction of free eye examinations, a lot of people were reluctant to go to an optician for fear of the on-going cost. However, free eye tests identify cataracts at an early stage and can identify other conditions such as diabetes and macular degeneration. Those conditions have an impact on the quality of life of those who acquire them. For example, they can prevent them from going out, taking part in things or, say, making a simple meal. We should continue to support free eye tests and ensure that community optometrists are aware of how they can signpost people to third sector organisations and other agencies and determine whether a person needs the on-going support of the national health service.
The integration of health and social care is probably the model that may—I stress may—make the biggest impact on health inequalities. At the moment, part of the problem that we have arises from the fact that we are addressing this issue in silos. We cannot do that, because we need to take a holistic approach to the problem of health inequalities, which affect all aspects of a person’s life.
I commend Stewart Maxwell for introducing the issue of people with sensory impairments in early education. For many years, those children have been disadvantaged, because the teaching materials that would enable them to obtain the level that they are perhaps capable of have not been made available to them, and nor has the necessary support thereafter. I know that a lot of work has been done to try to level that playing field, but a lot more needs to be done, especially for those who are deaf or hard of hearing. There is a great deal more to be done to resolve the inequalities that exist for them. We know that, when they leave education, those who have significant hearing loss, especially those who are deaf, can find that they do not have the opportunities that exist for other people to get into employment, further education or the skills market, which means that they are instantly affected by the fact of their sensory impairment.
You might wish to draw to a close.
Similarly, those with physical impairments are constantly disadvantaged because of their housing situation and our environment. We need to resolve those inequalities.
16:34
I compliment Duncan McNeil on one of the best speeches that I have heard him make in this chamber.
Health inequalities are often described as the clear and unjust differences that come to pass between groups in different situations in our society. Tackling health inequalities requires a co-ordinated approach because they are caused, primarily and fundamentally, by income inequalities and poverty. Those factors have a profound impact on which group or groups have the best chances in life. For example, people who live in affluent areas in nice houses, and who earn good wages, are not only better off financially than those in less advantaged circumstances, but have, as the figures show, a better standard of health.
I will explore that situation further. The health inequalities that people face are based on the areas where they live. I read over the helpful briefing and health inequalities publications by NHS Health Scotland and, in particular, the figures on the average life expectancy in my Central Scotland region, which I must say made for disappointing reading. In North Lanarkshire, the average life expectancy is 74.9 years for men and 79.2 years for women. Over in South Lanarkshire, the difference is even starker, where the average life expectancy is 76.4 years for men and 80.6 years for women. The difference between the 15 per cent most deprived areas and the rest of the local authority area is as much as 6.9 years for men and 3.9 years for women.
In 2011-12, Scotland wide, the healthy life expectancy of people who live in the 10 per cent most-deprived areas was 23.8 years lower for males and 22.6 years lower for females than for those who live in the 10 per cent least-deprived areas.
The question is how to tackle the inequalities. I suggest that this SNP Government has been working hard, using the powers that Parliament has, to tackle health inequalities. It has abolished prescription charges, thereby truly making the NHS free at the point of need. We provide free NHS eye examinations, which Dennis Robertson mentioned, as well as free personal and nursing care, which has benefited more than 77,000 of Scotland’s older people. We are also delivering free healthy school meals for all children in primaries 1 to 3.
That is in stark contrast to the UK Government, which has a lot to be responsible for, given its austerity agenda and drive towards more and more changes in the welfare system—changes that will no doubt exacerbate poverty and will, as a consequence, have a greater negative impact on health inequalities.
It is clear from the support that is being offered to tackle health inequalities through the £40 million primary care development fund that the Scottish Government is committed not only to delivering on our national health service, but to delivering on change to make our country a more fair and equal place for all Scots to live.
16:37
For those of us who are serial contributors to health debates, this afternoon has been something of a treat, given that we have had so many contributions from what I suppose one must regard as the glitterati of the Scottish parliamentary establishment—the committee conveners. I thank some of them for even staying to hear speeches other than their own. In that regard, I pay particular tribute to Michael McMahon, Rob Gibson, Margaret McCulloch and Christina McKelvie, who have sat through the whole debate. However, all the contributions that we have heard were interesting.
I will return to the opening speech by Duncan McNeil, with which I found myself in considerable agreement. It will probably be a cause of considerable alarm to Mr McNeil that we may find that we agree on far more than he imagines. When I came into politics, people asked me whether I did so to end poverty, to end war and save the world or to eradicate inequality. They would then say, “No, you’re a Tory—you came in to perpetuate all these things.” That is not the case. I am convinced that health inequalities are at the root of all the inequality in society. In so far as we can deal with health inequalities, we could unlock the solution to problems that bedevil so many people in society.
On Duncan McNeil’s assertion that all the political parties represented here have at some time been in Government and have been responsible for, and charged with, dealing with the issues that are under discussion, I advance the theory that our adversarial political system is one of the fundamental obstacles to tackling the issues at the heart of health inequalities. It is not that adversarial politics does not have considerable successes to which it can point—various parties in office at different times have secured significant advances in society. However, in our debate on the NHS, there is a gradual recognition across the chamber that what is undermining our ability to move forward with an agenda that would create a sustainable national health service is our need as politicians to fall back on that adversarial approach. That is because we live in a political system in which votes are won by so doing and arguments are somehow buried—albeit that we all recognise the far greater understanding that there is between us on many of these issues.
I wonder whether I might just briefly return to Jackson Carlaw’s statement that health inequalities underlie most other inequalities. I ask him to reflect at some point on the seminal study, “The Spirit Level: Why Equality is Better for Everyone”, which suggests that financial inequalities give rise to most other difficulties. I am not expecting him to counter that point right now, but I think that that is the message of a large amount of research.
I will, of course, reflect on that.
When I look at the train journey that was identified, I think that we are, in the future, going to see the biggest concentration of type 2 diabetes and the biggest concentration of dementia on exactly the same track on which we have seen all the other inequalities related to health that we have discussed. For me, there is an opportunity in this Parliament—if politicians from all sides are committed to so doing—to find and to map out a way to address the health service, which could lead to many health inequalities being resolved. That is one of the reasons why Conservatives are—as Nanette Milne said—so committed to the increase in health visitors.
Duncan McNeil asked, “Are we too tolerant?” The answer is yes. We are too tolerant of the loudmouthed adversarial political approach that has done little to advance a sustainable NHS, and undermines our collective will to tackle health inequalities.
16:42
The Health and Sport Committee report that was introduced by our convener, Duncan McNeil, is welcome. It has also been extremely important to hear from so many other conveners. The Education and Culture Committee convener dealt with looked-after children, the Infrastructure and Capital Investment Committee convener spoke about cycling and housing adaptations, and the Public Petitions Committee convener spoke about the accessibility of, and people’s eligibility for, services.
The Welfare Reform Committee convener spoke about the insensitivity of the desire to change the system, which is being done in a way that crushes far too many people, and the Finance Committee convener spoke about community empowerment and the therapeutic effects of gardening, which I particularly enjoyed. The Economy, Energy and Tourism Committee convener spoke about underemployment, the Rural Affairs, Climate Change and Environment Committee convener spoke about service delivery, access and climate change, and the Justice Committee convener spoke about drugs and alcohol, and referred to Families Outside and the children of offenders, which is a very important issue.
The Equal Opportunities Committee convener spoke about younger multiple morbidity linked to deprivation, about age and social isolation, and about food access, and the European and External Relations Committee convener spoke about the role of the EU and about human rights.
In the diversity of the conveners’ contributions, there was unanimity on one thing—inequalities are everyone’s responsibility. In this Parliament, there is clearly a general level of ambition to reduce inequalities. The problem is, how do we do it?
The helpful infographic that was referred to by Fiona McLeod and others on the gap in life expectancy along the train journey that Jackson Carlaw mentioned, and the related information on the years of good health and the differences between communities that has been published by NHS Health Scotland, although striking, do not take into account the fact that even in the wealthiest communities there is poverty, early ill health and premature death.
However, it is regrettable that the gap between the rich and the poor—between those who are empowered and those who do have power—has grown. The Organisation for Economic Co-operation and Development recognised that, under Labour, child and pensioner poverty was substantially reduced between 2000 and 2007, but since then poverty has increased. We were reminded by the BMA briefing about the increase of people in poverty in Scotland from 710,000 in 2011-12 to 820,000 in 2012-13, and that child poverty went up to 19 per cent.
Many speakers referred to Professor Marmot and Harry Burns and the powerful evidence that they gave the Health and Sport Committee. They suggested that there should be focus on a number of measures. The first was to give every child the best start; attempts are being made to deal with that. The second was to give everyone the chance to maximise their capability and—which is more important and is from the early Marmot study—to have control over their lives.
The third measure was to create fair employment. That is embodied in our common value that there should be a living wage, which the Scottish public health observatory has said is the single most important change that should be made. We must also eliminate exploitative contracts and improve workers’ rights, but that should be underpinned by a fair welfare state that does not punish people through the bureaucracy of trying to achieve a perceived better system.
As Marmot said, we need to create healthy and sustainable communities. That means providing good housing, education, transport and environments, as well as safe and healthy food. It also means strengthening social connectedness through services such as the Sistema Scotland big noise centres to which Nanette Milne referred. However, we need to tackle the gradient of health inequalities in all communities, not just those in the lowest decile.
The time lines that are illustrated in the Health and Social Care Alliance briefing are important, but the most important development is the Scottish needs assessment programme—SNAP—paper, which has not been referred to. It talks about a human-rights based approach, which is critical.
We have had a very short debate. Health inequalities could have been the subject of a full week’s themed debates; I agree with Murdo Fraser that we have merely scratched the surface. We must have a much fuller debate on the topic. Many important issues have been raised, but we need to consider them collectively and in an integrated way in a much fuller debate.
16:46
I pay tribute to the Health and Sport Committee for its report and for securing the debate. I also commend Duncan McNeil for his passionate opening speech, which set the tone of the debate.
I also commend the approach that the committee has taken to the debate, which is fairly innovative. The involvement of the other committee conveners has undoubtedly helped to widen the debate’s scope. I am not quite ready to agree with Jackson Carlaw’s depiction of them as the Parliament’s “glitterati”, but the debate has definitely benefited from their involvement.
As Fiona McLeod and Murdo Fraser mentioned, I took part in the reception that he hosted for Voluntary Health Scotland—I say in passing that I agree with the point that he made that the voluntary sector has a huge role to play in the challenge. The central message from VHS’s report “Living in the Gap” was that health inequalities are everyone’s business. On that basis, it is welcome that so many of the Parliament’s committees have engaged in the debate. I am sure that that interest and involvement will extend beyond it.
Does the minister also commend the work of the cross-party groups in the Parliament?
Of course I do.
Before I respond to as much of the debate as I can, I will add my reflections on the debate about health inequalities and how the actions that the Government is taking are, we hope, contributing to reducing the gap.
To improve the health of our people, we must address the fundamental drivers of health and wider social inequality. At the root of the health inequalities that we face as a society is, as Richard Lyle said, income inequality. The committee came to that conclusion and I agree strongly with that perspective. That is underlined by the fact that payment of the living wage has recently been found to be one of the most effective interventions to tackle health inequalities. The Government has taken measures to pay at least the living wage to all Government and NHS employees. It has also, of course, commissioned the Poverty Alliance to promote the living wage in the private sector. I was delighted to see that, yesterday, the Cabinet Secretary for Fair Work, Skills and Training marked the 150th accredited living wage employer in Scotland. I was even more delighted—if you will indulge me, Presiding Officer—that that employer was CMS Enviro Systems, which is based in Cumbernauld in my constituency.
Last November’s programme for government announced our intention to appoint an independent adviser on poverty and inequality to advise the First Minister directly on the actions that are needed to tackle poverty in Scotland. That accompanied the provision of £104 million in 2015-16 to mitigate the effects of the welfare benefit reforms that Westminster is implementing.
We also committed to establishing the fair work convention to develop, promote and sustain a fair employment framework for Scotland. We are taking action to increase educational attainment and to widen access to higher education. All those measures are designed to reduce inequalities and to make Scotland a fairer place.
I want to respond to some of the issues that were raised over the course of the debate. Jenny Marra mentioned access to sports facilities and cited the example of a girls football team from Carnoustie that has to travel to Dundee because of a lack of local facilities. I certainly agree that we should try to have as wide an array of local facilities as we can. Work to that end is under way. That was an interesting example, because it involved a group of girls who already engage in physical activity. The big challenge in this area relates to people who do not engage in physical activity. We know that the gap in physical activity rates correlates closely with people’s socioeconomic circumstances, so it is a health inequality issue.
Significant progress has been made through the active schools programme and the uptake of physical education, but I want to go further. I believe that sport can make a bigger difference in tackling inequalities and improving outcomes. Sport for development is a concept that is about intentionally delivering social impacts for individuals and communities through sporting activity. During legacy week, I was very happy to visit active east in Dennistoun. That programme is delivered by Scottish Sports Futures, which is heavily engaged in the concept of delivering good outcomes for youngsters. I believe that we can use sport to make a positive difference in tackling Scotland’s health inequalities. Much of my work as a minister with responsibility for sport will be about that.
I must respond to the remarks of Michael McMahon, the convener of the Welfare Reform Committee, as I am a former deputy convener of that committee. I agree with the perspective that he set out, which is that the UK Government’s welfare reforms are having a negative impact on people and are exacerbating health inequalities. In areas in which we have responsibility, this Government is investing to support vulnerable people. Our current and planned funding will result in an investment of around £296 million over the period 2013-14 to 2015-16. If only we could do more.
I see that I am running out of time, as I always do in such debates. I say to the Health and Sport Committee that I will respond to its report more fully in writing, and I will try to pick up on aspects of the debate that I have not been able to pick up on.
I very much welcome the tenor of the debate, which shows that we have a shared commitment to tackling health inequalities. I look forward to working with the Health and Sport Committee, every other committee of the Parliament and every member to do what we can to tackle Scotland’s health inequalities.
I call Bob Doris to wind up on the Health and Sport Committee’s behalf.
16:52
Like other members, I pay tribute to the committee’s convener, Duncan McNeil, for the tone that he set in opening the debate. I think that the committee’s work has been the best-kept secret in the Parliament over the years. We have done sterling work in getting on with the job at hand, regardless of party politics, and finding solutions and ways forward. I hope that our convener agrees.
If we see health inequalities as a matter simply for the Health and Sport Committee, the ministers in the health team and the national health service, we will never fully tackle the issue. That is why the committee sought a debate with such an innovative format. It has allowed us to hear from the conveners of all the relevant committees. On the Health and Sport Committee’s behalf, I thank them all for their time and effort. We see the debate as a starting point rather than an end point, and we think that the Official Report of it should not just gather dust on a shelf somewhere.
I will try my best to cover as many of the points that were made in the debate as possible. On the Government’s behalf, Fiona McLeod set out some of its policy commitments on tackling the poor start in life that some young people have, the cycles of poverty and deprivation that persist and income inequality. She talked about the upstream causes of health inequalities as well as what we are doing day to day to mitigate the effects of inequalities. Malcolm Chisholm made a strong point about that, too.
The minister made a bid for this place to have more levers of power to tackle the causes of inequality. I point out that, in paragraph 34 of its report, the committee made significant play of the level of pay in society, patterns of work and zero-hours contracts.
Our report also addressed welfare reform. We concluded that,
“Moreover, the implementation of welfare reform is reducing the income available to the poorest and most vulnerable individuals and families, potentially further impacting on health and wellbeing inequalities.”
Irrespective of where the levers of power are in politics and society, this Parliament must scrutinise all the policy decisions that are taken that could impact on health inequalities. We all have to make that commitment.
Jenny Marra made an interesting speech, which was partly about primary care teams and the funding that community and primary care receives. Earlier today, the Health and Sport Committee met the Northern Ireland Committee for Health, Social Services and Public Safety, which has been looking at ways of withdrawing from the acute sector and moving more into primary care. That committee is considering the idea of having fewer targets for things such as elective surgery in order to disinvest from certain areas. There will be challenges for this Parliament if we decide to go down that road.
Nanette Milne spoke passionately about the role of health visitors—I know that she feels strongly about it—and the Scottish Government’s work in relation to that.
I will move on to the speeches from our committee conveners. Stewart Maxwell, on behalf of the Education and Culture Committee, said that educational inequalities are corrosive, and he spoke powerfully about the plight of looked-after children with regard to poor health and life expectancy. The Scottish Government has undertaken a variety of work on that, and the Health and Sport Committee has in the past looked at kinship care and looked-after children.
John Pentland, on behalf of the Public Petitions Committee, outlined excellent examples of how that committee has empowered society, whether by achieving victory on insulin pumps or—as the Health and Sport Committee is well aware—by helping to ensure access to medicines for rare and ultra-orphan conditions.
Jim Eadie spoke on behalf of the Infrastructure and Capital Investment Committee about a variety of matters, including sustainable and active travel—I listened carefully to what he said on that. Active travel can be subject to what we would, in another context, call the inverse care law, in that providing more active travel opportunities can serve simply to make fit people even fitter, healthier and more active while not necessarily reaching the parts that we have to reach. However, it is important that Jim Eadie put on record his committee’s work in that area.
Kenneth Gibson spoke on behalf of the Finance Committee, and his point about the use of change funds—whether for younger or older people—chimed not only with me but with my committee. We face issues with ensuring that change funds stimulate the structural change that is required by ensuring the mainstreaming of successful pilot projects and disinvestment from areas that do not give best value for money.
Murdo Fraser spoke on behalf of the Economy, Energy and Tourism Committee about the benefits of the growing economy. I will look with interest at the work that his committee is going to do on the theme of work, wages and wellbeing.
Christine Grahame spoke on behalf of the Justice Committee about the need for better throughcare for prisoners on their release from prison. Margaret McCulloch spoke on behalf of the Equal Opportunities Committee about how social isolation and loneliness can impact on health and wellbeing. Christina McKelvie gave an international perspective on health inequalities, and Nigel Don spoke about looking at best practice in the UK.
I was determined to namecheck—quite deliberately—every member who spoke in the debate, but there are time constraints. By holding the debate, we are trying to make the point that tackling health inequalities requires a cross-party, cross-committee and cross-Government approach.
I will single out just a couple of contributions. Michael McMahon spoke about welfare reform, and we cannot ignore the impact that it is having on society and the health of our society when we are debating health inequalities. He also spoke about the transfer of powers.
Kevin Stewart spoke passionately about community empowerment. In my view, that is what the point of our debate comes down to. Yes, it comes down to how income in society is shared out and to the power relationships in society—we heard about the idea of progressive universalism—but, in my view, it is all about relationships. It is about the relationships that we all have—as individuals, families and communities—with the economy and the wealth in it. It is also about our relationships with each other in communities, and the need to foster positive and nurturing relationships—not least in the Parliament, to ensure that tackling health inequalities is not just the Health and Sport Committee’s job but the responsibility of the whole Government and the whole Parliament. The debate must be only the starting point in tackling the persistent inequalities that have plagued our society for far too long.
Previous
Penrose Inquiry