Chamber and committees

I wonder whether Public Health Scotland would be able to use the data that we already have access to with regard to people who are ranked 1 on the Scottish index of multiple deprivation and so on as some type of indicator that could address the issues that Bob Doris raises.

I find that turn of phrase to be particularly distasteful. Will Sue Webber reflect on that, and will she think about whether my mother’s death, which was legal under the current law and took two weeks in which she starved to death, was a “Disney death”?

To flesh out the issue, if we are looking at statistical significance and the prevalence of disease, we should not lose sight of what the primary cause of death would have been, which is the underlying condition. Mr McArthur’s amendment 46 would allow assisted dying to be put alongside the primary cause of death, but for medical purposes it is important that we understand the prevalence of disease across the population.

Would the member accept that the way that the system currently works means that conversations with people who are terminally ill are indeed happening? I have spoken on the record about my mum, and there are many others like her. They have conversations with doctors about voluntarily stopping eating and drinking, about medication that might have a double effect and might hasten or bring about death, or about withdrawing treatments in a way that will bring about their death. People are having those conversations with trusted doctors across the country at the moment.

In the light of the concerns that have been expressed by young people and their families that those with co-occurring neurodivergence, or those who are living with the less-understood eating disorder known as avoidant restrictive food intake disorder—ARFID—do not always get the support that they need at Skye house, how can the Scottish Government support the delivery of services in a way that is grounded in inclusive and trauma-informed practice and reflects the needs of those who are neurodivergent?

When resources are definitely tighter, the fact that we will not see the benefits until perhaps a decade later makes the argument difficult.

Paul Johnston said something earlier about zooming out and looking at what national Government, local government and our partners more widely can do versus putting all the onus on the individual. I think that that often ends up being our default position—we will just eat better, or just do this or just do that. However, we understand about food deserts and all of the issues that surround poverty and inequality. How do we ensure that that is where we keep our focus?

Maybe we should be looking at the Marmot principles and the Christie principles together when we make any decisions across all public services. Thank you.

Paul Johnston, you have already touched on the theme that I will cover, which concerns the ways in which persistent health inequalities can stall life expectancy. In addition to that, we know that people in Scotland’s poorest neighbourhoods are almost five times more likely to die from preventable conditions compared with those in the least deprived, and that, as you have alluded to, they live for 25 fewer years in good health, which has a huge impact on overall wellbeing.

You have touched on a couple of the drivers, but what are the key factors behind stalling life expectancy? I found a wee glimmer of hope in the latest figures that we have seen, but what factors are driving widening health inequalities in Scotland?

That leads me to the next question, which I was already starting to formulate. We understand that we can directly link stalling life expectancy and the widening of health inequalities to the decision making that happened in relation to austerity. Julie Bell spoke to this issue when she mentioned getting alongside one another. As we go into a period of public sector and services resource pressures, how do we work together to ensure that the decisions on national or local priorities that are taken at this point in time do not start to widen health inequalities again? How do we ensure that decisions are really taken in people’s best interests and not guided by resourcing only?

Thinking about 16 and 17-year-olds, I understand that the situation is different for those who are care experienced, who do not have to meet the criteria of being out of work and on universal credit for six months. However, it is difficult for someone who is 16 or 17 and has an opportunity to take up employment but who comes from a very low-income household, as the cost of travel, clothes and so on might be a barrier.

I know that that requires a bigger discussion than what we, as a committee, are asking of the Scottish Government. However, in looking at the authorisation rates, do you feel that that is a barrier? Are some individuals not eligible because they do not meet the criteria of being out of work for six months because they are 16 or 17 and living at home? They might be applying for the payment and not meeting the criteria, so their application is not being authorised.