Meeting of the Parliament 01 November 2022
I thank the Social Justice and Social Security Committee for bringing the debate to the chamber.
Earlier this year, the Health, Social Care and Sport Committee completed its initial inquiry into health inequalities in Scotland. The rising cost of living inevitably impacted on our evidence.
Scotland has enduring health inequalities that are the result, in due part, of a number of historical factors that were outlined by several experts from whom we heard. We found that health inequalities increased across the population during the years leading up to the pandemic, then the pandemic exacerbated them. We heard that destitution rose during the pandemic. People from black and minority ethnic communities and disabled people were more likely to die, and caring responsibilities became almost insurmountable and caused mental health issues.
This is not a debate about health inequalities, but the inescapable fact is that poverty is the root cause of health inequality, and the rapid rise in the cost of living is set to worsen long-term health inequalities if action is not taken.
During our inquiry, we heard that the number of households in which spending exceeds incomes is rapidly increasing. We hear this phrase a lot, but the reality is that people are choosing between eating and heating, and that is impacting more and more families.
People with complex conditions or those who provide informal care have additional costs and often very little income. We heard that people with multiple sclerosis, for example, will face, on average, an additional £200 per week in bills. We also heard that some families have extensive medical equipment to power—many medical and mobility devices require charging or constant electricity to function. Members will be aware of recent coverage of a family facing an expected £17,000 energy bill to keep their daughter, who has cerebral palsy, warm and alive. The rest of the family will freeze to ensure that she can have heat in her room. Many people with disabilities or reduced mobility must have their heating at higher levels to stay warm or to prevent them from becoming seriously ill.
During our inquiry, people told us that they have had to stop social and recreational activities due to the increased costs. We and our predecessor committees have advocated for the importance of physical activity, social interaction and participation in social and cultural activities as ways to prevent ill health. If people are unable to afford to do those activities, physical and mental health suffers and social isolation increases. We heard of people being unable to attend health and social care services and stopping self-management because of financial hardship. We heard of pensioners being pushed into extreme fuel poverty and that, as a result of the cost of living crisis, and despite all the interventions that have been made by the Scottish Government, child poverty is on the rise.
The poorest and most vulnerable people in society are bearing the brunt of the crisis, and things could get significantly worse for a lot of households. Professor Sir Michael Marmot told us that inflation has a much bigger impact on households with low incomes than it does on households with higher incomes. That seems self evident. This is not just an exercise in philosophy—inflation is making a real difference and pushing people who live on the margins of their income into poverty, thus widening health inequalities. That was laid bare to the committee. We were told that people in the poorest communities are, quite literally, dying because of inequalities, poverty and the repeated challenges that they are facing. Professor Gerry McCartney told us plainly that
“rising mortality for our poorest communities will get worse, and ... get worse faster, if those challenges are not addressed properly.”—[Official Report, Health, Social Care and Sport Committee, 24 May 2022; c 24.]
We are left in no doubt that the cost of living crisis is an urgent public health and social justice emergency. As a committee, we have recommended targeted action to address health inequalities, including tackling underlying inequality and poverty, the root causes, at all levels: local government, Scottish Government and UK Government. Action is needed at all levels, and it is needed now, or we will be seeing widening health inequalities for generations to come.