Hansard

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

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

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

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

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

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

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

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

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

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

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

She echoed the committee’s view when she said that

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

How right she is.

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

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

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

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

I move,

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