Lesson Starter Government Responses to Health Inequalities

1. Lesson StarterGovernment Responses to Health Inequalities ‘The Government, not the individual, is responsible for ensuring people are healthy’ Do you agree or disagree with this statement? Give reasons to back up your point of view.

2. Today we will I can… • Listandexplainwhat the Scottish Government have introduced to try and tackle health inequalities and evaluatethe success of these policies. • Researchanddevelopopinions on other government policies to reduce health inequalities using the internet. Listandexplainwhat the Scottish Government have introduced to try and tackle health inequalities and evaluate the success of these policies. Researchanddevelopopinions on other government policies to reduce health inequalities.

3. Tackling Poor Health… As health is a devolved issue, most of the policies affecting the health of people in Scotland are decided by the Scottish Parliament. In 2008, the Scottish Government introduced its Equally-Well Policy. • It focuses on young children as health problems that start then can last a lifetime. • It aims to tackle the ‘big killer’ diseases: heart-disease and cancer. • Reducethe problems caused by drugs and alcohol.

4. Carousel task- You will be presented with many of the initiatives that the Scottish Government have implemented to reduce health inequalities. This will take the form of a carousel task. You will work in your tables and move around the room to various stations. You will have 5 mins at each station to take notes individually on this initiative- these should form their own separate mind maps as each station delivers different health issues. This well help you extract the key information in a timely manner! • You should take notes abut the following: • Description of the initiative & identify the health inequality it seeks to address. • Impact of this initiative. • Include as many examples and statistics as possible

5. Scottish Parliament initiatives to tackle health inequalities As we go through the slides please add any information to your notes that you had missed out!

6. Government Responses to Health Inequalities and impact Smoking, Health and Social Care (Scotland) Act 2005 AKA “The Smoking Ban” (enforced as of 2006) linked to health inequalities in Scotland. A study of bar workers, using saliva, lung function and air quality tests, showed their respiratory health had greatly improved after the laws came in, thanks to thereduction in exposure to second hand smoke. Estimated that the ban could save 600 lives every year. The ban was popular with British adults when it was implemented - and a recent poll of more than 12,000 people found that 78% of adults still support it

7. Impact of the Smoking Ban • Amanda Sandford, research manager from Action on Smoking and Health (ASH) says it was long overdue. • "It is one of the most important public health acts in the last century. There's no question it's been hugely beneficial." • Shelia Duffy, Chief Executive of ASH Scotland has stated “The cultural impact of smoke-free public places has been profound, with a new generation growing up with smoke-free environments as their right and their expectation.” • Results show benefits for health, changes in attitudes and behaviour and no clear adverse impact on the hospitality industry.

8. Minimum Pricing of Alcohol (2012) The problem of alcohol in Scotland: https://www.youtube.com/watch?v=TLJkTjvp-9g https://www.youtube.com/watch?v=2Hu9YnPkdLQ

9. Minimum Pricing of Alcohol (2012) Law changed so that each unit of alcohol costs at least 50p. Why? - People who are drinking at potentially harmful levels are most likely to benefit from the effects of minimum pricing. Research shows that people on a low income or who are living in deprived areas are more likely to suffer from a long term illness as a result of drinking too much. There were 1,265 alcohol-related deaths in Scotland in 2016, an increase of 10% on 2015.

10. Tackling Alcohol Abuse - impact Minimum pricing will impact most on harmful drinkers - those who regularly drink more than the sensible drinking guidelines. Those who drink within sensible guidelines will only be marginally affected simply because they only consume a small amount of alcohol and also because they do not tend to buy as much of the cheaper alcohol that would be most affected by a minimum price. The small increase in the cost of alcohol to moderate drinkers has to be seen in the context of the total costs of alcohol misuse - estimates suggest around £900 per year for every adult in Scotland.

11. Tackling Alcohol Abuse – positive impact Almost all drinks bought in the pub are already sold well above any likely minimum price, so they wouldn't be affected. The minimum price of 50p per unit will mostly affect cheap white ciders and value spirits with high alcohol content which tend to be favoured by problem drinkers. The Chief Medical Officer believes that - like the smoking ban - minimum price would save lives within a year. The University of Sheffield estimated that the proposed minimum price of 50p per unit would result in the following benefits:

12. Tackling Alcohol Abuse – positive impact Alcohol related deaths would fall by about 60 in the first year and 318 by year ten of the policy. A fall in hospital admission of 1,600 in year 1, and 6,500 per year by year ten of the policy. A fall in crime volumes by around 3,500 offences per year A financial saving from harm reduction (health, employment, crime etc.) of £942m over ten years.

13. Tackling Alcohol Abuse - negative impact Reduce living standards for those on low incomes as it affects those on low incomes the most. There is already substantial tax on alcohol – does this policy simply “Tax on the poor”. Encourage people to switch to illicit ‘home brews’ and replacement alcohol. This is potentially dangerous as it leaves people exposed to alcohol of an unknown quantity and composition. It will be an easy way for supermarkets to increase their profits. The government would be better off just increasing tax on alcohol so that society pockets the extra cost rather than supermarkets. Then the tax revenue raised could be used to fund the cost of treating alcohol related diseases.

14. Tackling Alcohol Abuse - negative impact Five European wine-producing nations tried to block Scotland's plans for minimum alcohol pricing. France, Spain, Italy, Portugal and Bulgaria suggested that the policy was illegal, unfair and would be ineffective and could have a devastating impact on the wine and spirits industry (impact on jobs, economy, EU relations, trade). Of the 12 countries which wrote to the Commission to express their views on the matter, only Ireland supported minimum pricing. The legality of the law was challenged in court by the Scotch Whisky Association (SWA) and two other trade bodies. First challenge rejected by court in Edinburgh but appeal was won in November 2017 at the Supreme Court in London. THE LAW CAME INTO FORCE IN SCOTLAND IN MAY 2018. It’s actual impact is not yet known.

15. Plenary • Write down one reason on your post it note as to why you believe it is important that the government deal with health issues. • Give one benefit of the following: • Minimum Unit Pricing • Smoking ban

16. Abolition of Prescription Charges 2011 ‘Prescription charges are a tax on ill health, and can be a barrier to good health for too many people’ Nicola Sturgeon – Health Minister in 2011 It will make a significant contribution to achieving a healthier Scotland. Cost will no longer discourage the sick from consulting their doctor.

17. Impact of Abolition of Prescription charges in Scotland according to the Scottish Government Hundreds of thousands of Scots with long term conditions are better off as a result of the abolition of prescription charges. Latest figures show that since 2007/08, the number of items dispensed for long term conditions such as asthma, Crohns disease and diabetes has increased year on year, demonstrating the benefit of removing the barrier of cost. Since charges were scrapped in 2011, there has been an increase of more than 10,000 items for those with Crohn’s disease and nearly 237,000 items for those with asthma. The Scottish Health Survey 2016 highlighted that 47% of Scottish adults have reported having a long-term health condition. The policy is being held up as example of how decisions about Scotland are best taken in Scotland.

18. Criticisms of Free Prescription Charges Ruth Davidson, Leader of the Scottish Conservatives said that “It’s well known across the UK there are free prescriptions in Scotland. What it doesn’t tell you is what that costs us.We have seen the number of nurses and midwives reduced by thousands…The free prescription costs take money away from other parts of health spending.” In April 2015, just 4 years after the policy’s introduction,the bill was estimated to be over £900 million.

19. Tackling Poor Diet and Obesity • In 2010, Scottish Government estimated the cost of obesity as £457 million, most of which was avoidable • Various campaigns such as “Active Schools” and “Hungry for Success” aimed at tackling childhood obesity. • Active Schools: a nationwide partnership between SportScotland and all 32 local councils to increase the numbers of children accessing high-quality sporting activities both before, during and after school. Also aims to help children from deprived areas have equal access to sport/physical activity. • An estimated 68% of school aged children participated in a sporting activity in 2016 according to the Scottish government.

20. Hungry for Success:aimed to tackle childhood obesity through standardised nutrition across all of Scotland’s school meals and the introduction of nutrition/healthy lifestyles to the curriculum. • This was implemented in Primary schools by 2004 and secondary schools by 2006. • 2007 - The Schools (Health Promotion and Nutrition) (Scotland) Act – aims to put healthy eating at the heart of each school’s activities. • Banned “junk food” from school cafeterias. • Introduced healthier food menus in schools. Stopped the sale of sweets, salty snacks and soft drinks inside school (removal of vending machines, tuck shops, sales of fizzy drinks and high fat school dinners). • Set a legal limit on the age at which children are allowed out of school at lunch time.

21. Tackling Poor Diet and Obesity Free School Meals 2014 – ALREADY HAVE ALL NOTES ON THIS • All Scottish P1-P3 pupils have received free school meals from January 2015. However, the actual success of Active Schools, Hungry for Success, Nutrition and Promotion and Free School Meals is difficult to measure. At 29%, the proportion of children at risk of being overweight (including obesity) in 2016 was similar to previous years.

22. Government Health Promotion and Prevention Campaigns Scottish government has launched campaigns to tackle the ‘big killers’. e.g. Alex Ferguson's lung cancer adverts Health and Education Board for Scotland (HEBS) adverts – HEBS now merged with NHS Scotland • http://www.youtube.com/watch?v=oncSvLZ_d-Q • http://www.youtube.com/watch?v=ar3w8nT7GwA • http://www.youtube.com/watch?v=DcJy5m36n4o • http://www.youtube.com/watch?v=T22M8COzh8c • http://www.youtube.com/watch?v=qgegqcSdBfc

23. Government Health Promotion and Prevention Campaigns Success or failure? Difficult to measure success – millions of pounds invested in campaigns and advertisements for healthy eating, anti-smoking and alcohol etc. http://www.scotland.gov.uk/About/People/Directorates/Communications/hlthpromtnspend- spending on health promotion 2003-2005 2012-13 – SG invested £30 million in cancer research. This will increase the number of people who benefit as quickly as possible from the world-leading treatment and support we have for cancer patients and their relatives and carers in Scotland, reducing the impact of cancer and, as a result, reducing premature death in Scotland.

24. Overall, have government policies and campaigns improved health in Scotland? Overall Scotland’s health has improved in recent years…in some ways at least Smoking rates down…

25. Government Health Promotion and Prevention Campaigns – Success? Life expectancy up…

26. Government Health Promotion and Prevention Campaigns – Success? Alcohol issues…slight improvement

27. Government Health Promotion and Prevention Campaigns – Success? Death rates from certain illnesses have decreased…

28. Government Health Promotion and Prevention Campaigns – Success? However…obesity has increased…still a challenge for Scottish Government

29. Government Health Promotion and Prevention Campaigns – Success? Still inequality in health between social classes – poor tend to be less healthy than rich This is an on-going problem for Scottish Government. However perhaps government is already doing enough – when do individuals have to take responsibility for themselves? Also still inequalities between genders, ethnic groups

30. To what extent have government policies to tackle health inequalities been successful? (20) For an essay on government responses to health inequalities... • Identify several examples of government policies/initiatives to tackle poor health (in separate paragraphs) • Give HARD FACTS (knowledge points) • Analysis – explain impact of policies (positive and negative) • Evaluate – Overall impact of particular policies (i.e. success in most areas except obesity) • For overall conclusion…explain the extent to which particular policies have been successful and whether government policies have been successful or not overall…in your opinion.

31. Exemplar paragraph One policy introduced to tackle health inequalities in Scotland is the Free School Meals policy; introduced in 2014 by the SNP Government, every P1-3 pupil in Scotland has been entitled to a free, healthy school meal since January 2015 (K). The policy has been highlighted as a major success – not only has it helped families to save roughly £330 per year – but the Scottish Government has highlighted that this guarantees school pupils from the most deprived areas can now access a nutritious meal without the stigma generally associated with “free dinners” (A). However, critics of the policy have suggested it is not in fact tackling the issue of poor diet and obesity in the most deprived areas – it is instead helping more affluent families save money (K). Moreover, taking up the free school meal is not compulsory therefore there is no guarantee that the pupils who the policy is aimed at will actually benefit in terms of their diet – figures from the 2016 Scottish Health Survey highlight that children in the most deprived areas were still the most likely to be obese (A). Overall, it can be suggested that the free school meals policy has been successful in tackling health inequalities to a limited extent as obesity is still a major issue for the most deprived children in Scotland, however the policy is still only a few years old therefore these results may change in the future (E).