Audit Scotland- Health Inequalities

1. Audit Scotland- Health Inequalities • The poorer you are the more likely you are to be unhealthy. This is despite the Scottish Governments £170m given to the NHA to tackle health inequalities. • The more that things change, the more they stay the same. • Audit Scotland’s Report looks at three aspects of health inequalities • Evidence of health inequalities • Spending on health inequalities • The effectiveness of Government strategies • Evidence of Health Inequalities • Smoking: In most deprived areas 40% smoke compared to only 11% in least deprived areas. • Alcohol: Per 100,000 of the population, in Scotland’s most deprived areas there were 1621 alcohol related hospital admissions compared to only 214 in least deprived areas. • Mental Health: (E.g. depression, anxiety) • In 2010/11, GPs in the most deprived areas had 62 consultations per 1,000 patients. In 2010/11, GPs in the least deprived areas had 28 consultations per 1,000 patients.

2. Life Expectancy: Between 1999-2000 and 2009-10, the average life expectancy of men living in the least deprived areas remained around 11 years higher than in the most deprived areas. The example of Renfrewshire is quoted where men in the least deprived parts if the local authority live 9 years longer than men in the most deprived. The west of Scotland, especially Glasgow and its surrounding areas, has high levels of poverty. As a result, Glasgow and its surrounding areas accounts for a significant proportion of health inequalities in Scotland. The years 3-8 are critical in understanding health inequalities (see Sir Harry Burns handout.) These inequalities remain throughout life, and as Sir Harry Burns has explained, explains why poorer people suffer worse health and die earlier than richer people. Low birth weight: In Scotland’s most deprived areas, 31% of babies were born with very low birth-weight. In least deprived areas, 13% of babies were born with very low birth-weight.

3. Breastfeeding In Scotland’s most deprived areas, 15% of mothers in the most deprived areas in 2011-12 exclusively breastfed their child at 6-8 weeks. In least deprived areas, 40% of mothers in the least deprived areas exclusively breastfed their child at 6-8 weeks. Dental health In Scotland’s most deprived areas, 54% of children in the most deprived areas had no dental decay in 2011. In least deprived areas 81% of children in the least deprived areas had no dental decay in 2011. Obesity/Overweight In 2010/11, 25% of children in the most deprived areas were classified as overweight. In 2010/11, 18% of children in least deprived areas were classified as overweight. Teenage Pregnancy In 2010, 14 per 1,000 under 16s became mothers in the most deprived areas. In 2010, 3 per 1,000 under 16s became mothers in the most deprived areas.

4. How well has Scotland reduced health inequalities? The £170m spent represents around 1.5% of total Scottish health spending in 2010-11 which is around £11.7 billion. From the Audit Scotland report it found that the significant differences in life expectancy and general health between least deprived and most deprived areas has meant that there has to be a concerted effort from the government to change this. It concluded that: “Resources should be better targeted at those who require them most.” Has the £170m been money well spent? Local government social work departments have a critical role in providing health care services and receives around 85% of its funds from the Scottish Government. Tackling Health Inequalities has been a major priority for successive Scottish governments. The current SNP Government has allocated £170m if NHS spending, specifically to reduce health inequalities. Of this money, £15 million is for programmes such as Keep Well and Childsmile. Keep Well delivers health checks to people in the most deprived areas. Childsmile is a national programme designed to improve the dental health of children in Scotland, and reduce inequalities in dental health.

5. Local health Services GPs who work in the most deprived areas of Scotland have the greatest challenges in tackling health inequalities. Their patients have more health problems GPs in deprived areas lack the consultation time required to deal with the problems their patients present themselves with Interestingly, because of the introduction in 2007 of the Deprived Areas Allowance, which offers dentists an additional £9000 per year, the number of dentists based in the most deprived areas has doubled. The report showed that public health campaigns can improve overall health but widen health inequalities. For example, the introduction of free eye tests in Scotland in 2006 increased the numbers of people having their eyes examined. But the increase was lowest among deprived households, therefore inequality increased. Conclusion Audit Scotland is very critical of how the Scottish Government, local councils and health boards have tackled heath inequalities. It is not clear that they are targeting most deprives areas and there is no national information about how local NHS boards distribute their funding.

6. It recommends: “The Scottish Government and NHS boards should introduce measurable outcomes in GP contracts which monitor progress towards tackling health inequalities. NHS boards and councils should identify what they collectively spend on reducing health inequalities locally, and work together to ensure that resources are targeted at those with the greatest need".