As the life expectancy gap widens dramatically in the country, fragmented and short-term funding is frustrating efforts to reduce health inequalities. 

Funding must be distributed more fairly in order to reduce the deeply rooted health inequalities in Scotland, the authors of a new in-depth report argue. 

Research by the UCL Institute of Health Equity (IHE) has reaffirmed that social factors such as income, housing, work and education determine a person’s health, alongside access to care. 

The report, titled A Fairer, Healthier Scotland, set out to find out why, despite Scotland’s relatively progressive policies and clear ambitions, health outcomes are still worse than in England, Wales and Northern Ireland, with stark disparities between different regions. For example, men in Scotland’s most deprived areas can expect to live 16 years fewer than those in the least deprived parts; for women, the gap is almost 14 years. Meanwhile, healthy life expectancy has fallen, with a gap of more than 20 years for men and 22 years for women between the most affluent and most deprived councils. 

Scotland has been badly hit by the “sluggish” recovery from the 2008 economic crisis, which has affected salaries and, in turn, living conditions, explained Michael Marmot, director of the UCL Institute of Health Equity. The pandemic, climate change and political instability of the UK government have further compounded health inequalities, he said. 

Sir Marmot added, however, that the “relative stability” of the Scottish government and a strong public health sector are positives at work. Child poverty is lower in Scotland than England, the report found, and new laws, such as minimum unit pricing, have made a difference to Scotland’s alcohol-related health problems. 

Different approaches needed

Exploring why health inequality persists, researchers found short-term, fragmented funding and complex delivery arrangements waste resources and make it harder to help the people who need it most. Spending also often fails to reflect the level of need. For example, early years spending per child is about the same whether a council area has high or low child poverty.

The IHE is now working with Public Health Scotland to test new approaches to funding in three areas- Aberdeen City, North Ayrshire and South Lanarkshire. This includes £8m being spent in South Lanarkshire on redesigning local services to support families with young children and infants before problems reach crisis point. In Aberdeen, local data on deprivation and access to community assets is being used to assess which play areas need more investment. 

The authors of the report want to see funding shared more equitably between councils to reflect deprivation and further action on housing and early years support. For example, expanding home visits and health and nutrition checks for 100,000 under-fives in low-income communities could reduce the healthy life expectancy gap by 10%, the researchers found. 

Long-term funding must be prioritised, they add, with ten-year cycles implemented to allow for prolonged change. Further, there should be a senior health equity lead in every council, bringing in businesses and the NHS as partners.