A study, released today, highlights the persistent challenges in addressing health and socio-economic inequalities, in Scotland.
The report by the Scottish Health Equity Research Unit (SHERU), shows that life expectancy in Scotland is currently showing a downwards trajectory, while drug-related mortality remains the highest in Europe.
These troubling health outcomes are underpinned by stark disparities in living standards and bellwether indicators such as educational attainment between the richest and most disadvantaged segments of society.
Critical gap
A joint collaboration between the University of Strathclyde’s Centre for Health Policy and Fraser of Allander Institute, supported by the Health Foundation, SHERU’s report, ‘2024 Inequality Landscape: Health and Socioeconomic Divides in Scotland’, highlights a critical gap in the evidence needed to determine whether policy efforts have truly impacted these inequalities.
The report’s authors say that despite the Scottish Government’s clear understanding of inequalities and a comprehensive array of strategies in place, they have yet to see a significant move beyond announcing policies towards more rigorous evaluating of their effectiveness.
These significant gaps in data sources to assess the impacts of key policy changes mean that decisions are being made on outdated or poor-quality information. The findings raise serious questions over the quality of the decisions that are being made to respond to budget pressures now and in the coming months.
Emma Congreve, Deputy Director of the Fraser of Allander Institute and co-lead of SHERU, said: "If the government doesn’t have a clear understanding of which policies are effective, it cannot make informed decisions about which ones to keep and which ones to cut.
"We've already witnessed emergency spending controls being imposed based solely on expediency, rather than evidence. We are deeply concerned that future decisions will be made without considering the impact on people's lives and prioritising spend accordingly."
Better grasp
Professor Kat Smith, co-director of the Centre for Health Policy and co-lead of SHERU, further emphasised the importance of understanding how government actions shape the socio-economic determinants of health. She said: "Without a better grasp of how existing socioeconomic policies are performing, the government will continue to struggle with achieving meaningful improvements to help tackle the poor health affecting large segments of our society.
"In recent years, the Scottish Government has made strides in recognising the importance of gathering insights from service users and their experiences. However, evidence-based decision-making requires ensuring outcomes can be to tracked in the data, as well as engaging with community members."
The authors stress that Scottish Government needs to do more, along with its partners in local government and public bodies, to improve governance. Many of the report findings echo the reflections of the Auditor General in a recent blog reflecting on his period of office so far, where he made a case for enhanced governance and a better understanding of the impact of spend on people’s lives.
Starkest inequalities
Chris Creegan, Director of the Health Foundation’s Driving Improving Health & Reducing Inequalities in Scotland Programme said: "The health inequalities landscape in Scotland remains bleak, as captured both by our 2023 report, Leave no one behind and this new report from SHERU. They highlight the scale of the challenge we face to improve health outcomes for all, in particular those facing the starkest inequalities.
"The work of SHERU will be critical in shaping the policy landscape in future years. By funding research and analysis to bring greater scrutiny to Scottish policy debates and the development of practical policy proposals, the Health Foundation is aiming for it to play a part in reversing the trends in health inequalities."