Tag: health inequalities

LGBT+ communities face significant health equalities, says new report

LGBT+ people across Scotland are continuing to face health inequalities across every measure of wellbeing, according to a major new report by NHS Greater Glasgow and Clyde, NHS Lothian and Public Health Scotland.

The findings of the Health Needs Assessment, commissioned by the Boards, found that the COVID pandemic has exacerbated issues, with significant numbers experiencing loneliness and isolation, while almost a half of LGBT+ people in the survey said they had experienced discrimination in the previous year – with trans and non-binary communities experiencing higher levels of abuse.

The assessment also revealed significantly high levels of mental ill-health, with more than half of all respondents reporting issues such as depression, anxiety and stress, with the highest rates experienced by trans and non-binary individuals.

The comprehensive assessment was undertaken to better address gaps in knowledge about the health and wellbeing of LGBT+ patient groups, to better inform approaches to public health for LGBT+ people, across seven groups: lesbian and gay women, gay men, bisexual women, bisexual men, trans women, trans men (trans masculine) and non-binary people across the Greater Glasgow & Clyde and Lothian areas.

Nicky Coia, Health Improvement Manager at NHSGGC said: “This report should serve as a wake-up call for everyone involved in the health and wellbeing of LGBT+ communities.

“Too many continue to suffer from discrimination and abuse, are experiencing social isolation and loneliness and suffering the impacts of poor mental health. This, combined with the poor socio-economic situations many find themselves in, contributes to a substantial health inequalities on every measure of wellbeing.

“While there are positives to be taken in terms of how LGBT+ experience healthcare, particularly from the GPs, there is still work to be done to improve access to, and experience of, person-centred healthcare, that treats the individual, no matter their gender identity or sexual orientation.”

Dona Milne, Director of Public Health and Health Policy at NHS Lothian, said: “We interviewed more than 200 people and over 2,500 people took part in the online survey as part of this research. Their experience is in stark contrast to the progress that many of us may feel has been made in achieving equality in Scotland.

“I want to thank everyone who took part and express our shared desire to highlight this as a key public health issue and deliver real improvements in health and wellbeing for LGBT+ communities.”

Some of the key findings include:

·       Nearly three in four (73%) survey respondents said they ever felt isolated from family and friends and nearly two in five (38%) had felt lonely all of the time or often in the previous two weeks.  Trans and non-binary people showed the highest levels of isolation and loneliness.

·       The survey showed that overall more than half (54%) of respondents said they had mental health problems e.g. depression/anxiety/stress, but this was higher for trans masculine (75%), non-binary people (72%) and bisexual women (61%).  Only one in four (25%) survey respondents rated their general mental and emotional wellbeing positively – but this was lowest for non-binary (9%) and trans masculine (12%). 

·       Of those who answered the question in the survey, nearly one in three (31%) said that they had ever made an attempt to end their life.  Although the prevalence of suicide attempts was high across all LGBT+ groups, it was highest among trans masculine and non-binary people, with nearly half of respondents in these groups saying they had made a suicide attempt.

·       Overall, nearly half (44%) of LGBT+ people in the survey said they had been discriminated against in the last year, but this was highest for non-binary (65%), trans masculine (62%) and trans women (55%).

·       The survey findings show that 37% of LGBT+ respondents had ever experienced an abusive relationship; identity groups with the highest proportion reporting abusive relationships were trans masculine (48%), non-binary (45%), bisexual women (43%) and trans women (38%). 

·       only 59% overall rated their general health positively.  Gay men and gay/lesbian women were the most likely to rate their health positively, while trans masculine and non-binary people were the least likely. A third (33%) of LGBT+ people had a long-term condition or illness that substantially interferes with their day to day activities. 

·       Most (88%) survey respondent had financial worries at least some of the time. One in six (18%) had experienced food insecurity in the previous 12 months.  One in eight (13%) had ever been homeless.

The report’s authors have made 41 recommendations, including an immediate request that all Scottish local authorities should provide or fund at least some, community-led groups or activities for LGBT+ people, with provision for cultural, sport and physical activity and social interest groups, as well as targeting specific identity groups.

Other recommendations call for improvements in LGBT+ education in schools, improved LGBT+ training and awareness for health and other staff, improvements in mental health and gender identity clinics and more visibility of LGBT+ inclusive services.

Professor Nicola Steedman, Deputy Chief Medical Officer at the Scottish Government, said: “The assessment lays bare the fact that too many LGBT+ people are subject to significant inequalities which impact every aspect of their lives. I’m grateful to everyone who took part in the research and NHS Greater Glasgow and Clyde and NHS Lothian for carrying out this important work.

“The Scottish Government is committed to reducing inequality – in all its forms – and we welcome the report. We will continue to work with, and across our partners, to improve the health and wellbeing of our LGBT+ communities.”

Mark Kelvin, Chief Executive of LGBT Health and Wellbeing, said: “This report highlights what many of our community members experience in their daily lives.

“Whilst many people believe that LGBTQ+ people have achieved equality, this report reminds us that there is still a lot of work to do. Scotland is celebrated as being a welcoming and inclusive country and whilst that is true, almost half of LGBTQ+ respondents experienced discrimination in the past year.

“The report also highlights the health inequalities that still exist for many of us and provides very useful and realistic recommendations that will help LGBTQ+ people to live well.

Speaking specifically on how COVID-19 has impacted the LGBTQ+ community, Mark pointed out the dependency on LGBT nightlife for socialisation. He added: “Whilst the closure of pubs and clubs can be seen by many as an inconvenience, for LGBTQ+ people queer-friendly spaces provide an important place of safety and belonging.

“This meant that during the months of closures, people were shut-off from contact with others like them. I’m hopeful that this report can restart conversations with local authorities and other interested parties to open LGBTQ+ Community Centres, where people of all ages can access a place of safety, information, support, and importantly connection.”

Mhairi Crawford, from LGBT Youth Scotland, said: “LGBT Youth Scotland notes the publication of the health needs assessment of LGBT research findings report. We know from our own recently published research that health care remains a significant issue for LGBTI young people in Scotland.

“In particular, we welcome the recommendations for healthcare providers and other public bodies to undergo training, which is a key part of our LGBT Charter, in which we also support organisations to undertake reviews of policies and practice to ensure that they are as welcoming as possible for the LGBTI community, whether they are staff, clients, pupils or wider stakeholders.

“We know that alcohol free spaces are highly valued by young people we work with in our youth spaces – so we welcome the recommendation for more LGBT spaces that don’t have alcohol.

“Finally, we also welcome the recommendation that schools should undertake the LGBT Charter as we know this can have a massive impact on daily lives of LGBTI young people.”

Ten years of success for Scotland’s Family Nurse Partnerships

More than 10,000 young mothers and their children have been helped by a decade-long programme since it began as a pilot in NHS Lothian.

An analysis report on the Family Nurse Partnership shows positive results for mothers and babies in areas such as breastfeeding rates and stopping smoking, with most children meeting all their milestones, and 95% receiving all their immunisations.

The Family Nurse Partnership supports young, first-time mothers to prepare for motherhood and throughout the first two years of their child’s life.

Women’s Health Minister Maree Todd met mothers and staff who have taken part. She said: “Over 10,000 young women have now received support through this programme since it started, which is a fantastic milestone.

“Family nurses help mothers to think about the future, what kind of parent they want to be and their goals and aspirations for other areas of their lives like education and employment.

“Earlier this year we committed to expanding the programme to all young first time mothers aged 21 and under by the end of 2024. Where possible, we will also target first time mothers under the age of 25 who are care experienced or from the most deprived communities. This expansion will mean we can support up to an additional 500 families per year by 2025.”

Val Alexander, service manager of the Family Nurse Partnership, who has been with the programme since it began, said: “We are so proud of the Family Nurse Partnership and everything our clients have achieved. 

“The Family Nurse Partnership programme works to support young, first-time mothers to prepare for motherhood and continues that support for them and their child through the first two years.

“FNP was first delivered in NHS Lothian and to see it extended across Scotland to reach thousands more families is something very special for all of us.

“This 10-year analysis of the delivery of the service across Scotland will help us to see how far we have come and map out our goals and ambitions for the future of the programme and young families.”

Annual health checks for people with learning disabilities

Health boards are to share £2 million to deliver annual health checks for all people with learning disabilities.

The new service will help to address health inequalities and ensure that people in this group are able to have any health issues identified and treated as quickly as possible.  

Health checks will be delivered in the local community.

Mental Wellbeing Minister Kevin Stewart said: “Unfortunately we know that people with learning disabilities can experience poorer health than the rest of the population.

“Evidence suggests that people in this group are twice as likely to die from preventable illness. This is clearly unacceptable and I hope these annual checks will help to address this and begin to reduce this health inequality.

“Health issues like respiratory disorders, diabetes and thyroid problems can become serious if picked up too late. But if they are detected and treated early there’s a much better chance of a positive outcome and a good quality of life. That is where these annual health checks will be so valuable.”

 Eddie McConnell, Chief Executive of Down’s Syndrome Scotland, said: “This is a really significant moment in the lives of people with learning disabilities and their families. 

“The rollout of the annual health checks across Scotland has the potential to be a game-changer in improving the health outcomes for this community who deserve equal access to good health.  It is no exaggeration to say that a well-implemented annual health check could save lives.”

Community Learning Disability Nurse, Sharon Bandeen, who has an adult son with Down’s Syndrome, said: “The new health checks are a welcome additional layer of good health practice for people with learning disabilities in Scotland. 

“It is so important that everyone living with a learning disability has equal access to the health checks, no matter where they live in Scotland.”

‘Significant health inequalities persist’

Latest Health Inequalities statistics published

Scotland’s Chief Statistician today announced the publication of the latest Long-term Monitoring of Health Inequalities report.

The report includes a range of indicators selected in order to monitor health inequalities over time. These indicators include: healthy life expectancy, premature mortality, all-cause mortality, baby birthweight and a range of morbidity and mortality indicators relating to alcohol, cancer, coronary heart disease and drug use. The report investigates both absolute and relative inequalities.

The COVID-19 pandemic is likely to have had an impact on the most recent data for most indicators included in this report. Where there has been analysis undertaken to assess the impact of the pandemic that is relevant to a specific indicator the details have been included in the corresponding chapter.

MAIN FINDINGS

With the exception of the healthy birthweight indicator, significant health inequalities persist for each indicator covered in the report.

Changes in the gap between the most and least deprived areas in Scotland

For a number of indicators, absolute inequalities (the gap between the most and least deprived areas) have narrowed over the longer term:

  • Heart attack hospital admissions (aged under 75 years) – the gap in 2020 (63.2 per 100,000 population) is the lowest it has been since 2008 (58.4 per 100,000). The reduction in the gap between 2019 and 2020 has been driven by a 7% decrease in admissions in the most deprived areas and an increase of 13% in the least deprived areas.
  • Coronary heart disease (CHD) deaths (aged 45-74 years) – the current gap is 47% lower than at the start of the time series (185.4 per 100,000 in 2020 compared to 347.3 per 100,000 in 1997). However, between 2019 and 2020 the CHD mortality rate increased in both the most and least deprived areas (by 14% and 40% respectively).
  • Alcohol-related admissions (aged under 75 years) – the gap was widest at the start of the time series in 1996 (613.0 per 100,000) and reduced to its lowest level in 2020 (322.0 per 100,000). Between 2019 and 2020 the rate of admissions decreased in both the most and least deprived areas (by 14% and 10% respectively). It is possible that this reduction is a result of hospital admissions policies associated with the COVID-19 pandemic.
  • Alcohol-specific deaths (aged 45-74 years) – the gap has reduced from a peak of 184.7 per 100,000 in 2002 to 71.8 per 100,000 in 2020, the lowest in the time series.
  • Low birthweight – the absolute gap in 2020 was 3.4 percentage points, the lowest it has been since 2013 (3.2 percentage points).

The gap in healthy life expectancy for males has increased since the start of the time series, from 22.5 years in 2013-2015 to 23.7 years in 2018-2020.

The gap in premature mortality rates increased to its highest point since 2004 (680.4 per 100,000 in 2020 and 683.2 per 100,000 in 2004), although the gap remains lower than at the start of the time series (648.7 per 100,000 in 1997).

In 2020 the absolute gap in cancer deaths was the highest it’s been since 2015 at 353.7 per 100,000.

Whilst the gap for all-cause mortality (aged 15-44) reduced to its lowest level in 2013 (159.6 per 100,000), it has shown an overall increase since then and was 241.1 per 100,000 in 2020.

The gap for drug-related hospital admissions has increased overall since the start of the time series to reach a high of 696.1 per 100,000 in 2019/20 before falling slightly to 625.1 per 100,000 in 2020/21. This decrease may be due to hospital admission policies associated with the COVID-19 pandemic.

For the other indicators in the report, there has either been little change or long-term trends in the absolute gap are less clear:

  • Healthy life expectancy for females
  • Cancer incidence

Relative inequalities

The relative index of inequality (RII) indicates the extent to which health outcomes are worse in the most deprived areas compared to the average throughout Scotland. It is possible for absolute inequalities to improve, but relative inequalities to worsen.

There are three morbidity indicators for which the RII can reasonably be compared with one another: alcohol-related hospital admissions; heart attack hospital admissions; and cancer incidence.

Amongst these, relative inequalities in alcohol-related hospital admissions have remained highest over the longer term, though they have been decreasing. Relative inequalities in heart attack admissions have increased in recent years and cancer incidence inequalities have remained relatively stable.

Amongst the three comparable mortality indicators (CHD deaths, alcohol-specific deaths and cancer deaths), relative inequalities in both CHD and cancer deaths have increased over the long term whilst the RII in alcohol-specific deaths have shown more year to year fluctuation and are currently lower than at the start of the time series (2.02 vs 1.80). However, relative inequalities in alcohol-specific deaths remain higher than the other comparable mortality indicators.

Of the other indicators in the report, the two indicators relating to mortality (premature mortality for those aged under 75 and all-cause mortality for those aged 15-44) and healthy life expectancy for males and females have all shown increases in relative inequality over time.

Full statistical publication

long-term-monitoring-health-inequalitiesDownload

£15 million to help improve mental wellbeing in communities

A new fund has been established to help tackle the impact of social isolation, loneliness and the mental health inequalities made worse by the pandemic. The £15 million Communities Mental Health and Wellbeing Fund aims to support adult community-based initiatives across Scotland.

Grass roots community groups and organisations will be able to benefit from the funds to deliver activities and programmes to people to re-connect and revitalise communities building on examples of good practice which have emerged throughout the pandemic.

Mental Wellbeing Minister Kevin Stewart launched the fund at Saheliya in Edinburgh, a specialist mental health and well-being support organisation for black and minority ethnic women and girls.

Mr Stewart said: “This funding reflects the importance we place on promoting good mental health and early intervention for those in distress and will help develop a culture of mental wellbeing and prevention within local communities.

“It is vital now, more than ever as we start to re-open society that we support the mental health and wellbeing of individuals. I am very keen that this benefits communities across all of Scotland.

“I was pleased to be able to visit Saheliya this morning and meet some of the people involved with running and the project, and some of the people they help.”

A range of charity-support bodies and social enterprises, known as third sector interfaces,  will manage the fund in partnership with local integrated health authorities and other partners including Community Planning Partnerships and local authority mental health leads.

The Communities Mental Health and Wellbeing Fund is part of the wider £120 million Recovery and Renewal Fund announced in February 2021 to ensure delivery of the commitments set out in the Mental Health Transition and Recovery Plan in response to the mental health need arising from the pandemic.

Latest Accident & Emergency Activity report highlights scale of health inequalities

The latest Hospital Episodic Statistics (HES): Hospital Accident and Emergency Activity 2020-21 published by NHS Digital and NHS England show that attendance rates in the most deprived areas of England were almost double the attendance rates in the least deprived areas.

The data show in 2020-21 in the most deprived areas of England there were 39,161 attendances per 100,000, while in the least deprived areas this figure is almost halved to 20,784.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “The pandemic has highlighted the scale of health inequalities across the country. The data show that those from the most deprived area are almost twice as likely to visit their Emergency Department than those from the least deprived area.

“We welcome NHS England’s willingness to engage on the issue and address health inequalities, but we must see real action taken. We also look forward to the formation of the Office for Health Improvement and Disparities (OHID) and would welcome the opportunity to input into their agenda.

“The health inequalities are clear and tackling them will be a serious challenge. On a fundamental level, if the government is serious about levelling up and tackling these inequalities, the first steps must be to fund and support local authorities and Integrated Care Systems and invest in preventative health.

“The scale of health inequalities means tackling homelessness; immigrant health; domestic violence; and youth violence. While supporting those with; mental health illnesses; learning disabilities; and both drug and alcohol addiction.”

There were also 1.39 million reattendances in 2020/21 which is equal to 10.4% of all unplanned attendances. This is the highest figure on record and up 1.7 percentage points when compared to the previous year 2019/20.

Dr Henderson continued: “It is also deeply concerning that one in ten patients reattended the Emergency Department (ED), it is vital that patients have the appropriate information and support available to manage their condition following their visit to the ED. We need better data on this issue to understand what is driving people to reattend.”

In 2020/21 302,784 patients stayed in an Emergency Department for 12-hours or more from time of arrival, this is 21 times higher than the 12-hour figure from decision to admit, which is 14,150.

Dr Henderson concluded: “Utilising the right metrics in Emergency Departments is crucial to improving patient safety. It is vital that we measure health equalities, reattendances, and 12-hour stays from time of arrival across the country.

“Analysing these metrics will help us, NHS England and the government to take effective action to support the patients, communities and areas that need it most. That means fewer reattendances, closing the gap on health inequalities, reducing long stays, and improving the patient experience.

“This data paints a very real picture of the state of health and the state of healthcare in this country. We welcome the engagement of NHS England and the government’s agenda on these matters, but we must now see the tangible actions taken to tackle these issues.”

Scottish Government launches Women’s Health Plan

Plans to improve health and reduce inequalities for women in Scotland have been published today by the Scottish Government. Women’s Health minister Maree Todd said the plans are an ‘ambitious vision’.

Scotland is the first country in the UK to have a Women’s Health Plan, which outlines ambitious improvement and change in areas including menopause, heart health, menstrual health including endometriosis, and sexual health.

The Women’s Health Plan sets out 66 actions to ensure all women enjoy the best possible healthcare throughout their lives. It takes on board the real life experiences of women who have given their feedback on what is important to them.

Key actions include:

  • appointing a national Women’s Health Champion and a Women’s Health Lead in every NHS board
  • establishing a Women’s Health Research Fund to close gaps in scientific and medical knowledge
  • providing a central platform for women’s health information on NHS Inform
  • setting up a Women’s Health Community Pharmacy service
  • commissioning endometriosis research to develop better treatment and management, and a cure
  • developing a menopause and menstrual health workplace policy, and promoting it across the public, private and Third Sector
  • improving information and public awareness of heart disease symptoms and risks for women

Women’s Health Minister Maree Todd said: “Our vision for women’s health is an ambitious one – and rightly so. It is clear that wider change must happen to ensure all our health and social care services meet the needs of all women, everywhere.

“Women’s health is not just a women’s issue. When women and girls are supported to lead healthy lives and fulfil their potential, the whole of society benefits.

“Together, we are working to address inequalities in all aspects of health that women are facing. The Women’s Health Plan signals our ambition and determination to see change for women in Scotland, for their health and for their role in society. We want Scotland to be a world leader when it comes to women’s health.”

Head of British Heart Foundation Scotland James Jopling said: “Coronary heart disease is one of the leading causes of death in women in Scotland and kills nearly three times as many as women as breast cancer.

“At every stage – from the moment they experience symptoms through to their cardiac rehabilitation – women with heart disease can face disadvantages. We need to improve understanding of the risks for women and increase their awareness of the symptoms of a heart attack.

“We must also promote equality of treatment for women with heart disease within the healthcare system, at every point in their journey. The publication of the Women’s Health Plan, with heart health as a priority, is a welcome step to tackle these inequalities and we look forward to working together to help save and improve lives.”

Vice President of the Royal College of Obstetricians and Gynaecologists Dr Pat O’Brien said: “We welcome Scotland’s commitment to this ambitious and detailed plan as a key marker to making improvements to healthcare services for all women from different backgrounds. 

“We are pleased to see the Women’s Health Plan adopts an approach to prioritise the health and wellbeing of women throughout every stage of their lives, and ensure they can access care when they need it  – something we called for in our Better for Women report.

“It is important that all women are included and consulted about how health services can fit their needs. This Plan has been developed with extensive consultation with a diverse group of women, ensuring that the health service is inclusive and respectful, and can work to focus on closing inequalities in women’s health experience and outcomes.”

Read the Women’s Health Plan here.

New £7m consortium funded to boost research on urban spaces and tackling health inequalities

The University of Edinburgh, Queen’s University Belfast and University of Liverpool have been awarded over £7.1 million from the UK Prevention Research Partnership (UKPRP) as part of a consortium to investigate the impact that nature can have in helping to prevent and reduce health inequalities in urban areas. 

The Consortium, ‘GroundsWell: Community-engaged and Data-informed Systems Transformation of Urban Green and Blue Space for Population Health’ will explore how transforming cities with nature can reduce health inequalities, primarily around chronic and non-infectious diseases such as heart disease, diabetes, cancer and mental health.  

Over the five-year project, the interdisciplinary team will develop innovative approaches to work with communities where there are high levels of health inequalities. They will work with communities as key partners to develop and implement ways to improve health inequalities and prevent a range of chronic illnesses through harnessing the positive impact of nature.   

Dr Ruth Hunter, from the Centre of Public Health at Queen’s University Belfast and Groundswell Co-Director, said: “There is strong evidence that natural environments within urban areas, such as parks, woodlands (green spaces) as well as lakes and beaches (blue spaces), have positive impacts on health. 

“These urban green and blue spaces could be huge assets for protecting and equalising health if they were available, accessible, valued and well-used, particularly by less advantaged groups. The problem is that they are not, which is what this project aims to address.” 

Dr Hunter added: “We are delighted to receive this funding from UK Prevention Research Partnership. Working with a range of experts across health, data and community engagement, over the next five years we will seek solutions to improve our urban environment that will in-turn improve population health.” 

UKPRP supports multidisciplinary teams looking at ways to prevent non-communicable diseases such as heart disease, poor mental health, obesity, cancer and diabetes. Non-communicable diseases make up the majority of illnesses in the UK and account for an estimated 89 per cent of all deaths.   

Professor Kevin Fenton, London Regional Director for Public Health England and Chair of the UKPRP Scientific Advisory Board, said: “UKPRP is an important and timely programme that we need to address health inequalities and prevent the onset of non-communicable disease.  

“The projects funded under this programme are pushing the boundaries of prevention research by taking multidisciplinary approaches to addressing the complexities of population health, with the aim of improving people’s lives and health.  

“As we look to build back fairer from the pandemic, the creation of healthy communities and places is a key priority.” 

The project will use a range of approaches to ensure that communities, including residents, businesses and organisations, are fully represented. 

The Consortium will comprise of active, equal and embedded members and partners at all stages of decision making and will involve co-designing solutions that will benefit communities. 

Professor Sarah Rodgers, from the University of Liverpool and GroundsWell Co-Director, said: “Working with local authorities and charities, we will record how our environments change through time.

“Knowing when parks were adapted to encourage new visitors and how this subsequently impacts health outcomes will help provide robust evidence on what works and for whom. Everyone should have access to the right environments to support their health and wellbeing.” 

Professor Ruth Jepson, from the University of Edinburgh and Groundswell Co-Director, added: “We propose a new way of working which encourages communities and citizens to work with our partner organisations to plan, design and manage urban green and blue spaces so that they benefit everyone, especially those who need it most. 

“Through our partnerships and with the active involvement of our communities, we will identify small and large scale projects which can be developed and evaluated. We will involve communities and citizens in all stages of the work; from planning and prioritizing, to collecting data through citizen science apps, to writing, speaking and blogging on what is working well and what is not.” 

Health inequalities and the recovery from COVID-19

The impact of the COVID-19 pandemic has not been felt evenly across Scotland. Some people have been much more likely to get ill or die from COVID-19, and others have been disproportionately affected by the measures taken to control the virus (write ALEX PRIESTLY, Researcher and LIZZY BURGESS, Senior Researcher, Health and Social Care).

This blog looks briefly at health inequality in Scotland before the pandemic, how the virus has had an uneven impact, and what could be done during the recovery to address these differences in health across the nation. For a more detailed look at the effects of COVID-19 on health inequality, check out the SPICe research briefing Health Inequality and COVID-19 in Scotland.

What are health inequalities?

Health inequalities are “avoidable and unjust differences in people’s health across the population and between specific population groups”. Many people think they are unjust and avoidable as they are caused by societal and economic factors known as the ‘social determinants of health’.

Which groups are affected by these inequalities?

People living in deprived areas, people with physical and learning disabilities, people belonging to ethnic minority groups and unemployed people are just some groups who are more likely to have worse health than the rest of the population. This list is not exhaustive, and where people fit into more than one of these groups, the effects can be compounded. This is known as intersectionality – a word used to describe the “interconnected nature of social categorisations such as race, class, and gender, creating interdependent systems of discrimination or disadvantage”.

What’s health inequality like in Scotland?

Before the COVID-19 pandemic, health inequalities were very marked for some groups in Scotland.

In 2019, healthy life expectancy, the length of time someone can expect to live in good health, was 26 years shorter for men and 22 years shorter for women living in the most deprived parts of Scotland compared to those in the least deprived.  

In the most deprived areas, the premature death rate was over four times greater than in the least deprived areas.

People living in more deprived areas have lower levels of wellbeing than those living in less deprived areas. The hospital admission rate for heart attack is also higher for those living in deprived areas, more than twice that of those living in the least deprived areas.

Cancer incidence is also more common in the most deprived areas of Scotland. Public Health Scotland found mortality rates for all cancers combined are 74% higher in the most deprived compared with the least deprived areas.

How uneven has the impact of COVID-19 been?

Early in the pandemic, some politicians and commentators referred to COVID-19 as “a great leveller” which would affect everyone equally. It has become clear that this is not the case. A few examples are outlined below, but many more groups have been affected particularly badly.

Research during the first wave of COVID-19 infection found that people with learning disabilities were twice as likely to test positive for COVID-19, twice as likely to be hospitalised, and three times as likely to die from COVID-19 than the general population.

Those living in the most deprived areas were more than twice as likely to be admitted to hospital, and twice as likely to die from COVID-19.

People from ethnic minority backgrounds have also been disproportionately affected. National Records of Scotland analysed deaths from COVID-19 in the first wave of infection in 2020, and found that people of South Asian background were twice as likely to die compared to white people. When Public Health Scotland analysed data looking at the second wave of infection, they found that people of South Asian background were three times more likely to die or be hospitalised than white people.

The figure below shows how the impact of COVID-19 has varied by area of deprivation.

Here we’ve only looked at direct health harms. Indirect harms, such as longer waiting times for treatment, cancer screening programmes being paused, and worsening mental health, resulting from the restrictions to control the virus, rather than the virus itself, have also disproportionately affected some groups more than others. You can find out more about the indirect health harms in the SPICe research briefing Health Inequality and COVID-19 in Scotland.

How could we address health inequality as we recover from the pandemic?

So we’ve seen that some groups mentioned above (and many others) were more likely to experience poor health before COVID-19, and have suffered more than the general population during COVID-19. How will we ensure that these groups are not left behind as we recover from COVID-19?

The Institute of Health Equity published ‘Build Back Fairer: the COVID-19 Marmot Review’ in December 2020. This report makes recommendations for England, but many of them are relevant in Scotland too, looking at factors like employment, housing, previous health conditions and ethnicity.

Looking specifically at Scotland, the Scottish Government set up the Social Renewal Advisory Board to make proposals for how to renew Scotland after the pandemic. Its report “If not now, when?” looks at how income could be distributed more fairly and how everyone should have access to basic rights and services.

The Mental Health Foundation, has looked at how the COVID-19 recovery can address worsening mental health in Scotland. Its manifesto outlines building a ‘wellbeing society’, where the causes of poor mental health are addressed highlighting the importance of prevention.

Most organisations who have looked at the COVID-19 recovery’s impact on health inequality agree that it needs to focus on addressing the fundamental causes of differences in people’s health across the population, rather than just dealing with the symptoms.

To find out more check out the SPICe research briefing Health Inequality and COVID-19 in Scotland.

Alex Priestly, Researcher and Lizzy Burgess, Senior Researcher, Health and Social Care

‘Vaccine Inclusion: reducing inequalities one vaccine at a time’

Voluntary Health Scotland launches new report

Voluntary Health Scotland (VHS) has launched its briefing report ‘Vaccine Inclusion – Reducing inequalities one Vaccine at a time’.

The report explores the key barriers and enablers to accessing the COVID-19 vaccine and how the vaccine delivery model can be improved to reduce inequalities and provide holistic support to those who need it the most.

The key messages from the report are that our health system has a clear moral and human rights duty to those vulnerable groups who fall through the gaps of public service provision to ensure that they are not failed by this crucially important public health intervention.

Some of the key demographics highlighted within the research are at very high risk if they do contract COVID-19, including people who are homeless, prisoners, people living in poverty, people who abuse drugs and alcohol, black and ethnic minority groups, gypsy travellers, refugees and asylum seekers.

The report calls against viewing the Covid-19 vaccine programme as a silo: the programme has to be part of a whole-system, preventative approach to public health and to health inequalities. This requires a joined up suite of interventions that not only help people access the vaccine but supports them to stay well afterwards and enables them to adhere to the Covid-19 regulations safely.

There are a number of recommendations calling for improvements in the communications relating to the COVID-19 vaccine, a need to prioritise collection and analysis of local data about uptake of Covid-19 vaccine by different communities and groups as well as the need to conduct active research into the ongoing vaccination programme.

The report also recommends developing a rolling programme of outreach vaccination clinics, services and events as well as provision of accessible, affordable transport to vaccine centres and clinics.

Finally, the report highlights the importance of involving third sector and community partners in the planning, communications and delivery of public health interventions that could help prevent, mitigate and reduce health inequalities.

The findings of the report will be shared with Scottish Government, Public Health Scotland, NHS Boards as well as a range of key stakeholders across the third sector.