MINISTERS are to order a “fundamental re-think” of government efforts to close Scotland’s massive health gap between rich and poor, conceding that legal curbs on smoking and drinking are not effective alone.
In an article for Scotland on Sunday today, the Minister for Public Health, Michael Matheson, declares that while the flagship smoking and alcohol laws passed by MSPs in recent years have cut deaths, they will “not end the problem” of health inequalities in Scotland.
His comments follow a hard-hitting report by Scotland’s chief medical officer, Dr Harry Burns, which warned that “magic bullet” policies such as bans on smoking and healthy eating drives actually widened the gap between rich and poor because affluent people were far more likely than the poor to respond to them.
The latest figures have shown that Scotland now has a health gap wider than anywhere else in Europe, with the poorest people in the country dying 20 years before the country’s richest.
Among the poorest of all, healthy life expectancy for men is now just 47 years of age. Matheson signals today that a fresh approach is required which focuses on boosting the social and economic chances of poorer families, rather than in tackling the health problems after they have occurred.
“Scotland is rightly seen as a world leader in public health legislation and policy, with great strides taken in recent years that have seen smoking rates decline and alcohol-related deaths reduce,” Matheson said.
“So is better health education and delivery the solution? It is important, but the truth is the causes of health inequalities are extremely complex and concentrating solely on health solutions will simply not end the problem.”
He adds: “We need to shift the emphasis of our approach from dealing with the consequences of health inequalities to tackling the underlying causes such as poverty, support for families and improving our physical and social environments.”
The scandal of Scotland’s health gap was revealed in Scottish Government figures last year. Among men, the 10 per cent living in the most affluent parts of the country can expect to live until the age of 82, or 13.3 years more than those in the most deprived parts of the country. Women in the wealthiest parts of the country live on average to 84.6 years, compared with just 67.1 for those in the poorest.
The gap in healthy life expectancy is even wider. Men in the richest parts of the country can expect to reach the age of 70 before experiencing any serious health problems, compared to just 47.4 years for those in the poorest areas. For women, the gap is similar, at 51.1 years for the poorest and 73.2 years for the wealthiest.
Burns used his annual report in December to declare that health improvement strategies, like the historic ban on smoking in public, were not actually reducing the health gap. He said: “All these programmes are vitally important and will significantly improve health in those who respond positively.
“But they are all likely to widen health inequalities. The more affluent, who are much more likely to be in control of their lives are much more likely to benefit from such programmes.”
Instead, he said the best results could come from measures such as ensuring a healthy pregnancy, supporting families, giving out-of-work youngsters better job skills, and finding ways to boost physical activity.
Matheson adds today: “The chief medical officer calls for a fundamental rethink based on a more complete understanding of the basis of health inequalities That is an aim I fully support.”
NHS public health leaders last night said they were in favour of a reformed approach.Gerry McCartney, head of the Public Health Observatory, said: “Our health inequalities are the widest in Europe. Those inequalities are in the largest part determined by economic and social inequalities.
“The minister is right to say we have to look beyond health policy. It is not sufficient to rely on smoking bans and minimum unit pricing for alcohol, important as they may be. We need to reduce the social and economic inequalities to bring down the health inequalities.”