A team of researchers is calling on public sector leaders to take action to meaningfully deliver on health inequalities – as it reveals that Scotland is missing key evidence to determine the impact of current policies.

More than a year after the Health Foundation laid bare the state of Scotland’s health inequalities, follow-up research shows poor progress to tackle inequalities and, in some areas, worsening trends.

Findings from the newly established Scottish Health Equity Research Unit (SHERU) point to critical gaps in the way the government evaluates it policy efforts.

In its first report, SHERU shows Scotland currently lacks the transparency and data on policy outcomes needed to see how effective funding and policies are at improving health inequalities.

SHERU emphasises the government is not currently investing the necessary skills and resources in proper evaluation to fully assess either the effectiveness or the value for money of its own spending.

It comes after Edinburgh researchers outlined how scrapping the two-child benefit cap could improve children’s health, reduce health inequalities, and bring potential savings to the NHS.

The report says:

‘If the government wishes to reduce inequalities during a period when savings are being made to public service spending, a strong understanding of its programme impacts is essential.

‘While tackling societal issues extends beyond government, people often look to the government for leadership. To be credible and drive real change, public sector leaders need to be accountable for their decisions and spending.

‘Right now, we lack the transparency and data needed to enable accountability for major policy decisions and expenditures.’

Chris Creegan, Director of the Health Foundation’s Driving Improving Health & Reducing Inequalities in Scotland Programme, says the “scant evidence of positive improvements” underlines the need for change.

He says the findings present a “deeply troubling picture” and makes clear that despite fiscal constraints and UK policy, that Scotland does have the power to act.

The authors from the University of Strathclyde’s Centre for Health Policy and Fraser of Allander Institute stress that the Scottish government needs to improve local governance and oversight to ensure policy change is having the desired effect.

Emma Congreve, Deputy Director of the Fraser of Allander Institute and co-lead of SHERU,

explains that the government must improve the way it monitors policies to deliver the change needed:

“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.”

Only around 30% of people in poverty live in the most deprived areas, but action against health inequalities is often targeted here.

The researchers say policymakers must consider how inequalities in household incomes  – rather than just the areas people live – play a role in poverty and health.

This comes after deep-end GPs working in the most deprived areas called for more outreach work and personalised care as they found the reasons for patient missingness are complex and vary across the country.

Scotland’s First Minister emphasised the importance of addressing child poverty alongside delivering public service reforms in the latest Programme for Government, but did not detail how the government intends to monitor progress.

This also comes amidst “difficult” in-year cuts to health and care.

SHERU says it will work to ‘bridge the gap between rhetoric and reality’ and has urged public sector leaders to better understand what will drive improvement in health inequalities.

Probing government actions

Professor Kat Smith, co-director of the Centre for Health Policy and co-lead of SHERU, highlights the importance of investigating how government actions shape the socioeconomic determinants of health:

“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.”

SHERU is also calling on the government to recognise the interconnected socioeconomic factors which influence health and wellbeing when developing policy and evaluate the broader impacts of existing policies.

This means looking at how work from different areas, including education, employment, housing and social security, as well as health and social care, influence the broader goals of reducing poverty and improving health inequalities.

Read more: Can Scotland make health fairer?; Unpaid carers “spiralling” in cost-of-living crisis; Analysis: Why people are left behind; Rural health inequalities focus of £1m study; The health benefits of being able to work; Charity: Tax alcohol retailers for the harm they cause 

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