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Comment: We know what’s wrong, so what will we do?

Posted 25 January, 2023 by Jennifer Drummond

We need a radical shift and long-term prevention measures to genuinely improve outcomes for Scotland’s most deprived communities, writes David Finch (pictured)

Our Health Foundation report ‘Leave no one behind: The state of health and health inequalities in Scotland (click here to access)’ was published earlier in January. It is the summation of a multi-stranded review undertaken over the past 12 months, focusing on how Scotland has fared on health and health inequalities in the two decades since devolution.

The most glaring predicament revealed by the review is that the fortunes of those living in our most deprived communities are peeling away from the rest.

Compiled from research commissioned from the University of Glasgow, the Fraser of Allander Institute, Nesta in Scotland, and the Diffley Partnership, with the help of our expert advisory group, it has revealed some particularly worrying trends.

Poor childhood health, rising infant mortality rates and a persistent attainment gap

Early childhood development and the school years play a crucial role in determining future health. Poor outcomes in childhood can continue to have significant implications in life. For example, school readiness affects educational attainment, eventual access to job opportunities, lifetime income and ultimately health. Yet there are a number of concerning trends that risk the perpetuation of health inequalities for children now and later in their lives.

Infant mortality is a good indicator of societal health. The rate at which children die before their first birthday is rising for people living in the most deprived fifth of areas but is static or falling among the rest.

Since 2000 infant mortality has declined overall. However, from 2014 infant mortality rose in the most deprived areas and fell in the least deprived 60% of areas. Between 2016-18 infant mortality rates in the most deprived areas were 2.6 times the rate in the least deprived areas.

In the past decade, inequalities have also widened for infant immunisation uptake, low birth weight and childhood obesity. The overall proportion of children at risk of obesity has remained stable over the past 20 years in Scotland, with around 1 in 10 children at risk of obesity at the start of school. But the risk of childhood obesity has gradually fallen in the least deprived areas and gradually risen in the most deprived areas. By 2018-19 children living in the most deprived fifth of areas were twice as likely to be at risk of obesity, than those in the least deprived.

Further evidence of the rise in health inequalities is seen in Early Years. The proportion of 27 to 30-month-old children of development concern from the most deprived areas in 2019-20, only matched outcomes of the children from the next most deprived fifth of areas recorded in 2013-14.

The significant poverty-related attainment gap for primary school pupils in Scotland has not closed over the past two decades. The pandemic has reversed any progress in closing a similar attainment gap for secondary age children.

Life expectancy already varies greatly across Scotland. In the most deprived areas, men are dying more than 13 years earlier than their peers in the least deprived areas – and women almost a decade earlier.

Action is needed now to improve outcomes through childhood to support future health and reduce such inequalities.

Building blocks for a healthy community

A healthy community derives from a range of factors: stable jobs, good pay, quality housing and education. Poor health is almost inevitable when some or all of these factors are absent.

Scotland's wide and sustained health inequalities are being driven by the accumulation of severe multiple disadvantages, a lack of improvement in living standards and public service fragility due to the ongoing impact of austerity.

So, we know what is wrong now, in more detail than ever. The question is, what can we do about it? Because, if we fail to change course, Scotland’s most deprived communities are likely to continue suffering from poor quality of life and to die younger.

A radical shift in approach is needed. The Scottish Government, local authorities, businesses and the third sector must come together and collaborate closely with communities. Ultimately, we must shift focus from short-term measures to longer term preventative interventions. This is a wiser use of the funding available which will create a healthier nation.

Our review has shown that the public will support a longer-term approach, and that existing approaches can be adapted to have greater impact. This includes Local Child Poverty Action reports which can be used more effectively to build collaboration across sectors and drive action on underlying causes of poverty which in turn will support better health.

This is no longer about plans and strategies. It is about political will, and decisive action.

David Finch is Assistant Director of the Health Foundation’s Healthy Lives team

Children in Scotland conducted participative research with children and young people about health inequalities from 2019-2020. Click here to find out more about our health inequalities peer research project. 

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News: Learning hub launched to help tackle inequality

Posted 05 July, 2022 by Jennifer Drummond

A new learning hub aims to help public services professionals improve their skills and day-to-day working practices in order to take more action to reduce inequalities.

The Virtual Learning Environment, launched last week by Public Health Scotland, provides practice improvement support for making services inclusive, and strengthening partnership working and community advocacy.

Designed for those who provide essential and emergency public services including police, fire and rescue services, and health, social care, education, housing across all sectors, individuals can select sections most relevant to their learning needs and source information about how to integrate actions into their daily work.

It focuses on three broad areas:

  • Making services inclusive for all
  • Effective partnership working to reduce inequalities
  • Advocacy to reduce inequalities.

Vicky Bibby, Director of Strategic Planning and Performance at Public Health Scotland said:

“Understanding the necessity of addressing inequalities in our community is important; having the tools and support to put this into practice is vital.

“This new resource has been specifically developed to offer practical guidance, methods and frameworks to help those in public service roles reduce inequalities in the services they provide.”

The hub is hosted on the Public Health Scotland website.

Click here to find out more and access the hub

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Q&A with Susie Heywood: Tackling gender stereotypes

Posted 28 June, 2022 by Jennifer Drummond

Ahead of her webinar in July, Susie reflects on how gender and public health issues are intrinsically linked and the importance of counter-balancing harmful societal stereotypes

For the past four years Susie Heywood has committed to developing an approach to tackle gender inequality across Scotland. Along with Barbara Adzajlic, she created and delivered the acclaimed Gender Friendly Nursery programme for NHS Greater Glasgow and Clyde, designed to improve gender equality and raise awareness of the harmful impacts of gender stereotypes from a public health perspective.

To build on its success, she launched the new Gender Friendly Scotland website and will shortly be publishing a book on the topic of gender stereotypes in the early years.

Here, she shares the importance of recognising the long-term, harmful impact of gender stereotyping on physical, emotional and mental wellbeing and why it’s so crucial for early years professionals to help change the narrative.

You are a firm believer that many of the public health issues we face are rooted in gender inequality and that challenging the narrative will help progress change. Can you tell me more? 

Both Barbara and I have a professional background in public health which is why we make these links. We know that gender inequality is a root cause of violence against women and girls and that the stereotype of the strong, tough, self-sufficient man, which starts early with messages like “boys don’t cry” plays a role in the elevated rates of suicide that we see amongst men compared with women.

We know that the drip feed of messages to girls around the importance of their appearance leads to issues around self-esteem, participation in sports, body image and disordered eating.

Other areas like poverty, educational attainment, career destinations, mental health and others are all relevant to these gendered ideas and pressures too.

It can be argued there has been a significant shift in understanding over the last decade and more willingness to challenge standing stereotypes and change the narrative, evidenced in the work you do and through national movements and campaigns such as Let Toys be Toys and Let Clothes by Clothes.  Is this your experience? Are we making progress?

I think we are making progress. The number of people who seem to be catching on to this agenda has certainly increased, and we have seen many early years settings really embrace the learning we have shared, so that’s really encouraging.

However,  these gendered attitudes and ideas are so ingrained that it’s going to take a while to really reach the cultural change that needs to happen – but I think we are seeing signs that we are on the right track.

It is of course important to remember that gender stereotypes are only one of many ways that children can be limited and put into boxes – as a society we still have a long way to go when it comes to things like racism, disability and neurodiversity for example.

The event you are running with us is entitled Challenging Gender Stereotypes: How to change the narrative. What are you hoping those in attendance will take away from the session?

I hope they leave with an understanding of why it’s important that we challenge gender stereotypes, particularly with young children, as well as a sense of why doing this benefits everyone. This is not a siloed issue. Gender stereotypes don’t just impact one particular group in society, though they do affect us all in different ways.

Secondly, I hope that they feel equipped with ideas of how they can make a difference for children – by both reducing their exposure to gender stereotypes and by providing a counter-balance to the messages that society hammers home to us from birth about what it means to be a boy or a girl. At the end of the day this is all about ensuring that children aren’t limited by these messages – that they can dream big and free.

Susie will be leading the event Challenging gender stereotypes: how to change the narrative, held online on Tuesday 26 July.
Click here to find out more and book

Challenging Gender Stereotypes in the Early Years: Changing the Narrative by Susie Heywood and Barbara Adzajlic will be published in September 2022 by Routledge Education.