Who will safeguard Scotland’s Future Health?
By Tony Robertson, Eva Gallova, Mark Langdon, Sue Laughlin, Giulia Loffreda and Neil Quinn on behalf of the People’s Health Movement Scotland.
The ongoing COVID-19 pandemic has been an obvious game changer since the last Scottish Government elections, not only in terms of its immediate impact on public health but with its current and future impact on employment and economic activity across the UK and globally. It has perhaps tended to overshadow the impact of other significant developments in recent years that are linked to worsening population health and widening health inequalities, such as Brexit, continued austerity, the increasingly obvious effects of climate change (and associated climate injustice) and political turmoil at home and abroad.
These issues evidence the challenges faced by any government in Scotland to address inequalities in health and develop and fund a socially and ecologically just strategic plan which adequately addresses the problems that years of austerity have exacerbated. The Scottish Government has attempted to mediate aspects of the UK government’s assault on the most vulnerable sectors of society, but there is still much more that could and should be done.
The Scottish People’s Health Manifesto comprises a list of 32 demands, set around seven key actions that have arisen from a partnership of individuals, organisations and community groups from across the country. The actions and demands have been compiled from a process of dialogue and debate led by a group of health activists, the People’s Health Movement Scotland (PHMS), which actively sought to engage a wide and inclusive range of voices and perspectives, many of which are not heard when forging national policies, health or otherwise.
In 2016 we created our first People’s Health Manifesto, consisting of 20 demands, categorised within six actions. Ahead of the 2021 Scottish Elections we reached out to our network to help us develop a refreshed manifesto that better fits where our country and world find themselves in 2021. Below you will find our updated actions and if you are interested please see our manifesto for the more specific demands. Most notably the climate emergency has become a new focal point that is now so prescient, alongside the impacts of COVID-19 and a greater acknowledgment of the need to take an intersectional lens across our demands. In addition, the likes of education and inequality cut across multiple actions and demands given their importance. Demands against racial and ethnic prejudice and violence against women have also been introduced to address clear gaps in our previous approach.
As a group of health activists we think the people of Scotland need to consider the country we really want and the country we really could have in the face of the current climate and health emergencies. It is essential that we recognise these challenges are not just new but are linked to legacies of neglect, inequality and injustice. Hopefully these actions resonate with the readers of Bella Caledonia and help reframe and set new priorities for what our main political parties are offering as part of the ‘new normal’.
Once we see the shape of the new parliament we will offer readers our assessment of where election pledges need to be held to account and where the neglect continues, clarifying where campaign priorities should focus.
Seven Actions to Improve Scotland’s Health
Prioritise Health in all Policies
A Health in all Policies approach is an established method for improving health and health equity through cross-sector action on the wider determinants of health: the social, environmental, economic and commercial conditions in which people live. It is particularly important to recognise the role that the economy and the way that it is measured plays in either promoting or limiting health, depending on the decisions that are made.
Tackle Poverty and Socioeconomic Inequalities
Scotland has high levels of poverty and inequality. Approximately 1 in 5 of the population is living in poverty and the top 10% of the population have 24% more income than the bottom 40% combined. These experiences translate into unacceptable levels of health inequality – in 1997 premature mortality rates (deaths before age 75) were three times higher in the most deprived areas compared to the least deprived; from 2014-2018 premature mortality rates have been four times higher in the most deprived areas and look on course to continue to rise. These interrelated problems still exist despite considerable policy rhetoric aimed at addressing them suggesting that policies have not been sufficient to make an impact.
Play an Active and Leading Role in Tackling the Climate Emergency
There is a close relationship between climate, the environment and human health. The climate emergency will lead to more deaths, disease and displacement worldwide. Within Scotland, the population is increasingly affected by air pollution, changing weather conditions and a loss of biodiversity. It is still overly dependent on the fossil fuel industry. Whilst the Scottish Government has established a climate change plan, this does not maximise the role that Scotland could play in addressing the climate crisis and in promoting environmental justice both nationally and internationally.
Protect our NHS and Improve Social Care Services
The NHS in Scotland is rightly prized, the COVID-19 pandemic highlighting the need for well organised, publicly funded and publicly run healthcare which is able to respond effectively to both new health emergencies and to regular pressures. It is the NHS that largely deals with the health impact of economic and social policy making, with those experiencing the poorest health as the result of adverse conditions often having the greatest need. There are however still distinct differentials in the provision of health care for those with the greatest need – both physical and psychological. The COVID crisis has brought to the fore the need for a National Care Service for the elderly which is also publicly funded and publicly run.
Improve Democratic Debate and Accountability
Civil society groups and movements can prevent social inequalities, undo inequalities and reduce harm. However they also face challenges like funding, creating partnerships, influencing policy, setting priorities, having enough resources and their own culture. They need to be given more opportunities to flourish and strengthen their impact.
Acknowledge and Address Longstanding Injustices and Protect Equality and Diversity
There is extensive evidence of longstanding social and health inequalities in Scotland, with particular concerns that women, ethnic minority groups, disabled people and older people are disproportionately affected. We know, furthermore, that multiple structural, contextual and individual factors underpin these inequalities. There is a need to address these existing inequalities to achieve equity in health outcomes, through enforcement of the Equality Act 2010 and adopting an intersectionality approach within all policies, which acknowledges and addresses systemic discrimination.
Reduce Exposures to Health Risks at Work and at Home
Being out of work has been found to have major health consequences. However, even those in work experience health damaging and health protective exposures, as well as high levels of in-work poverty. As well as these work risks we are also faced with health-damaging exposures from the environments we live in (e.g. pollution) and our interactions with the so-called commercial determinants of health (e.g. tobacco). It is time to put people before profit.
PHMS is part of the wider PHM UK, whose vision is a future in which health equity and social justice is made a reality for the UK and overseas communities. PHMS/UK are part of a European network and global community of health and social justice activists.
For further information or to get involved in our health activism contact us via: