Scotland is a constituent country of the United Kingdom with a population of approximately five million. The majority of the population is concentrated in the central area around Glasgow and Edinburgh. Scotland has partial self-government, meaning that on some legislative areas such as taxation, social security, defense and international relations are decided by the entire UK.
For local government purposes, Scotland is divided into 32 councils that are responsible for the provision of local government services. For healthcare and postal districts there are different administrative divisions. Healthcare services in Scotland are mainly provided by NHS Scotland, and includes free care to all permanent residents financed by general taxation. These services are also supplemented by private healthcare services from a relatively large private sector. Scotland’s healthcare system is autonomous from the UK’s, and considerable differences between the public healthcare systems in the different countries of the United Kingdom are prevalent. Scotland faces stark levels of health inequalities, both between Scotland and the rest of the UK, and within the country itself.
Prior to 1999, the issue of health inequalities in Scotland was addressed by actions taken by the UK Government. However, the 1999 White Paper “Towards a Healthier Scotland” set the framework for public health and health improvement policy in Scotland, recognizing that all health improvement action should be underpinned by the need to reduce health inequalities. The issue of health inequalities is still high on the agenda, and political interest has risen since 2008, when the ‘Equally Well’ strategy was published. This document showed that it was necessary to focus on the determinants of health and the underlying causes, and that other sectors have an impact on the health status of the Scottish population as well. “Equally Well” was thus the first national strategy that addressed the issue directly, and which brought all approaches and sectors together to work on it.
In Scotland, the approach to building and implementing policies has changed. Earlier, national level politicians decided what needed to be done at the local level, and local authorities were asked to report back to the national level. Nowadays the targets and desired outcomes are decided at the national level, but it is up to the local governments to implement it according to their needs and to frame activities in the way they see fit. There are monitoring and evaluation systems in place to study the impact of policies, but the level of intensity and detail differs across policies. There is a gap regarding short term or intermediate indicators that could measure progress. It would be useful to have these in place to know whether the approach is appropriate and whether Scotland is on the right track to tackle health inequalities.
Despite these commitments and effort, inequalities in health status are increasing within Scotland as seen for example in significantly greater increases in life expectancy in more affluent parts of Scotland compared to the least affluent.
An overview of policy responses addressing health inequalities in can be found in our Policy Database.
An overview of projects and initiatives that are currently taking place or that have successfully been finalized, and that are addressing health inequality issues, can be found in our Project Database.
Please find below an overview of key actors in Scotland working on health inequality issues:
Are you aware of any other key actors that should be added to this list?
Please find below an overview of relevant documents addressing health inequality issues in Scotland. Further publications can be found in our Publications Database.
- Scotland performs: The Scottish government’s tracking of their strategic objectives. Specific focus on health inequalities
Are you aware of any other key resources that should be added to this list?
Please let us know!