Good health is not something created by the NHS, which is more about treating and managing illness, but comes from what were described in Professor Marmot’s famous report as the “social determinants of health” – a decent start in life, good quality housing, education, a satisfying job and being socially included.
The Scottish government is working to ensure children get a good start in life through various Early Years projects, including the Baby Box which provides every baby with the necessary essentials. The Childsmile dental program has helped tackle Scotland’s notoriously bad teeth – reducing children with caries by 24 per cent and bringing the worst area of Glasgow into line with the rest of Scotland; it has even saved £5m in dental treatments. This contrasts with the lack of a preventative dental contract in England, where children are struggling to access NHS dentists and multiple extractions are increasing.
Housing costs are the biggest financial burden on any family which is why the Scottish Government has invested more in affordable housing than other UK nation; building 33,000 new homes over the last parliament and committing £3bn to build 50,000 during this session. While the SNP Scottish government stopped the sale of council houses in 2016, the UK Conservative government is actually accelerating the process, making it harder for the next generation to even get on the rental ladder, never mind the property one, and increasing the incidence of homelessness.
Often described as the ‘sick man of Europe’, Scotland has traditionally had higher death rates from conditions such as heart disease, addiction, suicide and cancer. Indeed, cardiovascular disease causes more than a quarter of all deaths in Scotland and mortality of lung cancer in women has been either the highest or second highest in Western Europe for the past 50 years.
This has been attributed to the greater prevalence of smoking and high alcohol intake. But, while we have recently seen increased deaths among older citizens affected by addiction, combined with chronic illness, fewer young people are taking up smoking, heavy drinking or illicit drugs. The public smoking ban in 2006 (the first in the UK) helped get smoking rates below 20 per cent but the Scottish government has been fighting the drinks lobby since 2012 to introduce a minimum unit price for alcohol, which is proven to help tackle alcohol abuse.
While there have been substantial increases in both Life Expectancy (LE) and Healthy Life Expectancy (HLE) for both men and women across the whole UK, marked inequalities remain. With average household wealth in the south-east of England twice that of Scotland there is a ten-year difference in life expectancy between a man from a rich London borough and a man from the poorest area of Glasgow. However, figures published by the National Records of Scotland show life expectancy has improved over the last three decades, increasing by eight years for men and 5.9 years for women.
It is still, however, 2.1 years less than the UK as a whole. From my work on the APPG on Health in All Policies and our inquiry into the impact of welfare cuts, the correlation between poverty and poor life expectancy is clear, and poverty remains the biggest driver of both mental and physical ill health. Indeed, academics estimate that we lose 1,400 children each year as a direct result of poverty due to premature birth, low birth weight, hunger, malnutrition, chronic illnesses, road accidents, house fires, violence, suicide and addiction.
Child poverty has been rising since the Tory government’s first welfare cuts of 2012 and stands now at approximately four million. It is expected to reach five million by the end of this decade due to the housing benefit cuts within universal credit, the benefit freeze and the limiting of tax credits to just the first two children in any family. As I highlighted during the Welfare Debate in Parliament, the cynical Tory approach to tackling child poverty is simply to try and redefine it out of existence.
While, disappointingly, the Labour party failed to fight the benefit freeze or welfare cuts in Westminster, the SNP has opposed this Tory government’s austerity agenda at every turn. Seven years of austerity have failed to clear the deficit on schedule due to reduced tax take, and cuts to welfare spending have taken money out of local economies. The £1bn of welfare cuts in Scotland persistently hamper the Scottish government’s efforts to reduce poverty, as it has spent over £400m since 2013 just to alleviate Tory cuts, including £125m to mitigate the unjust “bedroom tax”. Devolution should allow us to enhance our country, not simply clean up the mess made by Westminster.
Newly acquired social security powers allow the Scottish Government to give greater dignity to those in need of support and their child poverty bill is currently making its way through Holyrood. Although 14 per cent of social security powers and 29 per cent of tax is now devolved to the Scottish Parliament, the Joseph Rowntree Foundation recently commented that, while it is clear devolved policies have gone some way to mitigate certain impacts of welfare reform, there is a strong case for giving devolved nations further tools to address rising poverty.
The main economic levers to combat poverty, such as the minimum wage, national insurance, corporation tax and VAT are still controlled by Westminster, which is why the SNP sought to have greater powers devolved to the Scottish Parliament in the last Scotland bill.
Sadly, this was opposed not just by the Tory government but also by the Labour opposition. Poverty is the root of inequality. It is crucial that we see a shift in focus away from dealing with the health and social consequences and aftermath, to tackling the underlying cause. I believe the opportunity to achieve this will only present itself when the Scottish government has full control of fiscal as well as social policy, and can set its own priorities.