Health inequalities in Scotland: an independent review

About this review

Rooted in Scotland and informed by Scottish experts, this review brings together evidence of trends in health inequalities and wider determinants of health over the past two decades since devolution.

It explores public perceptions of what affects people’s health and what future action they support to tackle health inequalities. It also draws on perceptions of barriers to progress from people working in the voluntary and community sector, public bodies and health services. This material is drawn on extensively in this report and is the source of evidence unless otherwise referenced.

The review aims to support improvements in health and health inequalities in Scotland, providing a picture of past and present health and inequalities to inform future efforts to improve both.

Our research partners

The Health Foundation has worked with four research organisations in Scotland as part of the review:

  • The MRC/CSO Social and Public Health Sciences Unit, University of Glasgow synthesised a wide range of existing data and new analysis including trends in social inequalities in health, health-related behaviours, and health and social care services in Scotland.
  • The Fraser of Allander Institute analysed trends in the wider determinants of health such as work, education and housing, and how these are experienced differently across the population.
  • Nesta in Scotland conducted in-depth workshops with health-related stakeholders to help understand implementation challenges for policy and delivery services that support better health.
  • The Diffley Partnership undertook a series of deliberative workshops with members of the public, exploring public perceptions of the reasons behind health inequalities, informed by the evidence from the other strands of research. A survey of stakeholders supported Nesta in Scotland’s qualitative work.

The public engagement project was complemented by a review of existing research on lay perspectives of health inequalities and determinants of health in Scotland, conducted by the School of Social Work and Social Policy at University of Strathclyde.

A further research project delivered by IPPR Scotland set out the extent of devolved powers in Scotland and produced a set of case studies to draw insights about policy implementation.

These projects, the interpretation of the evidence and the conclusions drawn in this report have been guided by our advisory group, bringing together experts from across academia, civil society, delivery and policy.

Box 1: Advisory group

The advisory group members are:

  • Chris Creegan, Chair and review Strategic Adviser
  • David Bell, Emeritus Professor of Economics, University of Stirling
  • Jo Bibby, Director of Health, the Health Foundation
  • Sarah Davidson, CEO, Carnegie UK
  • Cam Donaldson, Yunus Chair & Distinguished Professor, Health Economics, Glasgow Caledonian
  • Anna Fowlie, Chief Executive, Scottish Council for Voluntary Organisations
  • Mubin Haq, Chief Executive, abrdn Financial Fairness Trust
  • Katie Kelly, Depute Chief Executive, East Ayrshire Council
  • Michael Marmot, Professor of Epidemiology, University College London
  • Jim McCormick, Chief Executive, The Robertson Trust
  • Dona Milne, Director of Public Health and Health Policy, NHS Lothian
  • Shantini Paranjothy, Clinical Chair in Public Health, University of Aberdeen
  • Carol Tannahill, formerly GCPH Director and Scottish government Chief Social Policy Adviser.

Scope and structure of this report

This report sets out the key findings and conclusions of the review, drawing on and synthesising evidence from each of the funded research projects. It concludes by considering how Scotland can build on strong policy intent to reduce stubbornly high inequalities in the socioeconomic determinants of health and create a sustainable approach to closing the gap in health outcomes.

  • Section 1 provides the background and context in which the review and associated research projects are situated.
  • Section 2 sets out key trends and inequalities in health and social and economic determinants of health over the past two decades.
  • Section 3 explores core reasons underlying current health trends and inequalities.
  • Section 4 considers key risks to future health and inequalities in Scotland.
  • Section 5 discusses public perceptions of health inequalities and the views of policy and delivery stakeholders on the barriers to implementation.
  • Section 6 concludes by setting a direction of travel for making progress in tackling health inequalities.
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