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Health Inequalities

Part of the debate – in Westminster Hall at 5:07 pm on 20th March 2019.

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Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care) 5:07 pm, 20th March 2019

Obviously, we are discussing the duty to reduce health inequalities, but as other hon. Member have mentioned, the increase in life expectancy is stalling and healthy life expectancy is falling. There is an exact linear correlation with deprivation. Women in poorer areas will have 26 years of poor health compared with 13 years for the least deprived. That all generates health pressures in the health service and in social care. Last year, the Scottish Government passed the Fairer Scotland Duty, which puts an obligation on all public bodies to work towards reducing inequality.

There are different aspects to this issue, including access to healthcare, which Lucy Allan talked about. In Scotland, we now spend £185 a head more on health and £113 a head more on social care than in England. That allows us to offer free personal care, which allows people the luxury of staying at home if they need the support mentioned by Derek Thomas.

A key issue of access to healthcare is free prescriptions. They are not available in England, other than for a very limited number of conditions, not including asthma. Asthma UK has conducted surveys showing that, at some point, half of all patients have not collected their prescription, and that three-quarters of asthma patients struggle to pay for their prescription. Of those who did not collect their prescriptions during that period, 13% were admitted to hospital. That is not cost effective.

The long-term plan talks about access to a digital GP, video access, and healthy people being able to buy genomic testing. I am sorry, but all of that will feed the inverse care law of increasing demand from the better-off instead of tackling unmet need among poorer people. Those are the people who do not attend appointments for screening, who live far away from services and who do not have access to decent healthcare.

On the public health and prevention side, obviously Scotland was the first to enact the smoking ban, followed by England. We have introduced minimum unit pricing to try to tackle alcohol, which is another one of the scourges. That policy has yet to be enacted here. I welcome the UK Government’s sugar tax, but I would like to see some action on advertising junk food to children before 9 pm. Scotland has also signed up to the World Health Organisation’s global action plan, which tries to improve physical activity and participation in sport, particularly among women, girls and the elderly.

It is particularly important to invest in children and we try to do that in Scotland through the Best Start grant, the Baby Box and the fact that our early years education is available to all children and does not just depend on parents’ circumstances or work pattern. If we do not invest in children, we inevitably end up spending more later to pick up the pieces.

As has been said, Professor Marmot highlighted in his report that increasing poverty means increasing inequality. The welfare cuts, particularly the benefit freeze, have driven an increase in every group in poverty over the last number of years. Poverty in England is at 22%, it is 24% in Wales and it is down at 20% in Scotland. However, if we look at the disabled, pensioners and children, we see that they are particularly vulnerable. Child poverty was falling, but the Institute for Fiscal Studies says that it will climb by another 7% before 2022. In England, child poverty is now over 30%, in Wales it is 28% and in Scotland we had got it down to 21% but it has climbed to 24%. That is due to the impact of welfare cuts on families.

Infant mortality has risen for the last several years in England. That is a measure that we use to look at health on a worldwide basis in developing countries. The Scottish Government mitigate policies such as the bedroom tax, and they have measures such as the Scottish welfare fund, which is why we have the lowest levels of child, disabled and pensioner poverty. However, in all of those classes poverty is still increasing and we are having to use £100 million a year on it.

The Government talk about tackling worklessness, but 70% of children have a working parent. What we have is the working poor. The International Monetary Fund says that a more equal society is a healthier society, which brings better economic growth. So what we need to do is to promote the real living wage, to make work pay. We need to tackle poverty. It is the biggest driver of ill health, which means we need a “health in all policies” approach. The NHS alone cannot fix this problem.