Health inequalities, parenting and the third sector
NHS Health Scotland offers a simple definition of health inequalities as: 'unfair and avoidable differences in people's health across social groups and between different population groups.'[i] In Scotland, the classic illustration is the map of the Glasgow railway and underground, and the inequalities in life expectancy between men and women living in Jordanhill and those living eight miles away in Bridgeton; a shocking differential of 13 years.[ii] Similarly, health inequalities are a reality for particular groups of people based on, for example, gender, sexuality, ethnicity and disability.
Since the publication of the report from the Christie Commission in 2011[iii], there is consensus about the need to prioritise preventative approaches in health and social care. The language of upstream/downstream is now dominant: issues need to be tackled upstream, before patterns set in and individuals, families and communities are locked into inequality and set adrift downstream. Investment in early years intervention is the clearest example of this re-prioritisation.
However, in responding to health inequalities, there are three key approaches: to undo; to prevent; and to mitigate. As policy focuses on prevention in order to end inequalities, people continue to live with them, and need support to deal with the consequences and build their own resilience. The Voluntary Health Scotland (VHS) report, 'Living in the Gap'[iv], looks at the role of the voluntary health sector in tackling health inequalities. It describes the activities of the sector (including ten case studies) and the issues that it faces in supporting the most vulnerable people and communities. Much of this activity is about mitigating the impact of inequality.
Among the report's case studies is Circle, which provides a 'whole-family approach to supporting a group at risk of specific health harms, stigma and social exclusion'. It says:
'We supported a single mother to undergo treatment for Hepatitis C which she had previously put off for two years because of fears about being able to care for her children over the lengthy recovery. Her support worker researched treatment types and identified alternative medication with a shorter convalescence time-span and the mother engaged with this treatment as a result.'
For this parent, in supporting her health needs, Circle was able to support the family to stay together. This is the kind of intervention which can bypass the contribution of statutory services. So, as governments, politicians and public agencies seek long-term solutions to inequality, the voluntary health sector continues to be vital in tackling the day-to-day experience of living with it.
For PAS, the link between the quality of parenting and the long-term physical, emotional and social development of children will be readily understood. Public Health England has published a report on interventions to support child development and reduce inequalities (good quality parenting programmes). In Scotland, the Growing Up in Scotland (GUS) study argues:
'…it is clear that the health benefits of better parenting appear greatest for those families experiencing the highest levels of family adversity. This suggests that policies to support and improve parenting may contribute to a reduction in health inequalities. However……. families experiencing disadvantage are less likely than others to access services and to seek support and advice from professionals. While there is a range of parenting programmes being delivered across Scotland, overall programmes to support parenting are likely to provide only a partial solution to reducing inequalities in health.'[v]
Comprehensive solutions, therefore, remain elusive; a point not lost on Duncan McNeil MSP, who has become one of the key political voices on health inequalities in Scotland. McNeil has set party partisanship aside to acknowledge that all governments in the UK and Scotland have failed to properly address inequality. Even when funding was available, inequalities grew. In a recent article, he states:
'We don't have the answer. We do have questions. Why is it more equal societies enjoy better health outcomes? How important is community and quality of housing? Are the latest teenage pregnancy figures a sign of progress? …. When do a family's stress levels become intolerable?'[vi]
As these questions find their way into the discourse on health inequalities, VHS is developing a programme of work entitled 'Living in the Gap'. We will continue to promote the report and its findings, and are hosting a series of seminars, starting in Edinburgh on June 15.[vii] Our national conference, Closing the Gap, in November, will explore the latest practice and policy.
More information: alan.mcginley@vhscotland.org.uk
[i] The right to health: Tackling inequalities. NHS Health Scotland.
[iii] www.gov.scot/About/Review/publicservicescommission
[iv] Living in the Gap: a voluntary health sector perspective in health inequalities in Scotland. Voluntary Health Scotland, 2015. www.vhscotland.org.uk/wp-content/uploads/2015/03/VHS_LIVING_IN_THE_GAP_full_report_MARCH_15_WEBFRIENDLY_VERSION.pdf
[v] Health inequalities in the early years: evidence from the Growing Up in Scotland study (GUS) Briefing. Paper for the Scottish Parliament Health and Sport Committee http://growingupinscotland.org.uk/wp-content/uploads/2014/05/GUS-evidence-for-SP-Health-Sport-Comm-2014.pdf
[vi] We don't have the answer - investigating health inequity. Holyrood Magazine. April 2015. https://www.holyrood.com/comment/view,we-dont-have-the-answer-investigating-health-inequity_11442.htm
[vii] For further information, contact lauren.blair@vhscotland.org.uk