Policies to deal with health inequalities and the effects of these policies
1. Tobacco
Why?
Before legislation…
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1 in 5 Scottish deaths linked to smoking
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33,500 hospital admissions per year
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£200 million annual cost to NHS
Acts:
2006 Smoking Ban – banned smoking in public places
2007 – Age to buy cigarettes increased from 16 to 18
2009 – Tobacco and Primary Medical Services Bill – banned sale of tobacco in vending machines and
displays
Impact:
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The ban was popular with British adults when it was implemented - and a recent poll of more
than 12,000 people found that 78% of adults still support it (BBC, 2012).
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A study of bar workers, using saliva, lung function and air quality tests, showed their
respiratory health had greatly improved after the laws came in, thanks to the reduction in
exposure to second hand smoke (BBC, 2012).
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Another study looking at children's exposure to second hand smoking in England, between
1996 and 2007, found that their exposure levels had declined by nearly 70% (BBC, 2012).
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A Glasgow University study showed a 15% reduction in the number of children with asthma
being admitted to hospital in the three years after the ban came into force in Scotland (BBC,
2012).
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Research from Scotland reported a much larger 17% decrease in heart attack admissions in
the year after its ban (BBC, 2012).
Another Glasgow study which looked at smoking and birth rates before and after the ban
found a 10% drop in the country's premature birth rate, which researchers linked to the
smoke-free laws (BBC, 2012).
2. Food and Health
Why?
Before legislation…
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Government identifies that in the 1990s-2000s, many Scots not eating fruit and vegetables
every day, particularly in more deprived areas.
In addition, males have a worse diet than females.
In 1998, only 30% of males and 45% of females aged 16-64 in Scotland were eating fresh
fruit and vegetables regularly (Scottish Government).
The cost of dealing with obesity in Scotland is likely to rise to £3 billion per year by 2030
(Scottish Government).
Food-borne illness costs the NHS in Scotland around £140 million per year. Of 130,000
consumers contracting food-borne disease per year around 2,000 will be hospitalised and
around 50 will die. Making sure we eat a good, nutritious diet of safe, quality food is vital to
our ambition to ensuring people live longer, healthier lives.
Targets – improve fruit and vegetable consumption, reduce fat consumption and improve consumption
of oily fish.
Acts:
2007 - The Schools (Health Promotion and Nutrition) (Scotland) Act – aims to put healthy eating at
the heart of each school’s activities. Giving young people balanced school meals. Banned “junk food”
from school cafeterias.
2010 – Curriculum for Excellence – Various “food and health” outcomes being taught in school as part
of “Health and Wellbeing”. Encouraging young people to adopt healthy eating habits early in life in the
hope that they will continue to eat healthily.
Impact?
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Perhaps too early to measure success – Scottish Government expects to see reduction in
childhood obesity and illnesses caused by poor diet.
However, Health Promotion and Nutrition Act has perhaps not had the desired impact so far –
many young people have turned away from school meals, especially in secondary schools. In
Glasgow, 61% of young people ate in school canteens before 2007, now 34%. Children now
eating junk food outside of school so perhaps government policy not working.
Health – Prescriptions charges
Why?
Although pensioners, children and families on low incomes already get free prescriptions, there were
demands to make prescriptions free for all in Scotland. Nicola Sturgeon argued that prescription
charges were a “tax on poor health”.
Act:
2011 – Prescription charges abolished in Scotland
Impact:
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Conservatives said that move was “politically irresponsible” due to current recession – should
not be giving financial support to people that don’t need it. Doesn’t help anyone new – poor
already had free prescriptions.
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Hundreds of thousands of people on moderate incomes with long term health problems saving
an average of £180 per year (According to SNP figures).
40% of people in Scotland have a long-term health condition such as asthma, Crohn’s disease
or diabetes and are no longer being “taxed” because of their poor health.
Families have more money to spend on other necessities such as food instead of relying on
food banks which have increased in number since onset of recession in 2008.
3. Alcohol
Why? (All info. from Alcohol Focus Scotland)
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A quarter of men and just under a fifth of women (18%) were categorised as hazardous or
harmful drinkers (defined as men drinking more than 21 units per week and women drinking
more than 14).
Men living in the 20% most deprived areas were significantly more likely to exhibit signs of a
potential alcohol use disorder compared with those living in the least deprived areas.
In 2012, there were 1,080 alcohol-related deaths in Scotland (where alcohol was the
underlying cause of death).
In 2011/12, there were 38,000 alcohol-related discharges from a general acute hospital in
Scotland – people in poor areas 7 times more likely to be in hospital because of alcohol
Alcohol harm costs Scotland £3.6 billion a year
Before legislation possible to exceed daily alcohol allowance for £3-4.
Acts:
2010 – The Alcohol etc. (Scotland) Act – ended drinks promotions in bars such as 2 for 1 and ended
“happy hour”. “Challenge 25” policy now the law. Anyone looking under 25 has to provide ID to
purchase alcohol.
2012 – The Alcohol (Minimum Pricing) (Scotland) Act – set a minimum price of 50p per unit of alcohol.
Impact:
The following is the EXPECTED impact according to the Scottish Government…too early to say if this
will happen or not:
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Alcohol related deaths would fall by about 60 in the first year and 318 by year ten of the
policy
A fall in hospital admission of 1,600 in year 1, and 6,500 per year by year ten of the policy
A fall in crime volumes by around 3,500 offences per year
A financial saving from harm reduction (health, employment, crime etc) of £942m over ten
years
Price of SOME drinks will increase in supermarkets. For example, price of cheap brands of
spirits such as vodka will increase by £2-3 per bottle. 4 packs of lager will increase in price by
£1-2.
However, many drinks unaffected, especially top brands which were already more expensive.
Also, price of certain alcoholic drinks preferred by youngsters such as Buckfast largely
unaffected by change in law.
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Also concerns that over time the drinks industry in Scotland may be affected which could
damage Scottish economy.
Also, the law does nothing to address the cultural problem of alcohol abuse in Scotland – Scots
continue to drink more than in other parts of UK and Europe.
4. National Physical Activity Strategy
Why?
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Scotland not active enough. Many people are not exercising regularly which contributes to the
obesity epidemic in the country. In Scotland in the early 2000s, 67% of women, 35% of men,
37 of girls and 26% of boys were not exercising the recommended amount.
Acts/Policies:
2003 - “Let’s make Scotland more active” – Scottish Government policy to address health inequalities
by encouraging active lifestyles. Scotland is one of the first countries in the world to adopt such a
policy.
2004 – Physical Education Review – looked at PE curriculum in schools and made recommendations –
more time needs to be allocated to PE and the range of activities offered in school. Should be
increased by providing extra PE teachers.
Impact:
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Encouraging adults to exercise at least 30 minutes per day. 1 hour a day for children.
Pupils in schools should be getting 2 hours per week of physical activity.
Criticisms – not the responsibility of government of schools to provide physical activity.
Individuals and parents should provide this.
Young people are becoming more active although and obesity levels have fallen recently.
Perhaps partly because of these initiatives although time will tell whether they have been
truly successful or not.