We can take action across all sectors - public, private, third and independent to address inequalities in practice through our work.

Plan the right balance of action

Actions or programmes which aim to improve health across the whole population (known as universal provision) can risk increasing inequalities. This is because everyone has different access or ability to take up opportunities to improve their health. It is important to distinguish between targeting vulnerable groups and reducing inequalities.

  • Targeting vulnerable or marginalised groups might improve their health but not necessarily reduce inequalities.
  • Population wide approaches aimed at reducing inequalities are not likely to reach marginalised groups if buy-in is required e.g. cost or need for proactive action can be barriers.

The Health Inequalities Action Framework offers a tool for assessing plans against theoretical concepts. The framework

  • explains the link between social factors and inequalities in health outcomes
  • encourages consideration of the range of actions that might be taken.

For detailed information, you can download the Health Inequalities Action Framework, and you can also download example questions to help you to apply the framework to your own work.

What actions work

Our Health Inequalities Policy Review sets out what works to effectively reduce health inequalities. There are four key findings from the review.

  1. Tackling health inequalities requires a combination of actions, such as
    1. undoing fundamental causes
    2. preventing harmful wider environmental influences
    3. reducing the negative impact on individuals.
  2. Interventions need to focus on a structural or regulatory level.
  3. Providing universal services with added intensive support for vulnerable groups (known as proportionate universalism) is effective.
  4. Interventions which require individuals to opt-in and those which involve significant price barriers may assist in improving health, but tend not to be effective at reducing health inequalities.

Actions on reducing health inequalities

It is vital to support people working within NHSScotland and Health and Social Care Partnerships (HSCPs) to increase their existing knowledge and skill around addressing inequalities. Staff will be better equipped to deliver services that help reduce health inequalities and to respond to the social and economic circumstances affecting individuals' health.

We have produced statements that provide a framework of practical actions that the NHS and HSCPs should consider when developing their strategic plans. The publications allow health and social care planners and managers to consider health inequalities in the early stages of developing plans and priorities.

These publications focus on the key areas for reducing health inequalities. The areas are

  • employment processes
  • leadership and advocacy
  • procurement and commissioning processes
  • having effective partnerships across sectors
  • training the workforce to understand their role in reducing inequalities
  • provision of quality services with the allocation of resources proportionate to the need.

Maximising the role of NHS Scotland is the statement for staff working in NHSScotland, and the other statement is for Health and Social Care Partnerships.

Sources of support

There are several sources of support to identify effective actions, for example

You can build your skills and knowledge around finding and appraising research evidence through one of the many courses available in Scotland, such as the ones provided by Scottish Intercollegiate Guidelines Network (external website) or the Critical Appraisal Skills Programme (CASP) (external website) provided elsewhere in the UK.