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Seven key investments for health equity across the lifecourse: Scotland versus the rest of the UK.

Frank J, Bromley C, Doi L, Estrade M, Jepson R, McAteer J, Robertson T, Treanor M, Williams A - Soc Sci Med (2015)

Bottom Line: We present hard-to-find comparable analyses of routinely collected data to gauge the relative extent to which these investments have been pursued and achieved expected goals in Scotland, as compared with England and Wales, in recent decades.Despite Scotland's longstanding explicit goal of reducing health inequalities, it has recently been doing slightly better than England and Wales on only one broad indicator of health-equity-related investments: childhood poverty.Although Scotland did not choose independence on September 18th, 2014, it could still (under the planned increased devolution of powers from Westminster) choose to increase investments in the underperforming categories of interventions for health equity listed above.

View Article: PubMed Central - PubMed

Affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK. Electronic address: john.frank@ed.ac.uk.

No MeSH data available.


Related in: MedlinePlus

Cigarette smoking prevalence by most and least deprived quintile for England (Index of Multiple Deprivation) and Scotland (Scottish Index of Multiple Deprivation), 2003–2013. Source: Health Survey for England and Scottish Health Survey, UK Data Service.
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fig6: Cigarette smoking prevalence by most and least deprived quintile for England (Index of Multiple Deprivation) and Scotland (Scottish Index of Multiple Deprivation), 2003–2013. Source: Health Survey for England and Scottish Health Survey, UK Data Service.

Mentions: Tobacco restrictions include: a ban on smoking in enclosed public spaces (Scotland, March 2006; England, July 2007); raising the legal age to buy tobacco products to 18 years (October 2007, both countries); banning tobacco products from vending machines (Scotland, April 2013; England, October 2011); banning point-of-sale displays of tobacco products in large retail establishments (Scotland, April 2013; England, April 2012) and smaller stores (April 2015, both countries). Legal challenges from the tobacco industry (Scotland and England have separate legal systems) led to different implementation dates for some of these measures; sometimes, however, Scotland's politicians simply legislated sooner than their counterparts in England. Data from health surveys in Scotland and England over the last 20 years have shown that cigarette consumption has declined across both countries, particularly since the late 1990s. In Scotland, adult smoking prevalence is 23% and 20% for men and women respectively, while sitting at 24% and 17% in England (Craig and Mindell, 2014; Rutherford et al., 2014). Given the time differences in, for example the indoor smoking ban, natural experiments can be used to assess the effectiveness of policies that differ between similar jurisdictions. Pell et al. (2008) were able to use this technique to show that, overall, the number of admissions for acute coronary syndrome decreased by 17% in Scotland following the 2006 smoking ban. The comparable decline in England was 4% in the same time period (Pell et al., 2008). However, 67% of the decrease involved non-smokers (via reduced exposure to second-hand smoke). Therefore, while upstream interventions can have substantial health benefits across the population, changing behaviours in those who will experience the greatest health impact is a more difficult endeavour. Using data from the Scottish Health Survey and the Health Survey for England, both countries have seen smoking prevalence decline by approximately 6% between 2003 and 2013. However, the patterns by most and least deprived quintiles show that relative indices of inequality in both countries have increased similarly over this time-period (2.6–3.7 in Scotland and 2.5 to 3.8 in England) (Fig. 6). Absolute inequalities in Scotland did marginally decrease in Scotland (by 1%), but increased by 2.2% in England.


Seven key investments for health equity across the lifecourse: Scotland versus the rest of the UK.

Frank J, Bromley C, Doi L, Estrade M, Jepson R, McAteer J, Robertson T, Treanor M, Williams A - Soc Sci Med (2015)

Cigarette smoking prevalence by most and least deprived quintile for England (Index of Multiple Deprivation) and Scotland (Scottish Index of Multiple Deprivation), 2003–2013. Source: Health Survey for England and Scottish Health Survey, UK Data Service.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539344&req=5

fig6: Cigarette smoking prevalence by most and least deprived quintile for England (Index of Multiple Deprivation) and Scotland (Scottish Index of Multiple Deprivation), 2003–2013. Source: Health Survey for England and Scottish Health Survey, UK Data Service.
Mentions: Tobacco restrictions include: a ban on smoking in enclosed public spaces (Scotland, March 2006; England, July 2007); raising the legal age to buy tobacco products to 18 years (October 2007, both countries); banning tobacco products from vending machines (Scotland, April 2013; England, October 2011); banning point-of-sale displays of tobacco products in large retail establishments (Scotland, April 2013; England, April 2012) and smaller stores (April 2015, both countries). Legal challenges from the tobacco industry (Scotland and England have separate legal systems) led to different implementation dates for some of these measures; sometimes, however, Scotland's politicians simply legislated sooner than their counterparts in England. Data from health surveys in Scotland and England over the last 20 years have shown that cigarette consumption has declined across both countries, particularly since the late 1990s. In Scotland, adult smoking prevalence is 23% and 20% for men and women respectively, while sitting at 24% and 17% in England (Craig and Mindell, 2014; Rutherford et al., 2014). Given the time differences in, for example the indoor smoking ban, natural experiments can be used to assess the effectiveness of policies that differ between similar jurisdictions. Pell et al. (2008) were able to use this technique to show that, overall, the number of admissions for acute coronary syndrome decreased by 17% in Scotland following the 2006 smoking ban. The comparable decline in England was 4% in the same time period (Pell et al., 2008). However, 67% of the decrease involved non-smokers (via reduced exposure to second-hand smoke). Therefore, while upstream interventions can have substantial health benefits across the population, changing behaviours in those who will experience the greatest health impact is a more difficult endeavour. Using data from the Scottish Health Survey and the Health Survey for England, both countries have seen smoking prevalence decline by approximately 6% between 2003 and 2013. However, the patterns by most and least deprived quintiles show that relative indices of inequality in both countries have increased similarly over this time-period (2.6–3.7 in Scotland and 2.5 to 3.8 in England) (Fig. 6). Absolute inequalities in Scotland did marginally decrease in Scotland (by 1%), but increased by 2.2% in England.

Bottom Line: We present hard-to-find comparable analyses of routinely collected data to gauge the relative extent to which these investments have been pursued and achieved expected goals in Scotland, as compared with England and Wales, in recent decades.Despite Scotland's longstanding explicit goal of reducing health inequalities, it has recently been doing slightly better than England and Wales on only one broad indicator of health-equity-related investments: childhood poverty.Although Scotland did not choose independence on September 18th, 2014, it could still (under the planned increased devolution of powers from Westminster) choose to increase investments in the underperforming categories of interventions for health equity listed above.

View Article: PubMed Central - PubMed

Affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK. Electronic address: john.frank@ed.ac.uk.

No MeSH data available.


Related in: MedlinePlus