Published on 14th March 2022, a new Scottish Government report sets out 23 recommendations for actions to be taken to help primary care play a stronger role in reducing health inequalities in Scotland: Report of the Primary Care Health Inequalities Short Life Working Group.
VHS is a member of the Short Life Working Group that produced the report. The Scottish Government established the SLWG in October 2020 as an action to support the Covid-19 recovery agenda, in acknowledgement of the key role of primary care in relation to tackling and mitigating the impacts of inequalities. Primary care is provided by health care workers like nurses, GPs, optometrists, pharmacists and allied health professionals, and by other key staff like community link workers. VHS’s own direct contribution to the work of the SLWG has been to establish the Scottish Community Link Worker Network, to support and strengthen the work of the growing number of link workers embedded in primary care.
Poor health and premature mortality are largely shaped by underlying social determinants, including inequities in society such as poverty and discrimination. However, primary care is partly demand-led and, so, is easier for some groups of people to navigate than others, with various forms of disadvantage (such as power relationships, racism, education, social status) playing a part. Barriers to health care fall most heavily on those who are already most at risk of illness and disability. Inequity of access, or a mismatch between resources and need, can inadvertently widen health inequalities. The volume and nature of demand for primary care, and the complexity of the response required, are also influenced by health inequalities and deprivation.
For these reasons the SLWG has also worked closely with an expert reference group of people with first-hand experience of the impact of health inequality as individuals and within their community. Their remit has been to identify specific service improvements and actions for primary care to help reduce health inequalities and improve health equity. The Chance 2 Change group produced an accompanying report: Chance 2 Change Scotland
Recommendation 4 is likely to be of particular interest to VHS followers, as it says a strategy must be developed to invest in wellbeing communities through local, place-based action to reduce inequalities:
“Health and social care services are most be effective if they rest on a foundation of strong community networks and organisation. These encourage support from family, friends and peers; build self-confidence and belief in entitlement to services; enable access to information about health and wellbeing, including digital resources; give support to assert rights and articulate needs; and nurture skills to create and sustain health and wellbeing. Financial obstacles, discrimination and many other barriers prevent individuals and communities from realising their strengths and potential. A long term strategy, led by communities themselves with the support of locally embedded organisations, will allow community infrastructures to protect and promote physical and mental health, wellbeing and resilience, and will create an environment in which health and social care can begin to function more effectively as partners alongside the communities they serve.”