Summary

Limited highly processed evidence and limited review-level evidence and Scottish policy directives support early years interventions, access to community resources, including good-quality housing, education and training to enhance social capital and improve health and social outcomes to reduce inequalities and associated acknowledged vulnerabilities for onset of (problem)drug use.

As part of the Mental Health Outcomes Framework (NHS Health Scotland 2012) a chain of change ''Increasing social inclusion and decreasing inequality and discrimination' is outlined in logic model 4 of the framework. The evidence summary supporting the rationale for social exclusion activities can be accessed from the following logic model link: Evidence summary on social exclusion.

The full outcomes framework, tools and resources, for mental health are available here: www.healthscotland.com/OFHI/MentalHealth/content/MHtools.html

Provision of housing to improve health
There is review-level evidence from a rapid systematic review, that support with housing, particularly for the most vulnerable groups (homeless people with mental health or substance misuse problems), benefits health.

Evidence suggests housing provision should optimally be combined with other support services. [1]

Scottish policy and practice note

Commission on the Future Delivery of Public Services (2011) [2] outlines key elements of a programme of reform to improve Scotland’s public services to improve the quality of life and outcomes for the people of Scotland. The key objectives of the reform programme are to ensure that:

• public services are built around people and communities, their needs, aspirations, capacities and skills, and work to build up their autonomy and resilience
• public service organisations work together effectively to achieve outcomes
  – specifically, by delivering integrated services which help to secure improvements in the quality of life, and the social and economic wellbeing, of the people and communities of Scotland
• public service organisations prioritise prevention, reduce inequalities and promote equality
• all public services constantly seek to improve performance and reduce costs, and are open, transparent and accountable.

In describing the challenges ahead in addressing the social determinants of health and tackling inequalities, NHS Health Scotland’s Health Inequalities Policy Review for the Scottish Ministerial Task Force on Health Inequalities [3] highlights the key role and contribution of Community Planning Partnerships (CPPs) at the local level.

The policy review report states that the CPP role is to bring together partners to agree priorities and shared outcomes, and to pool resources around these shared outcomes. There is a need for CPPs to be explicit about the roles and contributions of the partnerships that sit within the umbrella context of community planning, for example Health and Social Care Partnerships, Alcohol and Drug Partnerships, Integrated Children’s Services Partnerships.

There are opportunities for CPPs to take on board the following:

• Clear leadership, understanding and shared values for changing power money and resource inequalities in their area through a thorough understanding of need and allocating budgets and resources proportionately to that need.
• Creating the social culture for communities to re-engage; a civic society in which there is increased democratic engagement.
• Ensuring the approaches that work to reduce health inequalities become reality in their CPP area.
• Ensuring measurement of indicators and evaluation is in place to understand impact and demonstrate progress over time to ensure that approaches are not inadvertently widening health inequalities.

The policy review report concludes by stating that closing the inequalities gap and lessening the inequalities gradient would bring greater cohesion, economic progress and better health in Scotland, lowering the burden on individuals, communities and public services and contributing to social equity.