Equalities and health inequalities

Reducing health inequalities is a priority for the Scottish Government. Healthcare services can contribute through prevention of poor health for those most at risk and by promoting equality of access to and outcomes from service provision.


"NHSScotland is committed to understanding the needs of different communities, eliminating discrimination, reducing inequality, protecting human rights and building good relations by breaking down barriers that may be preventing people from accessing the care and services that they need."
(NHSScotland Quality Healthcare Strategy 2010)

Everyone in Scotland can describe themselves in terms of their age, disability status, ethnicity, gender/sex, religion/belief, sexual orientation, and gender identity. Understanding the characteristics of an individual can help to improve individual care and support at the point of service delivery and recording information about personal characteristics can help to plan services that are accessible and beneficial to all.

The public sector duties included in the Equality Act (2010) place a requirement on all public bodies to consider the impact of policies and services on the needs of individuals with these ‘protected characteristics’. There is also a legislative requirement that human rights are considered by public bodies and this has some crossover with equality legislation.

There is considerable evidence to show how a characteristics protected under equalities legislation can be associated with health outcomes and experiences of health and care.  Examples are given for each protected characteristic on our webpages.

Health inequalities

Health inequalities are the unfair and avoidable differences in people’s health across social groups and between different population groups.  They are most commonly associated with socio-economic inequalities but can also result from discrimination.

Health inequalities are unfair because they do not occur randomly or by chance, but are socially determined by circumstances largely beyond an individual’s control. These circumstances disadvantage people and limit their chance to live a longer, healthier life.

Health inequalities are avoidable because they are rooted in political and social decisions. There was a substantial narrowing of health inequalities in the UK and USA between the 1920s and 1970s, the period in which welfare states were constructed and income inequalities declined.

The overall health of the Scottish population is continuing to improve, along with a decline in the death rate. However, the gaps between those with the best and worst health and wellbeing still persist, some are widening, and too many Scots still die prematurely (NHS Health Scotland 2013).

Welfare reforms are anticipated to exacerbate health inequalities.  The impact of welfare reforms are presented in a report detailing the impact on life course groups (Health Scotland, 2013)

The Scottish Public Health Network has published guidance for NHS Boards on mitigating the impacts of welfare reform.

An Audit Scotland report, Health inequalities in Scotland, says that while overall health has improved in the past 50 years, deep-seated inequalities remain. Deprivation is the key determinant, although age, gender and ethnicity are also factors. The report assesses how well public sector bodies are working together to target resources at health inequalities and monitor their collective performance, and reviews health services and initiatives aimed at reducing health inequalities. The report says it is not clear how much money NHS boards and councils spend in this area, or what it is spent on.

For more information about health inequalities and how to tackle them, see our briefing: Health inequalities – what are they and how do we reduce them?

Many interventions are rightly aimed at improving whole population health but can inadvertently widen health inequalities amongst marginalised groups, as this segment of the population experience different barriers to engagement with services. Where planning and practice systematically consider equality and inequality from the start, service provision decisions including diagnosis, treatment and onward referral whether to secondary healthcare, preventative services, social care or community based support can identify and rectify the barriers faced by some people more than others.

For example, low literacy, fear, poverty, social isolation, language and communication differences have all been identified in research as presenting barriers to taking up and benefiting from service provision. The Marmot Review of Health Inequalities in England proposed actions that the NHS could take to plan differently for services to be provided in proportion to need. Actions to contribute directly to reducing the impact of adverse social circumstances on health are unlikely to come within the day to day functions of most frontline staff. However, opportunities for referrals to local services for social support such as financial or social inclusion and for joint working or advocacy to act on the causal factors might present through membership or awareness of local partnerships (Craig, 2011).

Updated November 2015

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