The following case study looks at action taken by NHS Greater Glasgow & Clyde (NHSGCC) Public Health Screening Unit. They wanted to understand inequalities in access to screening through the use of data and address these inequalities.

The adult screening programmes targeted were

• abdominal aortic aneurysm screening
• breast screening
• bowel screening
• cervical screening
• diabetic retinopathy screening.

Reason action was taken

As noted in our take the right actions page, one of the key ways to reduce health inequalities is by providing quality services with the allocation of resources proportionate to need.

Rates of cancer

Rates of breast, bowel and cervical cancer have typically been 30% to 50% higher in the most deprived areas of Scotland compared to the least deprived areas. There are a number of reasons for this including lifestyle choices and variations in screening uptake.

Cancer mortality rates

Health inequalities can also be found in cancer mortality rates. Of people in the 45 to 74 year age group, those living in the most deprived areas are more than twice as likely to die of cancer as those in the least deprived areas.

Screening uptake

NHSGGC annual screening reports have shown there are inequalities in screening uptake based on deprivation, ethnicity, age, and gender. There is also low uptake among those with learning disabilities and mental illness.

External audits of the screening programme have further identified inequalities in screening uptake as an issue and advised that an approach should be developed to address this.

Action taken

Data analysis

Data on screening uptake based on the following was analysed

• deprivation
• ethnicity
• age
• gender
• health and social care partnership (HSCP) - standardised
• learning disabilities status
• mental illness status.

In addition, funnel plots allowed for visualisation of uptake by GP practice and data zone maps allowed for visualisation of uptake by data zone (including clinic locations).

Short life working groups

Short life working groups were established under each main screening programme and key stakeholders used the data to agree priorities and approaches to take.

Two evidence briefings were prepared on learning disabilities and mental illness to support this process.

Action plan

An action plan was created which had buy-in from all stakeholders and approval from the

• Public Health Committee
• Corporate Management Team
• NHS Board.

This is the first plan of its kind in Scotland and the learning from this has been shared with the Scottish Government Screening Inequalities Network.

People who helped

The following helped to take the agenda forward

• health improvement teams
• HSCPs
• clinical teams
• third sector
• screening team
• GP practices
• primary care development team.

Impact and lessons learned

This work has influenced the delivery plans of HSCPs and third sector colleagues.

It has enabled the targeting of activities by using data to pinpoint areas of low uptake and population groups of interest. For example, cross analysis of the data zone map, GP uptake and ethnicity data for cervical screening identified Chinese women in North East and North West Glasgow as a population group of interest. Discussions are now underway to develop an initiative to improve uptake among this group.

The data also revealed that ethnicity was a key area of inequality of screening uptake, evidenced by the lower rate of uptake and in the large number of people affected. Cultural issues including language barriers contribute to this problem, so this will be an area of focus and is in the action plan for further development.

Further information

You can find out more about ways to reduce health inequalities within our reducing health inequalities section.

Find out more about screening and health inequalities within our screening section.

This case study is based on information provided by Lisa Buck from NHSGGC. If you would like to discuss further, you can contact our Health Promoting Health Service (HPHS) team by email at nhs.HealthScotland-hphsadmin@nhs.net.