Take the right actions

We can take action across all sectors - public, private, third and independent to address inequalities in practice through our work.

Plan the right balance of action

Actions or programmes which aim to improve health across the whole population (known as universal provision) can risk increasing inequalities. This is because everyone has different access or ability to take up opportunities to improve their health. It is important to distinguish between targeting vulnerable groups and reducing inequalities.

• Targeting vulnerable or marginalised groups might improve their health but not necessarily reduce inequalities.
• Population wide approaches aimed at reducing inequalities are not likely to reach marginalised groups if buy-in is required e.g. cost or need for proactive action can be barriers.

The Health Inequalities Action Framework offers a tool for assessing plans against theoretical concepts. The framework

• explains the link between social factors and inequalities in health outcomes
• encourages consideration of the range of actions that might be taken.

For detailed information, you can download the Health Inequalities Action Framework, and you can also download example questions to help you to apply the framework to your own work.

What actions work

Our Health Inequalities Policy Review sets out what works to effectively reduce health inequalities. There are four key findings from the review.

1. Tackling health inequalities requires a combination of actions, such as
   1. undoing fundamental causes
   2. preventing harmful wider environmental influences
   3. reducing the negative impact on individuals.
2. Interventions need to focus on a structural or regulatory level.
3. Providing universal services with added intensive support for vulnerable groups (known as proportionate universalism) is effective.
4. Interventions which require individuals to opt-in and those which involve significant price barriers may assist in improving health, but tend not to be effective at reducing health inequalities.

Inequalities statements with practical actions 

It is vital to support people working within NHSScotland and Health and Social Care Partnerships (HSCPs) to increase their existing knowledge and skill around addressing inequalities. Staff will be better equipped to deliver services that help reduce health inequalities and to respond to the social and economic circumstances affecting individuals' health.

We have produced statements that provide a framework of practical actions that the NHS and HSCPs should consider when developing their strategic plans. The statements allow health and social care planners and managers to consider health inequalities in the early stages of developing plans and priorities.

These statements focus on the key areas for reducing health inequalities. The areas are

• provision of quality services with the allocation of resources proportionate to the need
• training the workforce to understand their role in reducing inequalities
• having effective partnerships across sectors
• employment processes
• procurement and commissioning processes
• leadership and advocating to reduce health inequalities.

Maximising the role of NHS Scotland is the statement for staff working in NHSScotland, and the other statement is for Health and Social Care Partnerships.

Case studies

We have produced a series of case studies aimed at service managers and planners from across Scotland. These reflect on the themes in the statements mentioned above. 

They illustrate inequalities sensitive practice, encouraging services and interventions to

• understand and respond to individual life circumstances to enable people to maintain and improve their health
• support vulnerable people to improve their health and prevent future service demand
• maximise the influence of universal services by connecting clients to other relevant services or support to improve lives.

Sources of support

There are several sources of support to identify effective actions, for example

• our Evidence Briefings on specific subject areas, informing policy and strategy and development and signposting partner websites
• NHS Evidence (external website) or Scottish Intercollegiate Guidelines Network (external website).

You can build your skills and knowledge around finding and appraising research evidence through one of the many courses available in Scotland, such as the ones provided by Scottish Intercollegiate Guidelines Network (external website) or the Critical Appraisal Skills Programme (CASP) (external website) provided elsewhere in the UK.