Reducing Inequalities in Health

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Kim Penman
Public Health Lead
Inverurie Hospital
01467 672844

About Work

Inequalities in health may be defined as “non random, unacceptable variations in health (outcomes)” (Public Health Institute for Scotland, 2002).

“Inequalities in health arise because of inequalities in society – in the conditions in which people are born, grow, live, work, and age. Taking action to reduce inequalities in health does not require a separate health agenda, but action across the whole of society” (Marmot review 2010:

Reducing inequalities in health is a Scottish Government priority and also a key strategic theme for NHS Grampian, Aberdeenshire Community Health Partnership (CHP) & Aberdeenshire Community Planning Partnership (CPP).

Audit Scotland produced a report Health Inequalities in Scotland 2012. The report aimed to assess how well public sector organisations worked together to tackle health inequalities. Information included the scale of health inequalities in Scotland, quality of evaluations and a review how well CPPs ensure that there is a coordinated focus on health inequalities.

Equally Well

Equally Well (The Report of the Ministerial Task Force on health inequalities) and its associated implementation plan was published by the Scottish Government during 2008. It included 78 recommendations to reduce inequalities in healthy life expectancy and wellbeing. An Equally Well Review document was published in 2010. Of these, 33 recommendations are applicable to the NHS and other Community Planning Partners. Further information can be accessed at : Equally Well Implementation Plan and Equally Well Review 2010.

The Ministerial Task Force reconvened to report on findings in 2013 (see Equally Well Review 2013). Recommendations included focusing on the following priority areas;

  • Development of social capital
  • Support for CPPs and the community planning process
  • Focus on 15-44 age group
  • Support the implementation of place standard

Review of Equally Well actions in Aberdeenshire 2012

Work was completed in 2012 in Aberdeenshire to review the actions and outcomes in Equally Well which are applicable to Aberdeenshire Community Planning Partnership. The key aim of this review is to

  • Identify progress of implementation of Equally Well in Aberdeenshire.
  • Raise awareness of the role of the Community Planning Partnership in improving health and tackling inequalities.
  • Influence the thinking of the Community Planning Partnership on inequality issues through sharing evidence and good practice.
  • Clearly define the contribution the Community Planning Partnership is making to tackle health inequalities.

The following draft documents are now available:

“A Guide to Improving Health and Reducing Inequalities in Aberdeenshire 2011-2015”

In Aberdeenshire “A Guide to Improving Health and Reducing Inequalities in Aberdeenshire 2011-2015” has been developed and endorsed by the Leader of Aberdeenshire Council. The guidance is intended to be useful for all Community Planning Partners working at strategic and local community level.

Much progress has been achieved on improving health in Aberdeenshire since the 2007-2010 Joint Health Improvement Plan. The guidance emphasises the increasing need to narrow our focus and utilise available evidence to support working with priority groups.

Health Profile

Overall the health profile for Aberdeenshire is good compared to the rest of Grampian and Scotland. However it is a complex picture. Health outcomes vary for different outcomes across Aberdeenshire and are notably worse across North Aberdeenshire (Banff and Buchan and Buchan), in Huntly and areas in South Aberdeenshire (particularly the coastal strip south of Stonehaven). Income deprivation and health inequalities are spread across the rest of Aberdeenshire in small towns and more remote and rural areas. This has the effect of making it difficult to target the rural deprived population.

Recent work commissioned in 2009 through the Aberdeenshire Community Planning Partnership (CPP) has provided detail on rural inequalities and isolation within Aberdeenshire. For further detail see Rural Deprivation and Isolation documents below:

Identified Priorities

Reducing inequalities in health is the overarching priority for Aberdeenshire.

In Aberdeenshire reducing inequalities in health may be loosely categorised into the following:

  • Priority focus on identified geographic areas / communities of deprivation
  • Priority focus on identified rural areas to address access and other identified needs
  • Priority focus on key vulnerable groups to address health needs and ensure equitable access to services

Early Years have been identified as a key priority area of work in Aberdeenshire. Other key areas of work include:

  • Mental health and well being
  • Tobacco
  • Alcohol and other drugs
  • Healthy eating & active living
  • Building capacity

Key issues for Aberdeenshire

The following issues: access and transport; service provision; affordable housing; fuel poverty; employability and opportunity for young people, have been highlighted as relevant issues which contribute to inequalities in rural Aberdeenshire.

Vulnerable groups

Health outcomes for key vulnerable groups are worse than those of the rest of the population and provide a focus for targeted effort to tackle health inequalities across all communities in Aberdeenshire. Vulnerable groups in Aberdeenshire which are prioritised in this respect are:

  • Homeless
  • Looked After Children
  • People with substance misuse problems
  • People suffering Gender Based Violence
  • Gypsy travellers
  • People with mental health problems
  • People with learning disabilities

Reducing inequalities in health is a Scottish Government priority and also a key strategic theme for NHS Grampian, Aberdeenshire Community Health Partnership (CHP) & Aberdeenshire Community Planning Partnership (CPP).

Key groups in Aberdeenshire

The Aberdeenshire multi-agency Health Inequalities Group (HIG)– previously the Health Improvement Group- is the key group in Aberdeenshire to co-ordinate and oversee action to tackle health inequality, increase physical activity, improve health and receive, discuss and agree new developments. It is a multi-agency group comprising of a range of Community Planning Partners.

Role and remit:

The Aberdeenshire Health Inequality Group (HIG) works collaboratively to address health inequalities and improve health of the population of Aberdeenshire. The core purpose of the group is to develop, progress, oversee and monitor actions on the Single Outcome Agreement priorities – reducing health inequalities and increasing physical activity. The group will develop a strategic vision to ?close the health gap? in Aberdeenshire and will lead and direct partnership actions to achieve this.

Tackling Poverty and Inequalities Group is a multi agency partnership group which manages Aberdeenshire’s allocation from the Fairer Scotland Fund on behalf of the Community Planning Board. Key strands of work are employability; tackling poverty and reducing inequalities in health.

Role and remit

The Tackling Poverty and Inequalities Group support activities that focus on the priorities set in the anti-poverty framework “Achieving Our Potential” and regenerating communities and tackling poverty through Aberdeenshire’s Single Outcome Agreement. The group has devolved financial responsibility for the management of the Fairer Scotland Fund. The group identifies good practice within this field, promoting research into this policy area, linking with strategies, which target the most disadvantaged. The group seeks sources of funding in addition to the Fairer Scotland Fund and links with national groups such as the COSLA Tackling Poverty Group.

Further information on Key Groups is available at:

Local projects/work streams

Specific partnership projects have been developed in communities across Aberdeenshire to work towards reducing inequalities in health. For example:

Healthpoints – Fraserburgh & Peterhead

NHS healthpoints are operating through the Hot Spot in Peterhead and in Fraserburgh. There has been an increase of access to information, services and advice on a range of health topics.

Child Healthy Weight Programmes

NHSG and Aberdeenshire EL&L are continuing to develop and provide a healthy lifestyle programme that supports a child?s learning journey from the early level through to level 2. Grow Well Choices (GWC) has been delivered across all school clusters by NHSG health coaches working with class teachers. An early years GWC is currently under development and is being piloted with selected nurseries, with roll out in 2014. Between April 2011 and Dec 2013 686 overweight children participated in the programme. Data analysis has shown the programme had a positive effect on participant?s weight status.

Work to Reduce Fuel Poverty

Aberdeenshire Council has a contract in place with SCARF which is an organisation that provides support to people living in fuel poverty. HEAT (Home Energy Advice Team) is a service from SCARF that provides free and impartial advice on energy efficiency and affordable warmth in an effort to eradicate fuel poverty and allow people to heat their home for less.

During 2013/14, SCARF received 5,544 enquiries relating to energy efficiency; from these enquiries, 2,949 where given further, more in-depth energy efficiency advice and 498 requested home visits (which HEAT undertook).  Of the 498 home visits made, 74% were found to be in fuel poverty, however, following advice from HEAT, 30% of those households were removed from fuel poverty. (This may have been by switching tariffs, switching suppliers or through income maximisation referrals).

Work continues to address and bring down the number of people who suffer from fuel poverty in Aberdeenshire.

Keep Well Community Pharmacy Project in Fraserburgh

Targeted health checks for 45-64 yr olds in community pharmacy setting. The health checks are being extended to target offenders, homeless, those affected by substance misuse and gypsy travellers.

Sexual Health Services for Young People

Development of sexual health drop-ins for young people in rural communities across Aberdeenshire to improve access to sexual health information, contraception and services with the aim of increasing sexual health and reducing unintended teenage pregnancy.

Huntly Community Training Kitchen

Huntly Community Training Kitchen and community allotment developed. The Community Kitchen and the Gardening and Growing Project offers opportunities for a wide range of groups in the community e.g. a whole class approach in Gordon Primary School, providing practical food / cooking skills and gardening / outdoor activities as a form of physical activity and community allotment developed.

Garioch Community Training Kitchen


The Garioch community kitchen was officially opened on the 8th of February 2012 by local Councillor Martin Kitts-Hayes and was supported by Homestart, the Harlaw centre, Childsmile, St Andrews Nursery, Kemnay CLD and Healthy Helpings.  The facility welcomed over 100 people from the local community, voluntary agencies and public sector representatives including Comraich, Cair Scotland, CVS, local schools and Community centres. Food taster sessions were provided throughout the day.

Health Inequalities Impact Assessment

Health Inequalities Impact Assessment is a process that helps to mitigate the negative impact of polices and enhance the positive. The result are policies that improve health and wellbeing and reduce health inequalities. In 2011 Aberdeenshire Council completed a pilot utilising an Integrated Health Impact Assessment incorporating assessment of equalities, health inequalities and the environment. With the introduction of the new equalities Duty in 2010 the council moved to using a standalone equalities impact assessment. It is hoped that the council will at some stage further consider the integration of HIIA to ensure health inequalities are fully considered in policy and service development. With the establishment of the H&SC Partnership, work will continue to raise awareness of the IIA within relevant services.

Aberdeenshire Alcohol and Drug Partnership (ADP)

The ADP is a multi-agency partnership organisation leading the development, implementation and oversight of a consensus approach to our goal of a healthier, happier and safer Aberdeenshire free from harm due to alcohol and drugs. Aberdeenshire’s Strategy for Alcohol and Other Drugs 2012-2015 concentrates on the following key outcomes that are absolutely essential to achieve:

  • Prevention
  • Protection
  • Recovery

A key feature of the ADPs approach is the recognition of the impact inequalities have on both the likelihood of developing a substance misuse problem and recovering from such difficulties. More information can be accessed at


Childsmile is a national programme that aims to promote and improve the oral health of children. In Aberdeenshire a Coordinator employed by NHS Grampian manages and supports the distribution of oral health packs via health visitors and dental practices, supervised tooth brushing in nurseries, the application of fluoride varnish twice yearly in nurseries and schools in targeted areas, and provide support to dental practices to promote oral health. More information can be accessed at

Health & Homelessness


Addressing the issue of homelessness is key to reducing health inequalities and in improving the quality of life for people who are often vulnerable and in need of support. Health inequalities can impact on people who have become homeless due to family break-up, mental health issues, substance misuse or simply loss of employment which can lead to financial problems. This can lead to people being displaced as they are moved to unknown areas to live in temporary accommodation until permanent housing is available.

The Aberdeenshire Homeless Strategic Outcomes Group is a multi-agency group set up to take the lead for homelessness across the area. The group develops an annual action plan which all partners contribute.

Further information on homelessness can also be found at the link below

Further information and contact details for all of the above projects are detailed in the team workplan available at:


“A Guide To Improving Health and Reducing Inequalities in Aberdeenshire 2011-2015”
A Guide To Improving Health and Reducing Inequalities in Aberdeenshire 2011-2015, including the full document and supporting papers (which give background information and inform the evidence base) can be accessed here.

Scottish Government Direction on inequalities
Direction from the Scottish Government on the importance of tackling poor health and inequalities is available at:

Audit Scotland, 2013, Health Inequalities in Scotland

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:

Equally Well
The full range of Equally Well documents, including the report, the supporting papers (which give the evidence base), the implementation plan, and 2010 review, can be accessed at:

Scottish Government, 2013, Equally Well Review:

Scottish Government, 2008. Equally Well Implementation Plan:

Scottish Government, 2008. Equally Well, Report of the Ministerial Task Force on Health Inequalities:

Scottish Government, 2010. Equally Well Review Report by the Ministerial Task Force on implementing Equally Well, the Early Years Framework and Achieving Our Potential:

Achieving Our Potential
Scottish Government 2008, Achieving Our Potential: A Framework to tackle poverty and income inequality in Scotland:

Early Years Framework
Scottish Government 2009: This framework is about giving all children the best start in life and the steps the Scottish Government, local partners and practitioners in early years services need to take to start that journey:

Health and Homelessness
Scottish Government 2005 The Health & Homelessness Standards (which provides more detail on the definition of homelessness and guidance for health boards to work towards helping people who have become homeless):

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