Highland health is not a level playing field

Directors of public health need to write a report on the health of the local population every year.

I have now produced about 20 such reports and many people have contributed to them over the years.

To be able to do this is a privilege rather than a burden and it is a unique opportunity to highlight areas of concern where we need to work to improve the health of local people.

In recent years the reports have tended to have one specific theme and the theme for the report that has just come out is health inequalities.

These are the differences in health and wellbeing between different groups of people.

Over the couple of decades when I have been doing the reports there have been many positive changes to health, notably the decline in smoking and consequently the reduction in harm from tobacco.

However, the significance of health inequalities has always been there.

No one goes to their doctor or nurse and wants treatment for a health inequality. People seek treatment for their poor health.

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However, when we look at illness across the population, we find that there are patterns where some people tend to have poorer health than others.

There are certain differences that are deeply fixed in our genes; for example, women tend to live longer than men.

Others relate to things that we can work more easily to change.

There are inequalities in health that arise from poverty and the great majority of health conditions are more common among people with lower income.

Locally, men in the richest fifth of the community have a life expectancy nearly 10 years more than those living in the poorest fifth.

Inequality can also result from lack of access to services and from discrimination as well as other factors.

People with a learning disability have a life expectancy 20 years lower than people in the general population.

Tackling health inequalities is not about making everything the same, since circumstances will always be different among different people and groups.

Instead, it is about fairness and making sure that people have a fair opportunity to live healthy lives and can make the choices and have access to the services that will make their lives better.

Many countries have health services of excellent quality and people there may praise them as we praise our local NHS services.

However, where the NHS stands out from its foundation is in a desire to be fair and to provide services regardless of the ability to pay.

The annual public health report is designed for people who make decisions about health in our communities.

However, it is important for all of us, whether we have a specific opportunity to shape decisions in our local communities or whether we are voters, to remember the importance of reducing health inequality and encouraging fairness.

Dr Tim Allison is NHS Highland’s director of public health and policy. You can read his report here.

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