Inequalities

'...health outcomes for people in lower socioeconomic groups are generally less favourable than for more affluent groups.  In the period 2000-04, almost a third (32%) of deaths in the most deprived quintile of Scotland were attributed to smoking, compared with 15% in the least deprived quintile.'   Source: Taulbut, M. and Gordon, D. (2007). Tobacco Smoking in Scotland: an epidemiology briefing, Glasgow: Scottish Public Health Observatory/ NHS Health Scotland..  [accessed 16 May 2011]

Key figures from 'Poverty and income inequality in Scotland: 2010/11'
This June 2012 National Statistics publication presents annual estimates for the proportion and number of children, working age adults and pensioners living in low income households in Scotland. The estimates are used to measure progress towards UK and Scottish Government targets to reduce poverty and income inequality.

• In 2010/11, there were 780 thousand individuals living in relative poverty in Scotland. Relative poverty has shown a statistically significant drop from 2009/10, with the number of individuals living in poverty falling from 17 per cent to 15 per cent between 2009/10 and 2010/11. This follows a 5 year period of little change in poverty levels.
• The percentage of children living in relative poverty fell from 20 per cent to 17 per cent between 2009/10 and 2010/11, this represents a reduction of 20 thousand children to 170 thousand children. This change is not statistically significant.
• The percentage of working age adults living in relative poverty fell in 2010/11 from 16 per cent to 14 per cent, which represents a reduction of 70 thousand, to 440 thousand adults. This change is statistically significant.
• 160 thousand pensioners were living in relative poverty in 2010/11. This is a reduction from 17 per cent to 16 per cent between 2009/10 and 2010/11. This change is not statistically significant.
• In terms of income inequality, the proportion of income received by the lowest 3 income deciles increased from 13 per cent to 14 per cent between 2009/10 and 2010/11. This proportion has remained at between 13 and 14 per cent since 1998/99.
• The equivalised median income fell in real terms from £439 to £416 in Scotland between 2009/10 and 2010/11
• No statistically significant changes were observed between 2009/10 and 2010/11 to the absolute poverty levels.

Equally Well: Report of the Ministerial Taskforce on Inequalities

Key information:

• ASH Scotland tobacco and inequalities section 
• recent tobacco-related research (updated weekly) on subject headings including black and minority ethnic groups, mental health, older people, women,LGBT groups etc

Useful links:

• Scottish Government information on health inequalities
• Tobacco Research Network on Disparities (TReND)
  Research to Reduce Tobacco-Related Inequalities: Worldwide Implications for and Exemplars of Tobacco Control
• World Health Organisation (WHO) social determinants of health - tools and indicators
• Glasgow Centre for Population Health
• Search the Health Scotland Knowledge Network

	A forgotten community: new Legacy report examines the impact of tobacco use among people with mental illnesses A report by Legacy that calls attention to issues, programmes and practices in tobacco control.
	A hidden epidemic: tobacco use and mental illness Research shows that American smokers with mental health problems smoke twice as much as their mentally healthy counterparts. Smoking prevalence for those with bipolar disorder, schizophrenia and diagnosed depression is between 60 and 80%
	Accounting for Scotland's Excess Mortality: Towards a Synthesis This report seeks to explain two distinct developments over the last century: first, the disparity between Scottish mortality and death rates across the rest of the UK and Europe which emerged in the 1950s, and second, the weakening causal link between deprivation and life expectancy from 1980 onwards.
	An atlas of tobacco smoking in Scotland: A report presenting estimated smoking prevalence and smoking attributable deaths within Scotland Published in 2007 this atlas, and supporting appendices, provide estimates of smoking prevalence at different geographical levels in Scotland. Also provided are estimates of smoking-attributable deaths for individual health boards and CHPs.
	ASH Scotland LGBT report July 2010 A report into smoking within and stop-smoking service provision for the LGBT population in Scotland.
	Better Info, Better Lives Accessible social care information for people with learning disabilities
	Closing the gap in a generation: Health equity through action on the social determinants of health The Commission calls on the WHO and all governments to lead global action on the social determinants of health with the aim of achieving health equity.
	Cough up: Balancing tobacco income and costs in society Smoking is the single, largest preventable cause of serious ill health and kills tens of thousands of people in England every year. It is a popular myth that smoking is a net contributor to the economy  our research finds that every single cigarette smoked costs the country 6.5 pence. In order to balance income and costs, tobacco duty should be progressively increased until the full societal cost of smoking is met through taxation.
	Dimensions of diversity: population differences and health improvement opportunities A report by ScotPho outlining basic information about 13 groups that make up some of the population of Scotland.
	Does income inequality cause health and social problems? A report examining the link between income inequality and health problems; who might be most affected by income inequality and other potential impacts of income inequality.
	Does the ‘Scottish effect’ apply to all ethnic groups? All-cancer, lung, colorectal, breast and prostate cancer in the Scottish Health and Ethnicity Linkage Cohort Study A study to investigate whether ethnic groups residing in Scotland are affected by the Scottish Effect
	Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study The data from this study shows the survival of never smokers in the lowest social classes was better than survival of smokers in the highest social classes (of the same sex). Being a smoker also negated the survival advantage women normally have when compared to men. From this study, smoking appears to be a greater source of health inequality than social position.
	Equality Evidence Finder A tool provided by the Scottish government which permits the user to access statistics about specific demographics of the Scottish population
	European Commission statistics on income, social inclusion and living conditions Covers objective and subjective aspects of these themes in both monetary and non-monetary terms for both households and individuals. The main source for the compilation of statistics on income, social inclusion and living conditions is the EU-Statistics on Income and Living Conditions (EU-SILC) instrument.
	Global socioeconomic inequalities in tobacco use The study set out to produce internationally comparable estimates of socioeconomic differences in tobacco exposure within low and middle-income countries
	Has Scotland always been the 'sick man' of Europe? An observational study from 1855 to 2006 Scotland has been dubbed ‘the sick man of Europe’ on account of its higher mortality rates compared with other western European countries. It is not clear the length of time for which Scotland has had higher mortality rates. The root causes of the higher mortality in Scotland remain elusive.
	Health and Social Inequalities, Findings 23 This briefing paper summarises a project to develop a local monitoring framework for reviewing Community Health (and Care) Partnerships’ (CH(C)Ps’) progress on action to address health and social inequalities.
	Health inequalities in Scotland 2012/13 A report illustrating the major differences in the health and life expectancy of different groups in Scotland.
	Health Inequalities Tool This tool is provided by Scottish Public Health Observatory. It assesses the potential impact of three types of intervention. The information is provided as Excel documents.
	Healthy young lifestyles: an exploration of obesity related behaviours in 18-25 year olds A research briefing about young people (aged 18-25) and obesity-related behaviours, provided by the Scottish School of Public Health Research.
	Help to Quit An American smoking cessation site for assisting those with mental health problems to quit smoking. Provides free resources and downloads to aid and facilitate cessation.
	It's not just deprivation:: Why do equally deprived UK cities experience different health outcomes? The link between deprivation and health is well established. However, recent research has highlighted the existence of a Scottish effect, a term used to describe the higher levels of poor health experienced in Scotland over and above that explained by socio-economic circumstances. Evidence of this excess being concentrated in West Central Scotland has led to discussion of a more specific Glasgow effect. However, within the UK, Glasgow is not alone in experiencing relatively high levels of poor health and deprivation; Liverpool and Manchester are two other cities which also stand out in this regard. Previous analyses of this effect were also constrained by limitations of data and geography.
	Marmot Review - Fair Society, Healthy Lives An independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010. The strategy includes policies and interventions that address the social determinants of health inequalities.
	Measuring socio-economic inequalities in health: a practical guide This is the first in a series of technical briefings to be produced by the Scottish Public Health Observatory. In Scotland - as in many other countries - there is currently considerable emphasis being placed on reducing socio-economic inequalities in health. But success in achieving such a reduction can only be gauged if the inequalities can be measured. This briefing paper therefore looks at several different methods available to measure inequalities and provides a commentary on each. It also comes with an Excel worksheet that will enable public health practitioners and analysts to interpret their own data.
	Moving towards smoke-free in mental health services in Scotland This study was commissioned to explore a move towards smoke-free environments in mental health services in Scotland. It: " Summarises available evidence on tobacco use and tobacco related harm in psychiatric services " Explores how different services have tackled the range of issues around smoking in mental health services.
	Population tobacco control interventions and their effects on social inequalities in smoking The aim of this 2008 report from the Centre for Reviews and Dissemination was to assess how the effects of population-level tobacco control interventions vary between socioeconomic groups.
	Research to reduce global tobacco inequalities A supplement to the journal Cancer Causes and Control which features 11 studies pertaining to tobacco-related inequalities in low- and middle-income countries.
	Review of equality health data needs in Scotland This review was commissioned to meet recommendation 74 of Equally Well. Health data needs were reviewed for gender, ethnicity, age, disability, religion and belief, sexual orientation and transgender identity. It recommends data development in order to improve individual care at the point of delivery, with the hope of reducing inequalities.
	Scotland's mental health: adults 2012 This report is the second systematic assessment of mental health in Scotland. It analyses 51 indicators, which cover the state of mental health (or ill-health) and context.
	Scottish Health Survey Topic Report: Equality Groups A national statistics publication for Scotland from 2011-2012, covering a number of health issues, including mental health, dental health, diet and gender, ethnic group, age and sexual orientation.
	Scottish Neighbourhood Statistics Scottish Neighbourhood Statistics is the Scottish Governments on-going programme to improve the availability, consistency and accessibility of small area statistics in Scotland.
	Scottish Prisoner Survey 2011 A survey of Scottish prisoners in the year 2011
	Smoke and mirrors: a review of the literature on smoking and mental illness As part of its Tackling Tobacco Program the Cancer Council NSW commissioned a review of the peer reviewed, published literature to examine the underlying evidence for many of the contentious issues around smoking and mental illness. The reviewers were asked to examine the evidence in an attempt to answer the most pressing question: Is there any reason why all the efforts put into reducing smoking should not be applied equally to people with a mental illness? Their answer is “no”.
	Smoke-free Mental Health Services Baseline survey report A baseline survey of the smoke-free status of various mental health sites in Scotland around the time of the dissemination of the Smoke-free Mental Health Services in Scotland Implementation Guide
	Smoke-free mental health services in Scotland: Implementation guidance In January 2009, the Scottish Government consulted stakeholders, service users and the public on the best way to achieve smoke-free mental health services in Scotland. As clear consensus emerged, guidance was viewed as a solution which avoided legislative bureaucracy and could effect change quickly. This guidance offers a step-by-step approach to support the process of engagement with all concerned, including staff and patients who are most directly affected.
	Smoking and exposure to racial insults among multiethnic youth in Jujuy, Argentina An investigation to discover if a correlation exists between adolescents who are racially abused and their smoking behaviours
	Smoking and intention to quit in deprived areas of Glasgow: is it related to housing improvements and neighbourhood regeneration because of improved mental health? People living in areas of multiple deprivation are more likely to smoke and less likely to quit smoking. This study examines the effect on smoking and intention to quit smoking for those who have experienced housing improvements (HI) in deprived areas of Glasgow, UK, and investigates whether such effects can be explained by improved mental health.
	Smoking Cessation for Persons with Mental Illnesses: A toolkit for mental health providers Consumers need to be alive to “recover” from mental illnesses. Smoking cessation is a key component of consumer-driven, individualized treatment planning. They want to quit. People with mental illnesses want to quit smoking and want information about cessation services and resources. They can quit . People with mental illnesses can successfully quit using tobacco. Significant evidence shows that smoking cessation strategies work.
	Smoking, giving up and mental health A factsheet is intended for professionals and students who want to know more about the relationship between smoking and mental health and to support people they work with in giving up smoking, should they wish to do so. A lot of the information in this factsheet is also useful for people experiencing mental distress and their family, friends and carers.
	Social inequalities, tobacco chewing, and cancer mortality in south India: a case-control analysis of 2,580 cancer deaths among non-smoking non-drinkers An investigation into the relationships between educational level, tobacco chewing and cancer mortality among middle-aged south Indian non-smokers/non-drinkers
	Still the 'sick man of Europe'?: Scottish mortality in a European context 1950-2010 A long-term study into Scottish mortality, compared with that of other European countries.
	Stop smoking support in HM Prisons: the impact of nicotine replacement therapy. Executive summary and best practice checklist Funded by the Department of Health and authored by the Institute of Social Marketing, this document provides a summary and best practice checklist of a study which aimed to gather evidence and insight into the impact of nicotine replacement therapy in HM Prisons.
	Tackling smoking in Glasgow: final report Produced by researchers at the University of Glasgow for the Glasgow Centre for Population Health in 2006, this full-text report examines the Glasgow Tobacco Strategy and assesses outcomes from the city's smoking cessation services.
	The aftershock of deindustrialisation: trends in mortality in Scotland and other parts of Europe This 2008 report published by GCPH and NHS Health Scotland reveals the 'aftershock of deindustrialisation' in Scotland by comparing Scotland's health with that of other comparable regions in Europe.
	The burden of smoking related ill health in the UK This 2009 paper quantifies the current health and economic burden of smoking in the UK. It provides comparisons with previous studies of the burden of smoking in the UK and with the costs for other chronic disease risk factors.
	The Knowledge Network: Learning Disabilities Portal A portal to provide information, resources and education for health and social care staff supporting people with Learning Disabilities in Scotland
	The Scottish Health Survey: Topic Report: The Glasgow Effect Topic report in the Scottish Health Survey series investigating the existence of 'The Glasgow Effect'
	The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries An investigation into transnational tobacco companies' practices in low and middle-income countries which serve to block tobacco control policies and promote tobacco use
	Tobacco Research Network on Disparities TReND Toolkit Toolkit for addressing tobacco-related inequalities. This toolkit contains a number of resources to provide some assistance to start, or continue, work on tobacco-related health inequalities.
	Tobacco use among minority ethnic populations and cessation interventions While smoking rates have decreased within the general population, this pattern does not seem to be reflected among black and minority ethnic communities Lower socio-economic status can influence tobacco usage, which may account for the prevalence of smoking among some minority ethnic groups Use of different tobacco products, including shisha and smokeless tobacco, is more common among minority ethnic groups Compliance with and enforcement of regulations on labelling and packaging of smokeless tobacco products need to be improved to protect minority ethnic communities from the health risks associated with using these products Regulation and cessation outreach work must acknowledge these different products, and adapt to the specific needs of different ethnic groups.
	Turning a new leaf: women, tobacco, and the future Published by the International Network of Women Against Tobacco (INWAT) in June 2006, this report examines womens use of tobacco in different social contexts, highlights the health effects of using tobacco and describes womens role in tobacco production and marketing.
	WHO Study Group on Tobacco Product Regulation (TobReg) Technical Report Series on the Scientific Basis of Tobacco Product Regulation. The third report presents the conclusions reached and recommendations made by the members of the WHO Study Group on Tobacco Product Regulation at its fifth meeting, during which it reviewed two background papers specially commissioned for the meeting and which dealt, respectively, with the following two themes.