 The next item of business is a debate on motion 7198 in the name of Gillian Martin on behalf of the Health, Social Care and Sport Committee on tackling health inequalities in Scotland. I invite members who wish to participate in the debate to press the request to speak buttons or put an RTS in the chat function if they're joining us online now or as soon as possible. I call on Gillian Martin to speak to and move the motion on behalf of the Health, Social Care and Sport Committee for around eight minutes. I'm pleased to open the debate on the committee's recent inquiry into health inequalities. This is an issue that is relevant to all areas of life, all areas of government and all areas of parliamentary scrutiny, we would argue. In 2015, our predecessor committee held an inquiry into health inequalities, but we didn't want to replicate that work. We instead set out to explore what progress has been made in tackling health inequalities since the report and what affect additional current factors such as the pandemic and the spiralling cost of living have had on people's lives. Before setting out our findings, I want to thank everyone who was involved in our inquiry, every organisation, every professional, every individual who spoke to us and who responded to our call for views. I'd also like to extend a special thank you to Voluntary Health Scotland, who we collaborated with in a series of informal engagement events involving people with lived and living experience of health inequalities to help us understand how they have affected their daily lives. What we heard during our inquiry sadly is not unexpected. Many witnesses pointed to de-industrialisation as having a generational and decades-long impact on Scottish health inequalities way before devolution, but health inequalities have also increased in the years leading up to the pandemic, but they've also worsened since. Clearly, the pandemic did affect everyone, but it affected some more disproportionately than others. That particularly includes people from black and ethnic minority communities, from deprived backgrounds, people with disabilities and parents with disabled children, as well as carers. We know that that particularly impacts on women most, as they shoulder on most care responsibilities and are more likely to be unpaid carers. It's widely accepted that the fundamental causes of health inequalities are rooted in the unequal distribution of wealth and power. The pandemic exacerbated income inequalities, with 36 per cent of low-income households increasing their expenditure, but 40 per cent of people with the highest incomes decreasing theirs. Then came a rapid rise in the cost of living. Of course that happened smack bang in the middle of our scrutiny. Again, while that has affected everyone to some degree, those with the least have been hit the hardest. Older people and those living with or caring for someone with disabilities or complex health conditions are among the more severely affected, and it's just not acceptable. Most shockingly, an increasing number of households have been forced to choose between eating and heating. How much inequality are we prepared to tolerate before taking collective and systemic action? As a committee, we were very clear that we wanted to set out some real tangible recommendations that could help tackle health inequalities and improve people's lives. A lot of the rhetoric around health inequalities for many years has been really forced on mitigating the outcomes, but we are very clear on the need to tackle the underlying causes at the source and to align policy and decision making along those lines. Our report found that there is a policy implementation gap, and this may be a lot to blame for the stubborn persistence of health inequalities. We need to look at that implementation gap in national policy as it is delivered locally. There are lots of policies out there, but are they landing? It's something that comes up time and time again in discussions with experts in health inequalities. Of all the good policies out there, are they having the effect that they were designed to produce and are they being deployed effectively? Decisions made at every level in reaching far beyond health policy to every area of decision making are having a major impact on people's exposures to health inequalities. Logically, the solutions must equally lie at every level and across every area of policy. We call for urgent action across all levels of government, local government, Scottish government and UK government, because they all have a significant part to play and our report made recommendations to each level of government. I suppose that we also did something unusual in our committee report in that we also made recommendations to other committees in terms of further scrutiny that they can do in their portfolio areas, because many of the causes of health inequalities and the solutions to them are actually not in the health portfolio. They lie in housing, planning, energy, social security, education, justice and many more areas. I am delighted that so many of the Parliament's committees are acknowledging this and taking part today. Professor Sir Michael Marmot told us at the outset that not one single policy measure could fix the health inequality problem. If it were that easy, it would have been fixed by now. They memorably said that every minister should be a health minister and that the equity and health and wellbeing needs to be at the heart of all policymaking. The Minister for Public Health, Women's Health and Sport put it very well when she told us that in her opinion, I quote, the Parliament needs to be a public health Parliament in which all parties come together to consider how we work jointly to tackle issues. She echoed the committee's own view when she said this, the answers to health inequality do not lie simply in my public health portfolio, how right she is. There is currently no overarching strategy for tackling health inequalities in Scotland. There are arguments as to whether that is needed. However, we are clear that, with or without a defined health inequality strategy, we do need to redouble our focus on fostering collaboration across portfolios so that all relevant policy areas and all levels of government are pulling in the same direction and contributing actively and positively towards tackling health inequalities. We would like to see a reinforced commitment to cross-portfolio working to explore preventative strategies for tackling health inequalities. I am not just talking about the Scottish Government. The recommendations that I report are equally directed towards the Scottish Government, the UK Government and local government too. I am aware that it is a considerable feat to align multiple Governments and diverse areas of policy towards any shared goal of reducing and ultimately eliminating health inequalities. However, if we are going to achieve that goal, our report is very clear that we need to break out of our silos. I am grateful for the Cabinet Secretary's extensive response to our report, which was received earlier this month. I note that the Scottish Government's commitment to strategic reform is part of its care and wellbeing portfolio and the proactive cross-portfolio discussions that it is embarking on to prioritise a preventative approach at aimed at tackling health inequalities. I also look forward to seeing the results of work by the Scottish Government of Public Health Scotland to undertake health impact assessments in relation to the rising cost of living, with a view to identifying future actions to mitigate those impacts. I want to end by thanking my colleagues across the other Scottish Parliament committees for their interest in today's debate. I look forward to hearing their perspectives and how we can take forward a genuinely collaborative cross-portfolio approach to tackling health inequalities. Thank you very much, Ms Martin. I can advise the chamber that we are pretty tight for time, so I appreciate it if colleagues could stick to their speaking allocation and accommodate interventions in that allocation. I now call Claire Adamson to speak on behalf of the Constitution, Europe External Affairs and Culture Committee for around four minutes, Ms Adamson. Thank you very much, Presiding Officer. I thank the convener and the committee for the deliberations on this informative and challenging report. The subject of this debate is relevant to us all, Deputy Presiding Officer, as the convener of the Health and Social Care and Sport Committee rightly pointed out relevant to all areas of life, all areas of government and all areas of parliamentary scrutiny. Today I want to reflect on the work that the Constitution, Europe External Affairs and Culture Committee have looked at in relation to the wellbeing society to which we all aspire. I want to cover three areas, cultures, wider benefits, mainstreaming and preventative spend. If I could start with what the University of College London described in its submission to our committee as the grade A evidence on the impact of music to sport infant social development, reading to sport child social development and the arts to support aspects of social cohesion, improve wellbeing and reduce physical decline in older age. The World Health Organization cited 3,000 studies which identified a major role for the arts in the prevention of ill health, promotion of health and management and treatment of illness across the lifespan. The challenges in fulfilling the arts role, according to Creative Scotland, are multi-fold. They are around funding, awareness, staffing, integration, whether we can reach those most compromised by inequality, building partnerships and evaluation, how do we measure what works as a preventative spend. Of course, inequalities of access to the arts play their part in those challenges. We should not underestimate the severity of the cross-of-living crisis. Our pre-budgetary scrutiny found a perfect storm of financial pressures facing the culture sector, and I am sure that other subject committees will have similar evidence. However, those are challenges that we must overcome if we are to make the most of the transformational power of culture. Mainstreaming, as my committee and many others condemned, is a means to do just that. Audit Scotland has made the case for a different thinking about what we consider to be health funding because health is much broader than the national health service. That is why, when the committee took evidence on the resource spending review, such as our commitment to mainstreaming, we took evidence on the published review from both the Cabinet Secretary for Culture and the Health Cabinet Secretary at the same time. COSLA challenged us and called for a whole system thinking when it comes to addressing the social determinants of health. National Galleries of Scotland highlighted the many individual cultural aspects and initiatives relating to health and wellbeing in Scotland, but they found those to be fragmentary and not joined up by any national strategy or framework, and actually described the ambition to embed culture in health as still rotating in mid-air rhetoric. The Deputy Deputy Presiding Officer is nearly 12 years since the publication of the Christie report, unless we forget the four pillars where partnership working, prevention of negative outcomes, reducing duplication and empowering individuals and communities. Since Scotland told us, we need to start to think, act and spend differently to see prevention within an investment paradigm, invest now and a flow of benefits will be released over time. There are a lot of culture projects out there working to support health and wellbeing. I'm delighted that we have been able to see some of them in action, whether that be storytelling workshops for children, dementia includes singing networks or art and hospital programmes. However, we need a better understanding of what works, who it works for and when it should be delivered. That understanding can then drive a greater use of cultural services in the support of health outcomes. Siobhan Brown will speak on behalf of the Covid-19 recovery committee again in four minutes. It's a pleasure to speak in this debate as a convener of the Covid-19 recovery committee on such an important topic that I commend the convener and the Health and Social Care and Sport Committee for bringing this debate to the chamber. Health inequalities has been something which has featured in all of our work and I will talk about one inquiry in particular but first it is important to stress that sadly health inequalities existed before the pandemic and these have been made much worse as a result. As we go through the recovery, this is an issue which has been really concerning to the committee. Recently in the chamber we debated the cost crisis which too has also exacerbated health inequalities. Therefore today's debate is very timely and I'm looking forward to hearing about other parliamentary committees scrutiny on this major issue and potential collaborative committee work in the future. In April this year we wrote to the cabinet secretary for health social care on our inquiry into excess deaths in Scotland since the start of the pandemic. We wanted to look at the extent to which excess deaths were caused by the Covid-19 as opposed to other causes such as indirect health impacts of the pandemic. It was a difficult inquiry as we were acutely aware when looking into the statistics that this represented the end of a life for real people and I would like to send my condolences to everyone who has suffered loss. We heard the pressures that are facing the NHS, we heard about the health impacts being experienced by individuals and the level of demand facing services and given the complexity of the inquiry we found it was too early to really tell the exact impact on the pandemic and what it had on excess deaths. However we did hear some stark evidence on how the pandemic had hit harder on those from deprived areas and that this could have had the impact on excess deaths. We were shocked to hear that excess deaths in the most deprived areas were twice as great as those in the least deprived areas and that people living in deprived areas are more likely to get cancer or to be diagnosed later and to die which simply is unacceptable in this day and age. In making recommendations we highlighted this as a priority issue which must be addressed as part of Scotland's recovery. We asked that the Government set out its response to the recommendations made by a primary care health inequalities short life working group who had looked into how primary care and communities could be strengthened and supported to mitigate health inequalities more effectively. They made five foundational recommendations which I think is worth highlighting today. The first one was to strengthen national leadership for health inequalities, to implement a national programme of multidisciplinary postgraduate training fellowships in health inequalities, to create an inclusion enhanced service that invests in the management of patients who experience multiple and intersecting socio-economic inequalities. To develop a strategy to invest in wellbeing communities through local place-based action to reduce inequalities and to commission an investigation to help barriers to health care can themselves inadvertently contribute to excess deaths and premature disability related to socio-economic inequalities. The Government agreed that the health inequalities is a priority issue that must be addressed as part of Scotland's recovery and said that they have established a new development group on focus on driving forward responses to these recommendations. It will be really interesting to monitor this work and we also intend to follow up on the excess deaths looking at recovery of cancer services in the new year. Just turning very briefly to our work on ongoing vaccination programmes, the committee has continued to monitor the vaccination programme including the boost of vaccination and we looked at reasons why below average take-up in some demographics, particularly among minority ethnic communities and in communities experiencing higher levels of deprivation. We considered equity of access to vaccination programmes as well as access to trusted and reliable public health information on Covid and vaccinations. I'm going to finish there because I've run out of time. Thank you very much indeed, Ms Brown. I now call Natalie Dawn to speak on behalf of the Social Justice, Social Security Committee around four minutes. Thank you, Presiding Officer. I'd like to thank the Health, Social Care and Sport Committee for bringing this important debate to the chamber today. The certain point for the Health Committee's inquiry is that health inequalities are a symptom rather than the cause of a problem. Health inequalities arise from the unequal distribution of income, wealth and power in the societal conditions that this creates. Addressing socio-economic inequality is a priority focus for the Social Justice and Social Security Committee. We've been exploring support for people experiencing low income and debt, investigating whether policies to tackle child poverty are achieving that aim and scrutinising the delivery of social security to ensure it provides a vital safety net for those who need it. Health inequality is a long-standing issue. Entrenched poverty can have a generational impact. It adversely affects every aspect of someone's life. Child poverty impacts on children's ability to enjoy their childhoods and achieve their aspirations. Low income households spend more of their money on essentials and often have little or no disposable income to cover a rise in costs. These extremely difficult circumstances have been compounded by the cost of living crisis. As Gillian Martin said in her speech, certain groups are more likely to experience poverty and therefore experience worse health outcomes. Disabled people are disproportionately more likely to be living in poverty, making up 48 per cent of the total number of people in Scotland living in poverty. Disabled people and families with disabled children face extra costs of more than £1,000 a month. Women are also more likely to be in poverty, more so than men. Their experiences of poverty are directly tied to their experiences of the labour market, social security and by undertaking caring roles. Looking at lone parents specifically too, the following example is from our fuel poverty focus group, and it details the punishing decisions that one lone parent faces daily. Heating is a no-go. I use energy for cooking, washing and lights. I keep a note of the units that I'm using, but the bills keep going up and up. The heating is on for a maximum of 30 minutes and I stay under a blanket with a hot water bottle to keep warm. I'm living on an income of just over £7,000 for three people and without food banks we wouldn't survive. I'm on 25 painkillers a day and eat one meal a day as I want the best for my kids. My mental health is getting worse and my health is getting worse. I hate winter, the temperatures are dipping. This is just one example of so many people in crisis. Our inquiry into local income and debt underlined the strong links between poverty, debt and poor mental health. Social stigma is highlighted as a significant barrier to seeking support and increasing the impact on mental health. Sammy H explained that the drivers for suicide can include feelings of humiliation, entrapment and hopelessness, all of which are very common among people in problem debt. People living in poverty are more likely to live in disadvantaged neighbourhoods and in overcrowded or unsuitable housing. Homelessness is both a cause and the result of social inequality, health inequality and poverty. Homeless people experience poorer physical and mental health in the general population. The complex needs and circumstances of many people who experience homelessness makes accessing housing and other services, including health services, more difficult. The health committee's report highlights the essential connection between access to safe, secure, affordable housing to achieve positive health and wellbeing outcomes. Key findings from our committee's work also show the need for suitable sustainable housing. Others include early identification of the threat of homelessness to enable prevention. Those actions, alongside better integration of support services, all contribute to minimising homelessness and its impact. Social security can do some of the heavy lifting in the short term, but to tackle poverty and the symptoms of poverty such as health inequality, there needs to be a comprehensive, radical, long-term, targeted economic approach. My committee will continue to work to improve the lives of the most vulnerable in our society. I'm very pleased to speak on behalf of the Criminal Justice Committee today. I thank the Health, Social Care and Sport Committee for bringing this debate forward. Inequality, poverty and health are threads that run right through many of the issues that the Criminal Justice Committee is considering. Inequality, poverty and health are threads that run right through many of the issues that the Criminal Justice Committee is considering. In the Scottish Government's vision for justice in Scotland, it states that crime and victimisation are intrinsically linked to deep-seated issues such as poverty and income and wealth inequality. It also states that 33 per cent of people in prison are from the most deprived areas of Scotland. A truly shocking statistic. I agree with the convener of the health committee that more focus is needed on prevention and tackling the underlying causes of health inequality. Last week, I attended a conference on policing mental health. I listened to one contributor describe how prevention always loses out in the backroom of power. That cannot and does not reflect our approach in Scotland. However, sectors, organisations and individuals must be supported with appropriate legislative and other structures to make preventative approaches succeed. One area for improvement is ensuring that support is in place for people leaving prison. When people are released without a fixed address, little access to benefits or employment and difficult access to health services such as a GP, there is a high likelihood that they will simply return to prison. As others have mentioned, the cost of living crisis as well as high fuel costs are disproportionately impacting the poorest people in Scotland. There is a real danger that, without extra support, those who are struggling to survive simply turn to petty crime. Recently, chief superintendent Phil Davison of Police Scotland warned that the force has noticed changes in the type of items being taken in shoplifting incidents with people now stealing more basic necessities. That change in behaviour is causing the police service to become extremely concerned over the wider impact of the cost of living crisis. An area of the criminal justice committee's on-going work is how to improve the policing responses to those experiencing poor mental health. Officers cannot take someone from a private place, normally their home, to a place of safety. Therefore, in order to fulfil their duty of care, when someone is in mental health distress, one option is that they may have to arrest the person, regardless of the fact that they have committed no crime. That simply makes their situation worse, leaving people feeling criminalised by a system that is supposed to protect them. A sensitive policing approach is very much needed when dealing with people whose issues are health related. We saw during Covid that a source sensitive and a considerate and compassionate approach to policing was extremely effective and appropriate. A couple of welcome developments in ensuring that people with health issues are given the right support include the collaboration between Police Scotland and Public Health Scotland to address public health and wellbeing in communities across the country. Each health board in Scotland is now providing access to a mental health clinician 24 hours a day, seven days a week. I look forward to seeing the impact of those initiatives. I thank everyone who has contributed to the work of the criminal justice committee and echo the comments of the Minister for Public Health that the answers to health inequality do not lie simply in the public health portfolio. Finally, I thank the health committee for bringing forward today's date on this very important issue. I welcome the opportunity to open the debate on behalf of the Scottish Government. Can I place on record my thanks to the health, social care and sport committee for the comprehensive work that is undertaken during the course of this year's part of its inquiry? Can I thank the clerks? Can I thank all those who have given evidence? Can I thank, of course, my colleagues around that committee table? I know the role that my colleague, the Minister for Public Health, gave evidence at that committee and she will sum up this debate on behalf of the Government. I think that it is a demonstration of the importance of this agenda that we have had so many committee conveners and representatives of committees contribute to this debate already. I think that it is a demonstration of the importance of this issue, not only this Parliament but indeed the entire country attaches to this particular issue at hand. I think that Natalie Dawn put it absolutely right that we cannot look at the issue of health inequalities without looking at the root causes of health inequalities. I will try to pick up on some of those points where I can. Of course, the Government has a role to play in addressing those long-standing health challenges and health inequalities that exist equally. That is not a job that we can do alone. It is more crucial now than ever before that we work collaboratively, not just across this chamber, which is something that everybody will agree to, but certainly right across society. It is also important that the Government works across those portfolio boundaries. I can again speak to more of that in the course of my contribution. Members were absolutely right to make the point, and the convener started on that point, that health inequalities existed pre-pandemic. We have no argument for me or the Government in that respect that we have faced ingrained challenges in relation to health inequalities pre-pandemic. She was equally right to say that those issues have undoubtedly been exacerbated because of the pandemic and, of course, even more impacted or further impacted, I should say, because of the on-going cost of living crisis. The scale of the challenges facing us, I think, have never been greater. The truth is that inequality has been exacerbated by years of austerity imposed by the UK Government. Recent evidence from the Glasgow Centre for Population Health and University of Glasgow found that a decade of cuts have damaged lives, made our communities more vulnerable and led to many dying earlier before their time. Our poorest areas have undoubtedly been hit the hardest. An additional 335,000 deaths were observed across Scotland, England and Wales between 2012 and 2019. This is unacceptable. The UK Government, we plead with them, we urge them to change course from their current harmful policies. The Chancellor's most recent autumn statement does not go nearly far enough. The measures that he outlined in our view are insufficient to help us to deal with this crisis. Let's be absolutely clear that the cost crisis is, at its heart, a public health crisis. Natalie Dawn spoke very powerfully. I'll give way shortly. As Natalie Dawn relayed one testimony from one parent having to choose between heating and heating, how can that not have an impact on somebody's public health? I'm very grateful to the cabinet secretary for taking intervention. If we're going to tackle health inequalities, do you not recognise that we have to deal in reality? You can't, on the one hand, say that you have record investment in the national health service of which you're 100 per cent responsible for, and then talk about health inequalities as the problem with Westminster? I'm suggesting that it's all a problem with Westminster. I'm simply making the point, as others have. I've mentioned Glasgow University. These are serious academics. There are many others. Child poverty, Action Group, the Joseph Rowntree Foundation have all made the point that austerity has clearly been the driver of inequality over the last decade. There can't be an argument about that. If he wishes to argue the opposite, he's happy to do so. Of course I will come to the importance of what I'm about to come to, the important action that the Scottish Government can take, but the financial levers—not all of those financial levers, I'm afraid—are at our hand. Some of them are. Hence why John Swinney, the Deputy First Minister, the Interim Finance Secretary will lay out our budget tomorrow. Some of those levers, of course, are at our hand. There is a possibility for us to take action. That's why I'm proud that we have put £3 billion towards this financial year, towards helping households, and the lowest paid, the most vulnerable, those in the areas of the highest deprivation to help them through the current crisis. I think that our tackling child poverty delivery 2022 to 2026 best start bright futures programme outlines the wide-ranging action that we're taking, that transformative increase to the Scottish child payment. I think that a real game changer when it comes to tackling poverty, not my words, but those of many of our third sector partners. I thank the cabinet secretary and, as he will know, I do agree around the austerity being the key driver. I just wonder if the cabinet secretary would make a commitment. I've been positive about what's happened in terms of the child benefit, but a lot of the organisations are saying that we need to go further. Would he agree that we should be going further at this stage? We will always engage with those third sector organisations, with the opposition and others, to see where we can go further. Of course, as I said, John Swinney is laying out the budget for the next financial year, and I'll leave him to say more about that tomorrow. I wanted to make the point, Presiding Officer, that many committee conveners and representatives have made already, which is incumbent for the Scottish Government to make sure that it's working collaboratively. Part of the way that we're doing that is through that care and wellbeing portfolio that we have brought together is doing just that, because the Minister for Public Health is absolutely right when she came in front of the committee to say that public health is a responsibility for every single Government minister. I want to give an absolute assurance that, right across Government, through the good work that we're doing in our portfolio, but, importantly, that the Deputy First Minister is doing in bringing cabinet secretaries, bringing ministers together from across portfolios is absolutely having an impact. Much of that work is inspired by the work of Sir Michael Marmot, which was mentioned by Gillian Martin and the helpful contribution that he gave to the committee. I also want to reference that point that was made in the committee report about racialised health inequalities. It was a point that was made also by Siobhan Brown and her contribution, because we know not everybody has been impacted equally, whether that's the pandemic or whether it's a cost crisis. Indeed, we have heard already from a number of members the importance of recognising intersectionality. Therefore, I want to give an absolute assurance that, from a Scottish Government perspective, that work on tackling racialised health inequalities and that assurance of intersectionality is one that is the forefront of our mind when it comes to tackling health inequality. In summary, we need, of course, effective and collaborative leadership to tackle the issues robustly and achieve the outcomes that we desire for our people and communities. I'm committed to playing my role in this endeavour using the powers that are very much available to us. I promise to work not just across the chamber but with other Governments, be it UK Government or indeed local government. There's an appetite for change amongst all of us in this chamber. I give my commitment, as I say, to work with anyone to reduce those health inequalities, which sadly still exists in Scotland. We do have a serious problem in Scotland regarding health inequalities. Our report makes for uncomfortable reading. Simply not enough is being done to improve health outcomes in the most deprived communities. According to Public Health Scotland, Scots die younger than our neighbours in other Western European countries. Those living in our poorest communities are three times more likely to die by suicide, twice as likely to have a mental health condition, four times more likely to die of an alcohol-specific death and 15 times more likely to suffer a drug-related death. The committee's report hooms in on the many, many factors that cause impact to exacerbate mental health inequalities and health inequalities. This includes housing, education, access to social and cultural opportunities, employment, income and social security. We have heard from the health convener and during evidence that the Scottish Government has no overarching strategy for tackling health inequalities. That's why the committee's report calls on the Scottish Government to set out in detail what it is doing within its devolved competence to tackle poverty as a public health issue. I'll take this opportunity to highlight some areas I feel should be prioritised for action. On housing, the committee heard compelling evidence of the essential connection between access to safe, secure, affordable housing and positive health and wellbeing outcomes. In the 2020-23 budget led by the SNP, there was a slashing in the core housing budget by £5 million. There are over 32,000 adults and 14,000 children currently registered homeless in Scotland. There are almost 100,000 children on Scotland's social housing waiting list as well as 230,000 adults. Despite strong SNP Government rhetoric and support of action to tackle inequalities, the evidence of what's happening in our community tells a different story. The committee recognises the benefit by will, yes. Emma Harper. It's a pity colleague for taking an intervention. One of the things that came out in the report was that the members who gave us evidence said that the universal credit uplift should be reversed and reinstated. I would be interested to know if you're saying that we should do more to help people in Scotland. That was one of the things that we could help with. I would be interested to know why members across those benches did not support that uplift in our report. Dr Gorgani. It's very clear that the UK Government put an increase in and that was for the Covid times and that is quite right when they said that. The committee recognises the benefit of giving local government the autonomy to innovate and to explore new ways of tackling health inequalities, affordable housing and transport, improved town planning, access to green space, ensuring health as prioritised in planning applications and investing in wellbeing communities. These are some of the areas that we should be supporting councils with. Local government knows what will work best for their local communities. On education, our committee recognises the important role of education in addressing societal and health inequalities. The First Minister is on the record by promising in 2016 the ending of the discrepancy in results between the richest and poorest school children and said it was her defining mission. But six years on, the attainment gap remains wider than in 2018-19. Grand statements and no delivery won't cut it. The SNP-led government should be laser focused on delivering for Scotland. It does have substantial powers. It is responsible for education, transport, health, housing. Of course, we can't discuss health inequalities without a focus on health. People in the most deprived areas are now expected to live a healthy life for 24 years less than those in the least deprived. This is in part linked to higher levels of smoking, obesity and alcohol consumption in the poorer areas. In other words, Scots from our poorest areas are not as healthy and so they'll rely more on our health services and the poor stewardship of our NHS is exacerbating these health inequalities. Any figures reach their worst ever level. Cancer waiting times are the longest on record. A patient in Shetland waited almost two years for cancer treatment. The average number of delayed discharges is at its worst ever level. Only two thirds of children are receiving mental health treatment within 18 weeks. However, the SNP-led government has cut £400 million from the health and social care budget and cut £65 million from the primary care budget. Of course, we had to take £400 million in reprofile across the budget because my budget is now worth £650 million less because of his party's economic incompetence. If he doesn't think that we should have taken money away from these services, where should we have taken money in order to afford record pay deals? That's the reason why, of course, nurses aren't going in strike here in Scotland and there will be tomorrow in his party's controlled England, but can I also say to him that he needs to come up with credible solutions on room reprofile? One point five billion from the national care service would be a fantastic start. Plus, let's be absolutely clear that we know the SNP aren't very good when it comes to stats and telling us what actually is happening and it's not that type of money that's lost. The SNP-led government has cut £400 million from the health and social care budget, £65 million from the primary care budget, cut, £38 million from the mental health budget, cut, £70 million from the social care, cut, £5 million from GP support, cut. Scotland's drug deaths rate is the highest in Western Europe. We have terrible rates of addiction. In 21, there were 1,330 drug related deaths in Scotland. These drug deaths exposed serious inequalities. Those in the most deprived areas are 15 times more likely to die of a drug misuse death than those in the least deprived areas and this has widened in the past two decades. So let's consider some solution, our right to recovery bill, giving people the statutory right to addiction and recovery treatments. In order to make it easier for people in deprived areas to get health problems diagnosed, let's roll out mobile testing facilities, take healthcare to the people, for example, conduct CT scans in areas of high deprivation to identify lung cancer earlier. The Scottish Government needs to up its game to reduce smoking, especially around looking at e-cigarettes and heated tobacco products. We need to maintain funding for smoking prevention and cessation services and reiterate our calls for community link workers to be embedded across all GP surgeries in Scotland. To conclude, the committee's report on tackling health inequalities in Scotland is an important piece of work. We must ensure that it does not gather dust and that we see concrete actions in place as a matter of urgency. I'd like to thank the convener, members of the committee and all invited witnesses to our meetings and declare an interest as a registered NHS GP. I remind you that we are tight for time, so I would encourage the interventions to be as brief as possible with that. I call Carl Mocken for up to six minutes. I take this opportunity to thank all my colleagues in the Health, Social Care and Sports Committee for the work that they have put into this report and to all those who gave evidence to the committee about the reality of health inequalities in our communities. I am pleased to open the debate on behalf of Scottish Labour. My party and I fully support the recommendations of the report and I would go further and say that it is essential that we recognise that this is one of the most significant political issues that we can address in this Parliament. To allow health inequalities in Scotland to have the detrimental impact they do, is to prevent our country from growing, progressing and improving. Health inequalities hold people back, they hold communities back and if this Parliament fails to recognise the scale of the challenge, they will hold back a nation. Before moving on, I must speak to the scale of the problem that we face. In Scotland, women from more affluent areas are more likely to attend screening appointments than women in our most deprived areas. Suicide rates are higher in our most deprived areas than they are in our most affluent, as are cancer rates. It is described in a recent report from Glasgow University that the gap in life expectancy between the most and least deprived areas has actually worsened. This is shocking and it should worry all of us in this chamber. Indeed, that represents a picture of a country whose Governments are letting it down, a country where the poorest pay the price of neglectful governance. I welcome the recognition in point 354 of the report that states that the committee considers that policy action today has been insufficient to address health inequalities and therefore concludes that additional action is urgently needed across all levels of government to resolve this. No-one can speak about health inequalities without condemning the policy of austerity. It is widely accepted and acknowledged from the evidence given to the committee that austerity drives health inequalities and causes undue harm to our most deprived communities. The current attack on the poor from the Tories must be addressed if we are ever to make far-reaching changes to address health inequalities in this country. I and those on these benches will continue to fight Tory cuts and the attacks on the poor. We will do that by not only attacking the important record of the Tories in power but highlighting the positive impact that a Labour Government could make in this country. However, the reality of my job here in this place is to ensure that the Scottish Government is meeting the responsibility to citizens. I believe that it is in this responsibility, it is the responsibility of this Government to do all that it can to change this downward trajectory. There is a lot here that the Scottish Government must act upon and if they fail to do so then they are letting down many people who would benefit greatly from serious reform. However, we come to the Parliament on a regular basis and we have plenty of warm words from the Cabinet Secretary and from the Government MSPs but we do not see enough action to seriously tackle health inequalities. Having said that, I am confident that with the great approach and good will we can take into account the testimony of experts that came to the committee, the experts that we heard on important matters such as access to safe and secure housing, whether we are efficiently using the housing stock that we have, embedding community link workers and all our GP surgeries, maximising welfare and eliminating barriers to employment. Those are just a few of the very necessary recommendations contained in the report which, despite being far from exhaustive, is a positive step in the right direction. The Scottish Government can and must do more. It is undeniable that we are facing economic challenges due to national and international pressures but now is the time to stand up rather than hide behind excuses. It is perfectly clear and we have a detailed plan from the STUC this week that there are significant levers that can be used to increase pay in the public sector especially, which is the most obvious and impactful contribution we can make to improving economic outcomes and with that health inequalities. Indeed, I quote Rose Foyer, general secretary of the STUC, who said, This is not a question of ability, it is a question of ambition and political will. I am fed up listening to the Scottish Government playing the Westminster blame game, simply being better than the UK Government isn't good enough. Presiding Officer, it is not good enough, it is a low bar with which to make a comparison and we can in Scotland do better. In closing, I would remind the Parliament that the solution to health inequalities lies largely in widening opportunities and increasing the provision of services so that they reach every community in their land, regardless of wealth or whether they benefit from a postcode lottery. Health inequalities are complex and multifaceted. We all accept that. They cannot be solved with a single policy or initiative. Health inequalities are everybody's business and so I support the committee's call for cross-party portfolio engagement on this issue. If this can move us one step closer to eradicating health inequalities, which is what this report intends to achieve, my colleagues on these benches and I will work across the chamber to deliver that change. It gives me great pleasure to rise for the Scottish Liberal Democrats in support of today's motion. I am grateful for the committee bringing this in charge, but it is debates like this that show this Parliament at its best. When we see the intersectionality of the issues that we are here to discuss around health inequalities manifest in the work of every committee of this Parliament, I commend each of the communists for their remarks. I would like to start if I may with a quote from Martin Luther King, who said that of all forms of inequality, injustice in health is the most shocking and inhumane. It is also largely the most preventable. We are, in this country, rightly proud of our national health service. We rightly celebrate and reaffirm its ethos of high-quality care free at the point of need. While we should be proud of that, we must never be complacent about it. For while much of our health system may be envied around the world, there is not always the quality of access to that healthcare for everyone in this country. Certainly, health outcomes are anything but equal. Last year, the national records of Scotland revealed that those born in the most deprived areas can expect 24 fewer years of good health than those in the least deprived areas. It also revealed that disadvantaged people spend around a third of their life in poor health, and the most deprived groups face barriers in their way when it comes to booking medical appointments and seeking treatment. As you all know, I represent Murehouse, the area of Murehouse in Edinburgh. It is one of the most deprived communities in Scotland regularly in the top five of the multiple industries of deprivation. Within that is Murehouse Medical. It is the highest-deep end practice in the country. I am proud to represent it. It is a dynamic and beautiful community. Every six months, I often make a point of going down to Murehouse Medical to hear about the health inequalities. The last visit I was there was really struck by a challenge or a question that I was given by the lead partner there. He said, how many of a practice size is roughly 10,000 people? How many dementia patients do you think we have? How many of our patient role do you think we have who have Alzheimer's? It has a gas at a couple of hundred. He said, it is a handful. It is barely 50. That is because nobody really makes it to dementia age because of the manifest comorbidities that the grinding poverty that so many people in that part of the community face. It is a really stark example. For the most alarming evidence of health disparities, one needs to look no further than in cancer outcomes. Those from most deprived areas are more likely to get cancer, more likely to be diagnosed later and more likely to die. A Public Health Scotland report just published last month found that cancer mortality rates in the most deprived areas are staggering 74 per cent higher than the least deprived, while there are almost 5,000 extra cancer cases each year as a direct result of socio-economic deprivation. There is even inequality when it comes to accessing NHS treatment. Take dentistry for instance, where we have seen the emergence over time of a two-tiered system between those who can afford private dental work and those who cannot. Disinterest in action have allowed this problem to fester and now one in five people are unable to get an appointment are turning to DIY dentistry. Imagine how horrific that must be. That is a shocking state of affairs in 21st century Scotland. That is why, at our conference in October, my party voted to reform the current NHS dentistry funding structure to incentivise dentists to take on and to treat NHS patients. We must not forget the postcode lottery that Stadley still exists in maternity services in the north of Scotland. Expectant mothers in both Murray and Caithness are forced to endure a dangerous and night-bearish journey to Rhaigmoor, sometimes in the snow and in the dark to give birth. That means an incredibly anxious car journey over icy roads during winter. Despite repeated calls from my colleague at Westminster Jamie Stone MP, the Scottish Government has yet to conduct a safety audit on this huge change in service for Caithness patients. That audit will come too late for the newborn who suffered brain damage after travelling three hours by car between Rick and Rhaigmoor in October when an ambulance was never even offered to the family. The health board in that case was forced to apologise and rightly so. It goes without saying that nobody should have to face that level of increased risk simply because of where they live. Everyone should have equal access to high quality localised maternity services. At the root of the problem is the asset stripping of local communities that we have seen this Government commit. This Government has continued to prove that it prefers to spend money on huge centralised bureaucracies rather than take the decisive action that will make a difference to people's outcomes today. As we have heard from the committee, there is a huge link between health and poverty. Income inequality often leads to health inequality and the knock-on impact on mental health cannot be understated. Those in financial difficulty are more likely to suffer poor mental health, while parental mental health has a significant impact on the wellbeing and life chances of children and adolescents in their care. I fear that the longer Scots are forced to endure the cost of living crisis, the more obvious and tragic the impact of poverty will become, and they join the longest lists in our NHS in terms of care. The Government must redouble its efforts to tackle rising poverty, treat it as the public health issue it is, and to give people the treatment that they need when their mental health fails them. As all evidence suggests, health inequalities in Scotland are continuing to grow, and I realise that I am coming to the end of my time. I will finish with the words of the former president of Barbados, Owen Arthur, who once said that he who has health has hope, and he who has hope has everything. We need to give the people of Scotland some new hope. Hamilton, we now move to the open debate. I remind members that speeches are of five minutes rather than the more usual six or four minutes, and I call first Evelyn Tweed to be followed by Brian Whittle. Thank you, Deputy Presiding Officer. As a member of the Health, Social Care and Support Committee, I would first like to thank all participants for sharing their time and their expertise throughout this inquiry. Our committee found that unjust and avoidable health inequalities are widening across Scotland. They are systemic and intertwined with other forms of inequality, and as we have heard today, poverty. Dr Sharon Wright from the University of Glasgow, along with 74 other respondents, told us that poverty drives health inequalities. Poverty has wide-ranging and dire consequences for health, and the Westminster cost of living crisis is having a disproportionate negative impact on those already experiencing health inequalities. Mary Curie shared stories of terminally ill people in Scotland struggling with bills and having to rough it through the winter. A terminal illness comes with extra use of energy for heating and specialist equipment. Dr David Walsh of the Glasgow Centre for Population Health told our committee that you can trace the effects of austerity through well-understood pathways to ultimately and tragically early death. As the cabinet secretary has highlighted, the most damning statistic of all is that life expectancy has fallen as a direct result of the UK's austerity policies. Research led by the Glasgow Centre of Population Health and the University of Glasgow show that austerity has led to almost 20,000 excess deaths in Scotland, and people living in the poorest areas are hardest hit. In fact, the study found a total of 335,000 deaths across Scotland, England and Wales between 2012 and 2019. Conservative policies have helped to shorten life expectancy for people across the UK, as well as diminishing the quality of their lives. During our evidence gathering, we heard from multiple experts that the most effective method of relieving poverty and thus improving health outcomes is putting money in the hands of those who need it. Scotland is making huge progress in this. As the Joseph Rowntree Foundation said, the full roll-out of the Scottish child payment is a watershed moment for tackling poverty in Scotland, and the rest of the UK should take notice. The child poverty action group also said that if the Scottish Government can make this kind of serious investment in protecting our children from poverty, then so too can the UK Government. Much is being done to mitigate health inequalities, but there is one clear fact that is driven by the data and not politics. That is that the most effective remedies to tackle poverty remain outwith the control of the Scottish Government. Many of the experts—no, not at this time—were unequivocal in their view that Scotland's ability to remedy health inequality is extremely limited whilst part of the UK. For example, the experts told us that benefits under control of Westminster are some of the most effective ways of delivering support to low-income families. I am tired of the Labour Party's continued attacks on the Scottish health service when Scotland is clearly performing better than that of Labour-controlled Wales. Labour and Sir Keir Starmer are enthusiastic backers of Brexit that are doing so much to damage not only our economy, but it is also depriving the health and care sectors of desperately needed staff. Presiding Officer, we have heard that poverty and health inequalities are inextricably linked. The Scottish Government will continue to support those in poverty, but we could do so much more with independence. As a result of the last Holyrood elections demonstrated and all the recent polls confirm, the people of Scotland recognise this. If the Opposition parties in this chamber were really serious about working collaboratively to tackle health inequality in Scotland, then they should be joining with us to demand that Scotland's people have the right to choose their own future. I am pleased to get the opportunity to speak in this debate and do so as the co-convener of the health inequalities across party group. Health inequalities is a topic that is tremendously important to me, and I welcome the chance to discuss the work that I and five of my other MSP colleagues and nearly 100 external organisations including third sector, health board and other MSPs have done. Health boards, other public bodies, academic institutions and royal colleges have done to raise awareness of the causes of health inequalities, promote evidence-based actions that reduce health inequalities and to avoid legislation and policies that make health inequalities in Scotland worse. Over the past year, the cross-party group has met to consider a range of topics including the inverse care law, socio-economic impacts on children's activity levels and mental health. Despite our work to draw attention to the needs of the underserved and marginalised groups and their evidence-based solutions, we are all aware that the Covid-19 pandemic has statly brought the realities of the gap in health outcomes between different population groups, particularly between rich and poor. I think that the NHS rate of recovery from the pandemic twinned with the cost of living crisis are alarming. Both will risk winding the health inequalities gap further. When we discuss health inequalities, it is important to make sure that we are not focused entirely on the outcomes of health inequalities but also look at the broader reasons for health inequalities outside of that healthcare. We should also recognise that there have always been inequalities and there will always be inequalities. The question is, at what level are inequalities acceptable and what can we do to ensure that we tackle those societal inequalities that we are able to address. With that in mind, I would like to talk again about the significant role that the preventative health agenda could and should play. For example, housing people with respiratory conditions in damp, poorly insulated housing will inevitably lead to more time spent in the hospital, with that cost coming out of the NHS budget rather than the housing budget. In fact, housing anyone in damp, poorly insulated housing will lead to more people with respiratory conditions. That highlights where I think the Scottish Government has failed to think and act across portfolio. You either invest in better quality housing, heating and insulation or you spend the money in the healthcare of those who do not have that quality housing. It all comes out of the same Scottish Government budget. It is just a quick question of what page in the ledger the investment will appear. The Scottish healthcare system, in my view, is funded to provide healthcare on demand rather than on need. It is reactive, more than proactive and preventative and it must be encouraged to change and evolve. I absolutely agree with everything that he is saying about good quality housing and ask him if he is supportive of the moves to build more social housing in Scotland. Is that something that the Conservative Party supports? Of course we do. I think that that is absolutely crucial what we do. If you cut the budget to social housing you will build less, therefore it will come out of the ledger of the healthcare budget. That is exactly what I am trying to say here. Scotland is the unhealthiest country in Europe and the unhealthiest small country in the world, which is a major reason why we have such stark health inequality data. We have such a poor record in conditions like obesity, where levels in Scotland are among the highest in the developed world. The condition is likely to result in rising levels of type 2 diabetes, colon cancer and hypertension. Decline levels of physical activity and sedentary lifestyles were highlighted in our report as a factor in the rising obesity levels in Scotland, affecting the lower SIMD areas more acutely. We also talked about changes in diet, including the availability of cheap energy dense food as a factor. That report also said that people were walking less, car use was up and people's jobs are less active. According to obesity action Scotland, the average BMI of the Scottish population has been rising steadily since 1995 and has gone from 26 to 28. For our children in Scotland living with obesity, more than half of them are at the risk of severe obesity, which costs the health budget billions. Those conditions are most certainly exacerbated by poverty, with life expectancy varying hugely in Scotland. Even when in the city of Glasgow, life expectancy can vary by more than 20 years within just a few miles. However, those conditions are preventable. It is why I am so passionate about ensuring, as part of our education system, that physical activity should play a much bigger part. It is why nutritional education should play a much bigger part. When we discuss free school meals, I believe that we should be ensuring that pupils have a much greater part in the development of that menu. I know a bit of time, but the Scottish Government's health strategy, education strategy and housing strategy are some of the reasons why health inequalities persist. We must join up the dots and think portfolio, put across portfolio. That is the only way we can improve Scotland's report card. Emma Harper will be followed by Rhoda Grant in five minutes. I want to thank everybody who was involved in the inquiry. I am a health and social care committee member myself. Fundamentally, the health inequalities inquiry, which we have heard already, has involved numerous committees of this Parliament. It has shown one crucial factor. That is that the Scottish Government is doing everything it can to tackle the root causes of poverty and associated poor health, but it has one hand tied behind its back by not having control over reserved powers, which currently sit with Westminster. The policies of the Tories in Westminster are having a negative and long-lasting consequences that directly impact on the health of low-income households here in Scotland that is clear and evidence-based. Game-changing policies such as the £25 per week Scottish child payment can only do so much when the Tories continue to inflict harm on the most vulnerable in our society, namely those relying on the safety net of the state. The people that are relying on the safety net of the state are the safety net that has been systematically dismantled by Westminster Government. I will give way to Brian Whittle. I am grateful to the member for giving way, which does not accept that the Scottish Government has total control over the biggest tools in the toolbox to tackle health inequalities. That is health and education, and in both of those, you are failing. Emma Harper. As the member is still intervening from a sedentary position, we do not have control of the budget. That is the bottom line. We need the finance in order to deliver what we need to do in order to tackle poverty and support health inequality. Our report, our committee's health inequality report, shows that successive UK Conservative Governments, particularly in the 1980s and from 2010 onwards, insisted on austerity agendas and on slashing welfare payments and public services. I think that it is important to state this, and I quote, difficult economic conditions created by government measures in an attempt to reduce public expenditure, austerity caused by political policy choices. I have only got five minutes. The report reflects that the austerity agenda has caused continued and immense damage to the health of the poorest and most vulnerable. Asterity has been an economic failure, but also a health failure. During our inquiry, we heard how experts from the Glasgow Centre for Population Health showed that nearly 20,000 excess deaths in Scotland were likely to have been caused by UK Government economic policy, and Tory austerity policies have likely caused more deaths in Scotland than Covid-19. Here is the evidence that members might want to listen to. Dr David Walsh from the Glasgow Centre for Population Health said, We must remember that these are more than just statistics. They represent hundreds of thousands of people whose lives have been cut short and hundreds of thousands of families who have had to deal with grief and aftermath of those deaths. The UN Poverty Envoy has also warned that another wave of austerity might violate the UK human rights obligations and increase hunger and malnutrition. Matthew Taylor, chief executive of the NHS Confederation said, The country is facing a humanitarian crisis. Many people could face the awful choice between skipping meals to heat their homes and having to live in cold, damp and very unpleasant conditions. Since Matthew Taylor stated this, we are seeing the reality of eating versus heating. It is not a choice anymore because folk are not eating their homes and they are missing meals. Families are omitting their meals. The inquiry shaped the committee's many recommendations. Gillian Martin has already said that areas such as employment, education, housing and social security, public services and health are all covered in many portfolios. The recommendations fundamentally call for urgent co-ordinated action across all levels of government in the UK to tackle health inequalities in Scotland. The committee was particularly concerned that the rising cost of living will have a greater negative impact on those groups that are already experiencing health inequalities, including those living in poverty and those with a disability. One of the key findings for me is that there is no overarching national strategy for tackling health inequalities in Scotland, but the evidence submitted to our inquiry shows that many instances where the design and delivery of public services may be exacerbating inequalities rather than reducing them. I am conscious of the time, Presiding Officer. It is clear from my report that many causes of health inequalities lie with policies made at Westminster. I welcome the Government's commitment to accept the majority of the committee's recommendations and will work together to tackle health inequalities in Scotland. I remind the chamber that it is up to members whether or not they take an intervention. If interventions are not taken, that is not an invitation to shout the intervention from a sedentary position. I call Ruda Grant, who joins us remotely to be followed by Fiona Hyslop. Health inequalities are a symptom of an equal society rather than a cause. That is a point that has been made by many speakers in the debate. There are inequalities in our health service, but those are because of the underlying societal issues. I live in Inverness, and from my home, I can walk 15 minutes in one direction and then 15 minutes in the other direction. Sadly, life expectancy between those two communities, which are separated by a 30-minute walk, is almost two decades. Those in the wealthy area live nearly 20 years longer than those in the less affluent community. Those people were born in the same hospital, they were educated by the same council and they live in the same city. The only difference is their access to wealth. People with a reasonable income can live in warm homes, enjoy nutritious food and focus on the education of their children as well as their own opportunities. People who do not have a reasonable income live in cold, damp homes, eat a poor diet, and the education of their children is secondary to their survival have no opportunities. Therefore, they are more liable to become unwell to suffer harms which damage their mental and physical health and therefore have a shorter life expectancy. It is absolutely unfair that these people also have poorer health services. GPs working in their most deprived areas tell us of the challenges they face when working in these communities. Lack of money and opportunity also diminishes people's expectations with regard to health services. They do not expect to be able to access services. They often cannot afford to access services due to the cost and availability of transport. The lack of expectation of a reasonable outcome can cause mental health issues and lead to self-medication and addiction as well and as we all know, drugs and alcohol also shorten lives. We know that women are more likely to earn less due to the gender pay gap and greater caring responsibilities. Therefore, we need to deal with health inequalities by dealing with the societal inequalities, which are the root cause. It is often easy to see those divides in cities to identify post-codes where low incomes and poor health incomes are prevalent. It is much more difficult to do this in rural communities where the wealthy live side by side with the poor. The Highlands and Islands Enterprise reports that a minimum income for remote rural Scotland points out that a minimum income for a reasonable standard of living in rural areas is between a tenth and a third more than in urban areas. The report tells us that the additional costs come from a range of sources, in particular the cost of travelling, heating one's home and paying for goods and their delivery, which is much higher for many residents of the area and areas under review, especially those in the remotest areas. Therefore, interventions that target geographical areas do not work for the rural poor. The Scottish Government passed up to the UK Government, which we have heard today, and indeed the UK Government's policies have made the situation worse. However, the Scottish Government continued to ignore its own responsibilities. With regard to heating, it is now insisting on those needing new heating boilers, funded by Government schemes, using heat pumps. In order to use a heat pump, you need to invest tens of thousands of pounds in the insulation of your home. Many of those people simply do not have. I spoke to someone recently who had a heat pump fitted to an old house who said that it was pointless to put on the heating because it was hugely expensive and did not provide any warmth at all. The Scottish Government needs to take responsibility for this and design its policies accordingly because they are now responsible for people freezing in their own home. They are also responsible for potential interventions that could lift people out of poverty. We in the Scottish Labour Party proposed improvements to the Good Food Nation Bill to enshrine the right to food in the act that was voted down. We also tried to make the Food Commission responsible for realising that right again voted down. The Scottish Government is directly responsible for that. We all aspire to live in a country where these basic human rights are met and it is to our shame that they are not. I welcome the committee report. I hope that it pushes the Scottish Government to act and make Scotland a fairer country. If they do that, they will begin to tackle health inequalities. I remind the chamber for those who participate in the debate, that you are expected to be in the chamber for opening and closing speeches. If you have made a speech, you are required to be in the chamber for at least two speeches after that. I notice that that has not been adhered to by a couple of colleagues, which is disappointing. I call Fiona Hyslop to be followed by Gillian Mackay for up to five minutes. As we have heard throughout this debate and in the evidence to the committee's informative inquiry and evidence from experts, health inequalities are symptoms not causes and we must tackle the causes. As expert witnesses to the committee have said, devolution policies have helped tackle these inequalities but so much more needs to be done. The findings in the report that a decade of austerity is behind stalling improvements in life expectancies must make us all angry. Health inequalities reflect the values of the state and we currently have a state that enables the likes of Michelle Moon and her family to make millions from Covid contracts from a pandemic that laid bare the health inequalities for all to see and many to suffer from. Poverty does not recognise your age, poverty does not recognise that you are a child and no child should suffer health inequalities as a result of living in poverty but life chances, health, cognitive, linguistic and childhood development are all affected by your start in life. When giving evidence to the committee, Professor Jerry McCartney said, we know that health inequalities are a result of inequalities in income, wealth and power in society and it is because those inequalities have continued to widen that health inequalities have continued to widen. Jackie Lambert, director of the Royal College of Midwives in Scotland, recently commented that she is now seeing health inequalities starting to be the cause of increasing deaths of recent mothers who have given birth and that countries like Denmark who are better at tackling inequalities aren't seeing this. The worst start in life must be to lose your mother. The Scottish Government continues to drive to reduce childhood inequalities, introducing the Scottish child payment and increasing it to £25 per week to all eligible under 16s is a long-term measure but one that will be a lifeline to many families this winter. In West Lothian there have been 7,105 applications to the Scottish child payment submitted from families as of 30 September this year and many more will be eligible with the expansion to under 16s. The new parental employability support and the best start grant also only available in Scotland are increasing household incomes in order to improve family wellbeing. Children also need access to safe, secure affordable housing as that leads to more positive health outcomes which is why I welcome the Scottish Government's affordable housing supply programme which priorities tackling child poverty and will deliver 110,000 more affordable energy efficient homes by 2032. Early years stimulation, development and resilience and nursery can help children in later years but it also enables parents and carers to work which leads to the imperative of tackling in-work poverty and the need for a decent living wage. I welcome the Scottish Government's recent announcement that it will introduce measures to ensure businesses and organisations receiving public funds need to pay the living wage. The voluntary sector also plays an important role and with estimates that 8,740 children were living in relative poverty in 1920 in West Lothian. The pioneering West Lothian school bank and the West Lothian financial inclusion network with the Christmas present shoe box appeal also helps families. However, it does not have to be this way. It is clear that the Scottish Government is using the limited resources and powers available to them to take a wide and connected approach to tackling inequality and dealing with child poverty in Scotland. The majority of powers required to address economic inequalities are reserved to Westminster which presides over one of the worst levels of inequalities in the G20. As long as economic inequalities continue to widen, so too will health inequalities. The Institute for Government, which before the Covid pandemic said that an independent Scotland with full powers over every area of policy in Scotland would immediately face an £8 billion black hole. What would it be £8 billion of spending cuts, SNP austerity or £8 billion of tax increases? Mr Hoy should be ashamed of the state of the UK and its economic experience that puts Scotland in a position that it would actually have to deal with any problem whatsoever in its economy. Its recent stewardship leaves a lot to be desired and in terms of causing inequality, I am sincerely concerned about what that impact will be on constituents in my constituency. The UK Government should use its powers over employment law and many work-related benefits and use those powers to reduce inequalities. The debate and the report rightly state that health inequalities cannot be viewed in isolation. In order to reduce health inequalities in Scotland, we must work to ensure that no child in Scotland lives in poverty. I want a Scotland that can use the powers of independence with a value system that tackles and does not perpetuate inequalities. We cannot, we must not rest until there is no child in Scotland living in poverty. Only by working to make this a reality in Scotland will we end health inequality and give the children of Scotland the health, equality and life chances that they deserve. I thank committee colleagues, clerks, those who gave evidence and all those who have sent in briefings ahead of today. The report is hugely wide-ranging, covering a lot more issues than I can do justice to in five minutes. I know that colleagues across the chamber, as well as I have myself, had numerous constituents faced with overlapping and intersectional health inequalities. Inequalities do not exist in a silo and I'm pleased by the steps taken in this chamber to acknowledge health inequalities holistically. The biggest factor to have an impact on health outcomes that we heard was wealth inequality and, given the current cost of living crisis, it is likely that this will be made worse in the short term. As many others have said, we cannot get through a debate on health inequalities without mentioning austerity. The Scottish Greens would like to see the implementation of a universal basic income, but, given the current powers available to the chamber, we welcome the work taking place to implement a basic income guarantee. I would welcome an update from the minister in closing on what, in addition to this, is currently being done to support low-income households, maintain their health and wellbeing. As the convener of the cross-party group on stroke, it would be remiss of me not to mention the important statistics related to deprivation and stroke prevalence. There is a strong relationship between deprivation and stroke mortality. This is particularly so in the under-65 of age group, where the standardised mortality ratio is over four times higher for the most deprived 10 per cent of the population compared to the least deprived 10 per cent of the population. The death rate for cerebral vascular disease in the most deprived areas was 43 per cent higher than in the least deprived areas in 2020, which is consistent with the previous five years. The association between mortality and deprivation was stronger in the under-65 age category than in the over-65 category. In the under-65s, there is a clear pattern between SMR and the deprivation decile. The SMR in the under-65 age category was 86 per cent above the Scottish average in the most deprived 10 per cent of the population, whereas in the under-65 category, in the least deprived 10 per cent of the population, was 61 per cent below. As noted in the engender's briefing on women's health inequalities, women and girls still face significant and distinct barriers to adequate mental and physical health in Scotland. Health inequalities disproportionately affect women who have historically lacked adequate physical health in Scotland. Women's health has not historically been understood and respected as it should have been. As I touched on already intersectional equality issues have a significant basis on women's health and equality. Yay, I have a question. mental a physical health in Scotland. Health inequalities disproportionately affect women, have historically lacked adequate funding and the professional focus needed to address them. Women's health has not historically been understood and respected as it should have been. As I touched on already, intersectional equality issues have a significant bearing on health outcomes and the same is true for women. Importing into examples of this include historic ableism, racism and homophobia, which have contributed to the unmet health needs for women of colour, disabled women and LGBT-plus women. A 2017 study found that women in the most deprived areas of Scotland experienced good health outcomes for 25 years less than women in the most affluent parts of the country. Inequality has also persisted across gender divide with health outcomes. In a 2020 report from the Alliance of Health and Social Care, it highlighted that when it comes to healthcare, women consistently raise their experiences of their concerns not being listened to or taken seriously and that they are not actively involved in treatment or planning prescription choices. As a result, women end up waiting longer for pain medication than men, wait longer to be diagnosed and are more likely to have physical symptoms ascribed to mental health issues as well as being more likely to have heart disease misdiagnosed or to become disabled after a stroke. We must remember in each and every portfolio across government that they all have an impact on health in one way or another. The impact, poverty and the added pressure that the cost of living crisis is having on mental health cannot be understated. In the Mental Health Foundation's briefing, it said that, in November, new evidence emerged on the negative mental health effects of the cost of living crisis in a poll conducted for the Mental Health Foundation by a pinmium. The Foundation found that when asked about the past month, one in nine adults in Scotland were feeling hopeless about the financial situation, four in 10 were feeling anxious and a third were feeling stressed. This research on a representative sample of 1,000 adults in Scotland is worrying and shows the early signs of the negative mental health impact of the cost of living crisis. The effects of adversity are cumulative and those who have already experienced stress due to the recession of 2008 prior poverty and other adversity and or the Covid-19 pandemic will be at higher risk if they also experience financial stress due to the cost of living crisis. The issue that we are debating today as well as it being on the report from the committee is actually how we switch to a preventative health agenda, reducing the ill health that people experience and increasing their ability to stay well. We have a way to go to move to truly preventative health approaches that reach as many people as possible and more work needs to be done to ensure that those from low-income households attend appointments such as cancer screening and vaccination. We need to make sure that, for carers, there are flexible appointments and that the time and cost to get to those appointments is not a barrier. However, we should not underestimate the ability of preventative approaches to make a difference. We know the impact they have had on mortality rates. You do need to wind up now, Ms Mackay. Apologies, Presiding Officer. There is a lot more that I could have got through, but I want to thank committee colleagues again and those who gave evidence. Thank you very much indeed, Ms Mackay. I now call Clare Coy to be followed by Fose of Todry for up to five minutes. Thank you, Deputy Presiding Officer. I would like to thank the Health, Social Care and Sport Committee for their wide-ranging and impactful report. The report was published by the Health Committee, but this debate goes way beyond the realms and the remit of public health. The causes and implications of health inequality reach over a far broader public policy canvas—housing, community and planning, access to social and cultural opportunities, education and early years development, employment and securing a growth-based economy where everyone has access to skills development and access to well-paid employment. If we fail in those areas, we fail to tackle the underlying causes of health inequality. As spice notes, the fundamental causes of health inequalities lie largely outside the health system. Health inequalities are a symptom rather than the cause of the problem. The committee is concerned by evidence that, despite strong rhetoric in support of action to tackle them, the level of health inequalities here in Scotland remains higher than in England. The responsibility for that and the responsibility to combat poverty over decades rests with all political parties—yes, my party, the Labour party, but now the SNP. We cannot escape the simple fact that the SNP has been in government here at Holyrood for the last 15 years. That is happening on their watch, and blaming Westminster minister simply will not wash. I thank the member for taking an intervention. I wonder if he would just touch on how austerity affects communities and the fact that there are lots of reports out there. The recent one from Glasgow is really very clear that austerity is driving some of most of the health inequalities that we have. Scotland has now the largest settlement from Westminster that it has ever had, and it has control over welfare powers and employment. The way to tackle austerity and poverty in the long term is to make sure that we get people in a position. The minister is saying that austerity has had no impact. I remind him of the fact that he is advocating independence, which would lead to £8 billion of austerity. We must remember that the Covid pandemic shone a light on the severity of the problem of health inequalities here in Scotland today. Death rates among those from deprived backgrounds, as well as from the South Asian community, were around double the general population. It was this data quite rightly that prompted the committee to look into the issue. The social and economic cost of inequality is immense. Those are very real costs—people living in poor health and in chronic pain, people living in poverty, poor housing and poor diet, facing lower mortality rates. For too long, we have written off severe pockets of deprivation in our communities as a problem too entrenched and too tough to fix. The problem, sadly, is often hidden within our communities in pockets of extreme deprivation shut away from sight, and we must shine a light on it. The committee recognises the benefit of giving local government the authority to innovate and to explore new ways to tackle health inequalities. However, it also notes that a lack of strategic co-ordination could exacerbate inequality in some instances. However, if local government has a major role to play in combating inequality, then it is vital that our councils are properly funded. I have very real concerns that year after year of SNP cuts to housing and council budgets will have exacerbated many of the social determinants of health inequality. To break that link, it is vital that we work across party and across this Parliament to end the depressing cycle of intergenerational poverty, because only by doing that can we set out on a different path—a path that, as the committee notes, will rightly save lives. Take cancer, for example. Cancer-related deaths are 74 per cent higher in the most deprived communities than in the least deprived in Scotland. There are around 5,000 extra cancer cases each year in Scotland attributable to deprivation, a staggering 13 extra new diagnoses each and every day in Scotland. A recent report from Cancer Research UK sets out clear recommendations for the Government. It calls on SNP ministers and the NHS to fund and roll out interventions that tackle the known drivers of inequalities. It calls for bold action to diagnose cancers earlier and to ensure that everyone has access to the right treatments for them. Poverty remains a scar on the face of modern Scotland, and tackling it remains one of the greatest priorities, one that must be addressed if we are to reduce health inequalities. We need a Scottish Government that focuses on tackling the inequalities of place across Scotland, not one that is obsessed with dividing the country on the constitution. A Scottish Government that is truly committed to reversing the inbuilt disadvantages that hold urban and rural Scotland back, and to achieve that, we need a Scottish Government that is truly committed to improving health outcomes for everyone across Scotland today. I pay tribute to the committee members and staff for their work in producing this report, which covers a very wide range of issues across Scottish society under the umbrella of health inequalities. I also wish to thank the witnesses who gave evidence to the committee to allow it to develop this report on such an important subject. I wish to focus my attention on the very welcome recommendation from the committee to treat the elimination of poverty as public health measure. As a member of the Social Justice and Social Security Committee, I'm grateful that the committee considered our recent report as part of this. The report introduced itself with a history of the failed action to try to reduce health inequalities in Scotland. I'm glad that the committee so clearly lays out the gravity of the health inequality faced in Scotland. Because we do not do ourselves any favour by sugarcoating the situation, it is incumbent on all of us as Scottish parliamentarians to find a way to tackle this distinct problem we face. To this end, as a co-convener of the cross-party group improving Scotland's health, I'm grateful to colleagues from the CPG on Diabetics, Heart and Circulatory Disease, Lunge Health and Stroke for agreeing to participate in a joint inquiry into non-communicable disease. I'm also grateful to British Heart Foundation for supporting this work. While NCDs are only one aspect of the health inequalities in Scotland, I'm hopeful that by pulling the resources of our CPGs we will be able to come up with recommendation to help the situation. These inequalities are close to home. In 2018, the report found that a boy born that year in Murhouse or Westpiltern had life expectancy 13 years shorter than a boy born in Navering Crammond. This is shocking, and it was so before COVID-19, which the committee's report tells us has made health inequalities considered to be worse and worse than across the board. Indeed, the last report from the national records of Scotland shows that in the last 10 years, improvements in life expectancy have stalled and most recently have started to reverse. That reverse is put down to COVID, but the stalls was not. Decrease in death from heart disease have slowed. Death from the drug have risen. It is important for all of us to find a way to help and reverse these trends to improve life expectancy in Scotland. Perhaps greater use of organisations like the Fantastic Piltern Community Health Project, a community well-being programme in North Edinburgh, can bring local expertise to bear where it might help. However, the committee makes clear that there is sadly no magic bullet to fix these issues. It will take systemic change across the variety of systems. For example, the report highlights the way that systemic racism creates poverty, and we know the poverty list, the poorer lifelong outcomes. In 2020, Hannah Lawrence produced a comprehensive report for Edinburgh and Lothian Regional Equality Council, which detailed the barriers of poverty and inequality for ethnic minorities in Scotland. I would like to draw the House by note of interest. I am the chair of Edinburgh and Lothian Regional Equality Council. Ethnic minorities in Scotland often face multiple overlapping disadvantages that cannot be fixed by any single initiative. As I said earlier, it is incumbent on all of us to work towards fixing this problem. I thank the committee for guiding us in this work. I now call on David Torrance, the final speaker in the open debate. Thank you, Presiding Officer. Before I begin, I would like to put on record my thanks to everyone who played a part in this inquiry and brought us to where we are today. There are far too many to mention, but I would like to pay particular thanks to every single individual and organisation that took time to contribute to our evidence sessions. Those sessions provided us with an opportunity to hear first-hand accounts of individual experiences and the invaluable to the work of the committee. We all recognise the effect of inequality on individuals, families and communities, and that there are a number of communities that are disproportionately affected by inequality. Health inequalities are commonly understood to be unjust and avoidable differences in people's health across the population and between different groups. As noted in the report, it is internationally accepted that the fundamental causes of health inequalities lie largely outside the health system. They are a symptom rather than a cause of a problem arising from an equal distribution of income, wealth and power and societal conditions that it creates. Through this inquiry, the committee sought to focus on what progress has been made in tackling health inequalities in Scotland since the 2015 report. What impacts on additional factors have on health inequalities and the addition of action to address them, and what opportunities exist to reduce such inequalities and increase print of work to tackle them before they impact on individuals' health and wellbeing. Over the past seven years, since the previous report, Scotland has also faced considerable new challenges and the pressures that have intensified pre-existing inequalities. Back in 2015, no-one could have predicted what was around the corner and how devastating impact both directly and indirectly the Covid pandemic would have on certain sections of our population. The disproportionate effect on our ethnic minority communities, people with learning disabilities, those with severe mental illnesses and the most vulnerable cannot be overstated. As we slowly continue with difficult recovery, we are faced with the Tory cost of living crisis that threatens to push households into vulnerable positions, increasing health inequalities and worsening health and wellbeing. Yet again, the greatest negative impact will be felt by those groups who are already experiencing health inequalities, including those living in poverty and those with disabilities. Matthew Taylor, the chief executive of the NHS, said that the country is facing a humanitarian crisis. Many people could face an awful choice between skipping meals to heat their homes and having to live in a cold, damp and very unpleasant condition. This in turn could lead to outbreaks of illness and sickness around the country and widen health inequalities, worsen children's life chances and leave an indelible scar on local communities. In my constituency, I see a wide and varied impact of these inequalities every single day on my communities that I represent. In the past, people attending my surgeries came in the main to discuss general issues or to seek advice and help. That has now changed and now come because they are scared. They come because they have very real fears about how they are going to keep their families safe and healthy. In the face of inflation that has risen out of control and astronomical energy prices, they are terrified about what the future holds. I want to touch on one of the findings from the communities' inquiries that charges the Scottish Government to ensure the impact on inequalities. It is a primary consideration of the future design and delivery of all public services. I was extremely interested to see the Fife initiative being praised and used as an example of good practice in the written response received by committee from the Royal College of Occupational Therapists. We noted that the benefits of local level working have been seen in Fife, where children and young people of occupational therapist service are key stakeholders in working collaboratively to develop a community play experience that offers invisible inclusivity, where it goes to create an environment that has no boundaries and that supports participation in play in every sense of the word. There are so many local examples of good practice outweir across all our constituencies that have a massive impact on what we all hope to achieve. I, for one, am eternally grateful for each and every one of your contributions. Statisticics consistently show that poverty inequality impacts on a child's whole life, affecting our education, housing and social environment, and in turn affecting our health outcomes. The Joseph Rowntree Foundation reported that boys born in low income communities can expect on average 47 years of health life, girls 50. Two decades of quality of life have been taken from people solely because of where they were born. In conclusion, the committee agrees that urgent action is needed to address health inequalities. However, it is clear that UK Government's action to date to tackle health inequalities in Scotland simply has not been enough. By enforcing austerity and slashing welfare payments on public services, the Tories have caused immense damage to the health of the poorest and most vulnerable in our society. Today, I call on the Westminster to follow Mr Gullant to follow the lead of the Scottish Government because it has used the powers that it does have to ensure that people of Scotland benefit from the most general social contract in any part of the UK. We must continue to drive national and local action through partnerships with local government, public services and voluntary sector and our local communities. Our policies and approach must be shaped by lived experience and they must tackle the root causes of health inequalities because life is literally dependent on that. Thank you, Presiding Officer. Thank you. We move to closing speeches and I call on Martin Whitfield. I'm very grateful, Presiding Officer, and it's been a fascinating debate this afternoon, one of perhaps two halves, but can I say, it's a great pleasure to follow David Torrance. Indeed, I would refer members both in this chamber but also those who were unable to be here today to read the speech afterwards because I found it very powerful, that drawing on the personal experiences of what happens in the constituency and also the fact that there is phenomenal good practice around Scotland. If we had a way of pooling and sharing that, many of the challenges that some areas face may indeed have found answers from other areas. I thank David Torrance for that and also for his festive greeting that I received during his speech for the holiday period when it came. As I say, it's been very much a debate of two halves and I would like to concentrate on the initial opening contributions because to have so many conveners here speaking on a committee report I find unprecedented in the 18 months that I've had the pleasure to serve here but also how powerful all of those contributions were. I, like others, have to thank the committee and the convener for the report that they've produced which truly does make frightening reading but also provides tangible recommendations which I think the government and I hope the government will find very helpful. I would like to concentrate on Gillian Martin's initial contribution and the request of the committee with regard to an overarching strategy. I know that the cabinet secretary talked about the group contained within government that addresses this but I think the report spoke of something more formal, better understood and more wide reaching that could be held to account because I think there is a difference between cabinet secretary's rightly gathering together to discuss this and a strategy which people outside of this parliament can see and outside of the government can hold to account. Claire Adamson's very powerful contribution talked about the role of arts in fighting inequality and again this is frequently an area that becomes almost the after mention but the art and culture of a society speaks volumes to the mental wellbeing of the members of that community both to find simple answers sometimes to problems that are a challenge for individuals but also to find community-wide solutions to problems and I found the contribution incredibly useful to Siobhan Brown and the Coffin recovery group a very powerful testimony about the effect of Covid has had on our deprived areas and although some of the statistics still need to be finalised I think it is with some concern that we are going to look to the actual impact on some of our poorest communities of the period that Covid has given us and to Natalie Don and the discussion of child poverty and the strategies which are successful and I very much welcome her comments about disabled people. I'm very grateful for Presiding Officer Martin for giving away does he agree with me that the more that more affluent communities are unable to live longer that that will exacerbate the strain on our NHS and potentially make those health inequalities worse now it's not an argument to say we shouldn't be helping people to live longer but we need to accommodate that in our planning for the NHS. Martin Whitfield I'm very grateful for that intervention and it is true that the the answers to these problems are sometimes made worse by the benefits certain elements of our communities get and obviously it's right that we shouldn't seek to curtail communities but actually the tale at the other end of the communities have suffered historically for so long and continue to do so and if time allows I'll come back to that at the end with a question to the cabinet secretary who's who's summing up. I would like to mention Audrey Nicholl's contribution because of the very powerful discussion about the change in shoplifting items that are now taken where people are stealing to live they're not stealing to make money they're not stealing as a job they're stealing to feed their families and also the relatively simple I say this and anticipate of many emails to come the simple solution about how can people leave our prison service and not have an address not have a GP surgery not have a dental surgery to go to because to cast people back into the area that they came from is only merely inviting them to have to recommit crime just to live and to the cabinet secretary's opening contribution I would like to make thanks because I felt there was a recognition there of the challenge and I think that you know that should should be agreed with because the challenge that faces us is huge you made mention of the three billion that's been helped households but then I would say there was Natalie Dawn who gave evidence of a mother who came before her committee living on merely £7,000 conscious of time it's very quick Mr Whittle Brian Whittle very grateful for the member giving me again I wonder if he would agree with me that the two big tools we have in the toolbox to tackle health inequalities are our education portfolio and our health portfolio and we're not leveraging that enough at the moment I'm very grateful for that and it leads me to the the question of education and I would like to ask why the Government feel unable to follow the committee's recommendation that they said to conduct a survey about the early years entitlement and those families who are unable to access it I recognize that this rests with local authority but I also recognize that I think the Scottish Government is best placed to take a picture across the whole of Scotland about why some families are feeling excluded from the system and I would like if possible a comment on that and to my final point let me say the outset that Scottish Labour does support the findings of the health social care and sports committee to damning indictment of the state of health equality across Scotland it is a travesty that today in Scotland people in our poorest areas are dying 10 years before those in the wealthiest and this is not a fixed outcome for someone when they're born it is not inevitable and it rests at the door of those who offer to lead our communities 12 years of Tory austerity has undoubtedly been a key driver in health inequality but the lack of an overarching strategy by the Scottish government for tackling the health of quantities is simply unforgivable there was a report published by Glasgow out of Glasgow University the Scottish poverty inequality research research unit which stated that actually we talk about this a lot but we don't build into our solutions how it's going to address it this has been a fascinating debate Presiding Officer and thank you for your indulgence Thank you Presiding Officer while I was not a member of the health and social care and sport committee at the conclusion of this inquiry I am pleased to have a chance to speak in this debate today and I'd like to thank the convener members of the committee and all invited witnesses that came to our meetings we have heard extensively from a range of other committee conveners today outlining the complex nature of issues and solutions needed to tackle and address health inequalities and according to Public Health Scotland Scots die younger than our neighbours in any other western European western country and Scots in our poorest areas die 10 years earlier than those in our wealthier areas the committee report recognises the effect of inequality on individuals families and communities and that there are a number of communities that are disproportionately affected by inequality the report states it's internationally accepted that the fundamental causes of health inequalities lie largely outside the health system health inequalities are a symptom rather than a cause of the problem and many members have said that today and the cabinet secretary highlighted some of the scientific legacy issues that we face which contribute to premature illness and death among our many diverse communities unfortunately this SNP government is failing to tackle the health inequalities in 2018 to 2020 males in the most deprived areas were on average expected to live 23.7 fewer years in good health than those in the least deprived areas and in 2020-21 the drug related hospital admission rate in Scotland's most deprived areas was more than 21 times greater than that of the least deprived. Cancer incidence is 33% higher in more deprived populations in Scotland and cancer mortality rates are staggering 74% higher in the most deprived populations compared to the least. I could continue but we have heard contributions about these worrying statistics from across the chamber this afternoon and make no mistake the Scottish government has the levers at its disposal to tackle these health inequalities but instead it blames the UK government or as Rhoda Grant stated passes the buck and when the UK government does address some of the points that have been made in the report they're not often acknowledged let's recall some of the most recent UK government announcements from November where the chancellor announced the national living wage would increase for over 23s to £10.42 which will benefit over 2 million of the lowest paid workers across the country disability and working age benefits will increase in line with inflation and across the UK people will receive much needed help next year for example a family on universal credit will benefit next year by around 600 pounds or indeed the flexibility that will be given in real time to the new legislation around workforce that allows people to access flexible working which will go a long way to tackle the economic inequalities decisions taken now by the SNP will continue to directly impact the inequalities the SNP's 400 million announced cut to health and social care and 38 million cut to mental health services will have an impact and thanks yes mr mason i will john mason is the member saying that we should not have given that pay increase to the health staff to for the 400 million sue weber the scottish government has the money it gets when you can govern to make its decisions and it's in every right to do that and i would like to carry on if you don't mind cabinet secretary heckling from a sedentary position thanks to audit scotland we learned the truth about this cash strapped scottish government and administration so short of money that in the last year it could afford to not spend just under 2 billion pounds of its 51.2 billion budget through incompetence or choice this s n p have wasted millions of pounds whether it be preswick airport ferguson marine by fab the lochabur smelter and the budget for the constitution remains untouched it is their choices it is their priorities as an ex smoker changing the tone here as an ex smoker i've always believed passionately in the need to smack tackle smoking and i applaud many of the universal measures that are in place to help people stop but i believe we need to be far more targeted in our interventions remember one in three people smoke in scotland's most deprived communities compared to one in ten in the least deprived and reaching into and working specifically with marginalised communities can be done we have shown this to be the case with our targeted community outreach vaccine programmes so let's learn from this and do more of this as the report clearly states and we've heard from sandesh and fion sandesh gohani and fiona hislop about the importance of safe secure and affordable housing and how that is so critical to tackling inequalities and mr whistle presented a compelling case for the investment in more warm dry homes to tackle costs that ultimately sit with the nhs in us in dealing with respiratory illnesses and the critical role nutrition and sporting activity play in the prevention agenda craig hoy accepted the responsibility for the failure to combat poverty rests with all the political parties over decades but we cannot escape the simple fact that the snp has been in government here at hollywood hollywood for the last 15 years and more and this is happening on their watch the blame cannot be laid at the door of anyone other than the snp their lack of a credible strategy does nothing to address the widening health inequalities our society is facing as the convener stated in her opening remarks it is time for collective and systemic action inaction is not an option thank you thank you now call on mary todd up to eight minutes please thank you presiding officer i want to start by thanking members for contributing to what's been a lively debate on an issue that i know that we all deeply care about i've stressed in previous debates and sessions that this parliament needs to be a public health parliament where all parties come together to work jointly to tackle the key challenges for population health and wellbeing in scotland and i've viewed the committee's inquiry and this debate is an important step in that process only by combining and strengthening our efforts will we be able to reverse the worrying trends in life expectancy and reduce health inequalities in scotland i will give way creak hoy i thank the minister for reaching out and saying that across this parliament we should all be focusing on policies does she therefore share at my regret and no doubt regret for those watching at home that a succession of her own backbenchers decided to get up and talk about policy rather than process and does she not see that this constitutional smoke screen is wearing thin and hiding the snp's failures minister no i don't agree at all i have to say i find your tone during this debate the members tone during this debate frankly astonishing it's austerity denying we've had evidence from academics in scotland most recently but right across the uk that have laid absolutely bare the fact that those political choices made by the coalition government of the Conservatives on one side and the Lib Dems on the other in 2010 had the most devastating impact on our population in scotland and not only not only did it have a devastating impact immediately on our most vulnerable citizens which i witnessed when i was working as a mental health pharmacist with people with severe and enduring mental illness it is still having an impact life shortening policies brought to us by the tories and the Lib Dems and complete denial from that side of the chamber today we all acknowledge the impact of the pandemic it has both shone a light on pre-existing inequalities and it has exacerbated them it is my belief now that the scales have fallen from scotland's eyes we will not tolerate this injustice any longer poverty is the driver of health inequalities health inequalities like other inequalities are about an inequality in power wealth and status yes i will take an intervention finley carson well thank you for taking the intervention maybe the minister would comment on the inequalities that have been overseen by the nsnp over the years any quality when it comes to rural health the closure of our cottage hospitals and the downgrading of our maternity units that sees people giving birth on the side of the road that's your problem that's your responsibility perhaps somebody on the conservative benches would like to explain how why they supported the UK mini budget which wiped 64 billion of our economy in one day if what you are asking me collectively is do i think we could have spent that money better in the Scottish government or in independent scotland absolutely the answer is yes let me tell you about what we are doing in the Scottish government to tackle child poverty as Fiona Hyslop so eloquently set out in the appalling lifelong impact that poverty has on our children in this financial year alone we've allocated almost three billion pounds through a range of measures which will help to mitigate the impact of the cost of living crisis on households that includes supporting energy bills childcare health travel as well as social security payments that are neither available elsewhere in the UK or are more generous than elsewhere in the UK such as the Scottish child payment and the bridging payment the Scottish child payment has been further expanded to eligible six to 15 year olds and increased in value to 25 pounds per child per week and around 400 000 children are potentially eligible now all the conservatives said they wanted to hear what the Scottish government is doing to tackle poverty i am setting out what we are doing to tackle poverty in addition we are supporting families in a variety of other ways including massively expanding the provision of fully funded high quality early learning and childcare free bus travel for under 22s free school meals to around 145 000 pupils and the child winter heating assistance but let's listen to what the child poverty action group report notes Scottish policies are making a major contribution to helping families over the cost of bringing up children yet many of the factors causing families to risk deep poverty in the coming months and years are well beyond the Scottish government's control we will continue to urge the UK government to use all of the powers at its disposal to tackle the cost of living crisis on the scale that's required including access to borrowing providing benefits and so no i will not take another intervention from the conservative benches they are simply austerity denying and they are absolutely refusing to listen to what the Scottish government is doing to tackle poverty certainly thank you minister clear adamson does the minister agree with your united nations poverty expert philip alston who's compared the conservative party welfare policies to the creation of 19th century work houses and word that unless austerity ended the UK's poorest people will face lives that are solitary poor nasty british and short minister absolutely couldn't agree more and we have seen a number of times where the UK government has had an opportunity to tackle poverty by increasing wealth and increasing welfare increasing the pay that is given that that is earned by working parents and instead it has taken the opportunity to punish poor people further we have yes certainly carol mochan thank you thank you minister for taking an intervention and she knows that we have a lot of agreement in in this place but what i would like to ask given that you've just agreed to what extent people are living in and we heard from other members such as natalie dawn will the government agree to do absolutely everything that they can to make sure that people do not continue to live like this and will they take into account and i hope it comes up in the budget tomorrow some of the levers that the stuc have put forward that they could use in conclusion minister absolutely our budget will be set out tomorrow by john swinney and i know how carefully he is considering the suggestions put forward by the stuc but let me reiterate again everything that we are doing we are doing with both hands tied behind our backs every additional percentage point on a pay deal every pound that we spend on measures to deal with rising cost has to be funded from reductions elsewhere given our largely fixed budget and our limited fiscal powers scotland is once again at the mercy of UK government decisions and that to me and to many in this chamber and to many in this country in this nation absolutely reinforces the urgent need for independence thank you i now call on call okay to wind up the debate on behalf of the health social care and sport committee thank you Presiding Officer and i'm pleased to be closing this extremely important debate on behalf of the health social care and sport committee and i think what we've heard across the debate today most clearly is that health inequalities exist they are pernicious and they continue to widen and i think that has to be a matter of shame for us all and i think we have to recognize the challenge and the scale of the challenge that lies before all of us of course this isn't the first time that we have debated health inequalities in this place and it won't be the last because it's an enduring problem i think the challenge most acutely that lies before is is that things aren't improving instead the evidence that committee saw is that things are actually getting worse so i think we all have to resolve across this chamber to do much more in order to tackle these issues from our inquiry the committee is clear that health inequalities themselves are a symptom of wider challenges and i think we've heard that echoed across the chamber by many colleagues today and that real acknowledgement that we have to get to the root causes there are a result of wider social economic inequality there are a result of systemic racism and discrimination particularly discrimination against women and against lgbt plus people there are also a result of how our public services can sometimes be organized in a way that focuses on what's convenient for administration rather than providing the support that is most effective for people in our communities i think it's fair to say that there's also a result of very often siloed working and a lack of joined up action across services on a local and national level yes i'll take brine whittle brine whittle i'm very grateful for the member for taking intervention i'm wondering if he would agree with me that despite what the minister says there but apparently all this money that the scottish government are putting into health inequalities until such times as they recognize that scotland is still the unhealthiest nation in europe it's still got the least life expectancy across europe until they start accepting that and doing something about that we will get no further forward i think mr whittle for his intervention i'm just coming on to make the point that along with everything i've just outlined as the causes of these issues we cannot get away from the fact that they're also often rooted in the political choices that are made whether that's made in any sphere of government and indeed in this place as well and we have to acknowledge the many deep reasons that run through all of the issues that we've discussed today because i think the hard choices to tackle them are everyone's responsibility and actually by saying that it's everyone's responsibility that can often go the other way and can result in them becoming no one's responsibility so it is incumbent upon all spheres of government to find the ways to work together in order to change these things because without addressing the underlying causes we are treating symptoms and we're not tackling root problems and i would add my voice to supporting the evidence that committee heard from Professor Sir Michael Marmot in this regard which i think is very powerful about how we can empower particularly local government in order to deal with many of these root causes on the ground i want to echo what the committee convener has already set out that our report has called for that urgent action across spheres of government both local, Scottish and UK and a prioritisation of the actions aimed at tackling underlying causes of health inequality. Challenge is enormous and i think we've heard that reflected across the chamber today but i think it is one that we collectively must aspire to addressing and we've heard many important contributions today from committee colleagues and from colleagues representing their own local areas affected by health inequalities. I thought we had particularly powerful contributions about what is happening locally in Muirhouse from Alex Cole-Hamilton and then Verneth from Rhoda Grant and some of the stark inequalities that exist between neighbourhoods that sit side by side and indeed from Fiona Hyslop about the actions that are undertaken locally in West Lothian to start to tackle some of these at a community level and a neighbourhood level as well and i think we would do well to listen to those experiences and to see what we can do to continue to push forward in the policy agenda. I also want to highlight that committee colleagues have raised the issues of Covid and indeed the current cost of living crisis. We can't escape from those, those are challenges that continue to affect everything that we do and of course cost of living became really acute during our work on this report. Of course as we seek to rebuild and renew following the pandemic and to navigate our way through the rising costs of living and its effects there are opportunities I think to reframe our thinking and to tackle some of those really difficult issues. If we're going to meet the challenges effectively we need to think in radical and innovative ways and I'm really hopeful that our report sets that out and helps colleagues to begin to think about all of those things. I want to particularly highlight the contributions of other committee conveners that were made today in the chamber. I think Martin Whitfield reflected that it has been good to have so many committees contributing in this debate and to the wider work of the Health, Social Care and Sport Committee. To Claire Adamson who spoke on behalf of the Constitution, Europe and External Affairs and Culture Committee we heard about the wider societal benefits of culture in tackling health inequalities, the importance of mainstreaming preventative spend and thank you for highlighting the four pillars of the Christie commission report. Still very much relevant today 12 years on and I do think we have to ask ourselves some serious questions about how far we have come in times of Christie's vision and how far we still have to go in achieving that. Siobhan Brown spoke on behalf of the Covid-19 recovery committee laying out I think shocking statistics on those death witnesses in the most deprived areas during the pandemic and I recognise that as someone who in part represents him for Clyde who had very high levels of death during the pandemic. She spoke about the on-going work on vaccination and the determination to make tackling health inequalities a priority issue to be addressed I think as part of Scotland's wider recovery and I think that that chimes with many of the recommendations in our report. Natalie Dawn on behalf of the social justice and social security committee set out their recent work on low income and debt, the scrutiny of policies to tackle child poverty, housing issues and homelessness and indeed their work on social security policy, all of which have a bearing on health inequalities and we too would agree that there has to be that joined up preventative approach that enables people to thrive rather than just survive. Finally Audrey Nicholl spoke on behalf of the criminal justice committee highlighting the link between crime, victimisation and inequality and the growing number of people who are having to turn to crime to survive. I think that that was really stark today and we have to acknowledge that that is a current and persistent problem. I think I could also mention a number of other colleagues but I'm conscious of time, Presiding Officer. I will just say I thought Brian Whittle's contribution on behalf of the CPG on health and equality speaking to that with very helpful Gillian Mackay similarly in terms of her cross-party group work on stroke and indeed what the cabinet secretary has said in the chamber and in his response to the committee. I know that there are going to be further discussions and debates in this chamber about how we move forward so in concluding can I again thank everyone who has contributed to the report, the work of the clerks and everyone involved in the committee and as my hope and I know one shared by many in the chamber that by addressing these challenges we can start to tackle health inequalities and in doing so improve the lives of people in Scotland. Thank you.