title: Seven key investments for health equity across the lifecourse: Scotland versus the rest of the UK.
abstract: While widespread lip service is given in the UK to the social determinants of health (SDoH), there are few published comparisons of how the UK's devolved jurisdictions 'stack up', in terms of implementing SDoH-based policies and programmes, to improve health equity over the life-course. Based on recent SDoH publications, seven key societal-level investments are suggested, across the life-course, for increasing health equity by socioeconomic position (SEP). We present hard-to-find comparable analyses of routinely collected data to gauge the relative extent to which these investments have been pursued and achieved expected goals in Scotland, as compared with England and Wales, in recent decades. Despite Scotland's longstanding explicit goal of reducing health inequalities, it has recently been doing slightly better than England and Wales on only one broad indicator of health-equity-related investments: childhood poverty. However, on the following indicators of other 'best investments for health equity', Scotland has not achieved demonstrably more equitable outcomes by SEP than the rest of the UK: infant mortality and teenage pregnancy rates; early childhood education implementation; standardised educational attainment after primary/secondary school; health care system access and performance; protection of the population from potentially hazardous patterns of food, drink and gambling use; unemployment. Although Scotland did not choose independence on September 18th, 2014, it could still (under the planned increased devolution of powers from Westminster) choose to increase investments in the underperforming categories of interventions for health equity listed above. However, such discussion is largely absent from the current post-referendum debate. Without further significant investments in such policies and programmes, Scotland is unlikely to achieve the 'healthier, fairer society' referred to in the current Scottish Government's official aspirations for the nation.
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK. Electronic address: john.frank@ed.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Frank
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bromley
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK.
authors.forename: Larry
authors.initials: L
authors.lastname: Doi
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Estrade
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Jepson
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK.
authors.forename: John
authors.initials: J
authors.lastname: McAteer
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Robertson
authors.affiliation: School of Social and Political Sciences, University of Edinburgh, EH8 9LD, UK.
authors.forename: Morag
authors.initials: M
authors.lastname: Treanor
authors.affiliation: Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, EH8 9DX, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D004739:England / Q000453:epidemiology; D005260:Female; D000069576:Health Equity / Q000191:economics*; D006291:Health Policy / Q000191:economics*; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D011203:Poverty; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D012923:Social Class; D013222:State Medicine / Q000191:economics; D014852:Wales / Q000453:epidemiology
keywords: England and Wales; Lifecourse epidemiology; Policies to reduce health inequalities; Public health; Scotland; United Kingdom