Equally Well

Equally Well is a report of the Ministerial Task Force on Health Inequalities, outlining an early intervention method as the key approach to take with the early years. The recommendations set out in Equally Well support the approach outlined in The Early Years Framework jointly developed by the Scottish Government and the Convention of Scottish Local Authorities (COSLA) and are currently being implemented across Community Planning Partnerships.

Equally Well recognises that reducing inequalities in health is a long term process and needs a generational approach. This may require significant shifts in culture and resources from dealing with the consequences of inequalities to prevention and early intervention.

Seven principles underpin Equally Well. These include:

  • reducing exposure to factors in the physical and social environment that cause stress, are damaging to health and wellbeing, and lead to health inequalities.
  • addressing inter-generational factors that perpetuate Scotland’s health inequalities, particularly focusing on supporting the best possible start in life for all children in Scotland.
  • engaging individuals, families and communities most at risk of poor health in services and decisions relevant to their health, and promoting clear ownership of the issues by all involved.
  • delivering health and other services that are both universal and appropriately prioritised to meet the needs of those most at risk of poor health, and that seek to prevent problems arising as well as addressing them if they do.

Equally Well identifies a number of specific recommendations, the first of which sets the context for The Early Years Framework – reducing health inequalities should be a key outcome for The Early Years Framework developed jointly by the Government and the Convention of Scottish Local Authorities (COSLA). Thereafter, the Task Force identifies the earliest years, where inequalities may first arise and influence the rest of people’s lives, as a priority.

Other recommendations relevant to early years include:

  • NHS Boards should improve the capacity of antenatal services to reach higher risk groups and identify and manage risks during pregnancy. This will include rolling out and evaluating a 3-5 year programme to better identify and support vulnerable women and families, through a number of professionals providing effective care.
  • the Government should arrange a Scottish survey of the incidence of Foetal Alcohol Syndrome.
  • NHS boards should improve breastfeeding rates in deprived areas and among disadvantaged groups. The Government’s new infant nutrition coordinator is concentrating efforts on reaching these groups.
  • the Government should lead the development of holistic support services for families with very young children at risk of poor health and other poor outcomes. This should test how the Nurse Family Partnership approach can work in Scotland. Testing will need to examine how best to target the families most in need, how to engage families effectively and work alongside them to build up their own capacity. It must ensure fidelity with the strong, evidence-based Nurse Family Partnership approach.
  • there should be a range of services that identify need and provide support to the most vulnerable children and families. As part of that, the Government should develop a community-based integrated school health team approach, targeting children at risk and increasing the nursing staff and other professionals supporting schools.
  • the Government should continue to improve support for children at risk in households where alcohol or drugs are misused.
  • Physical environments that promote healthy lifestyles for children, including opportunities for play, physical activity and healthy eating, should be a priority for local authorities and other public services. The Government should support the third sector to increase opportunities for play, through investing in an Inspiring Scotland theme.
  • each NHS board should assess the physical, mental and emotional health needs of looked-after children and young people and act on these assessments with local partner agencies. Boards should ensure that health services are more accessible to looked-after children and to those in the transition from care to independence.

Equally Well identifies specific areas where effective action in the early years will address future inequalities in health, and linked aspects of people’s lives. These include:

  • high-quality antenatal care that identifies and addresses risks early
  • improving maternal nutrition during pregnancy
  • improving the quality of interaction between parents or carers and children in the very early years, for example through high quality home visiting services and parenting programmes
  • tailored interventions and programmes for children at particularly high risk
  • high quality centre-based pre-school provision and school education
  • alleviating poverty in families with young children
  • reducing environmental hazards.

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