We must remember that policy on housing, employment, education and more all have an impact on health, says LILIAN MACER
In 1948 a socialist Labour government set out to create a healthier nation not based on class, gender, race, age, religion or financial circumstance but based on an ethos of social justice.
Removing long-standing inequalities in access to health care based on the ability to pay was a central plank to ensuring the very best health care was universally provided.
In 2013 we celebrated the 65th anniversary of the NHS which allowed us to recognise the achievements and the chance to reflect on whether we have met the ambition set out in 1948.
There have undoubtedly been huge improvements.
The good news is that Scots are living longer. What has not changed is that Scots from better-off areas are living much longer while those from poorer areas are only living a little longer, and not always in good health.
The gap between rich and poor in life expectancy is getting wider. The same trend is apparent in other areas of health.
No-one says that tackling health inequalities is easy. Popular opinion has been that health inequalities are influenced by personal choices such as diet, alcohol, smoking and lack of exercise.
Therefore huge effort has been put into addressing these factors.
Banning smoking in public buildings and other efforts have started to have an impact.
In June 2012 the Scottish Public Health Observatory reported the reduction in smoking prevalence would save around 540 lives a year, reduce smoking-attributable hospital admissions by around 2,300 and reduce estimated NHS spending on smoking-related illness by between £13 million and £21m.
Measures to address the over-use of alcohol, increase participation in sport and exercise or proposals to reduce sugar within food are all important contributions to addressing overall health issues.
However none of these are likely to address the fundamental fact that richer Scots benefit more from health improvements than poorer Scots.
They can afford gym memberships, better-quality food and can perhaps find other pursuits than alcohol consumption.
What is evident from research is that the fundamental reason for health inequality is inequality itself.
Nye Bevan did not just build the NHS. As minister for housing and health, he led a crash programme of house-building to give working people decent accommodation.
Key factors in health inequality include access to good employment, education, leisure, food and decent incomes - all factors which are related to wealth and social class.
Since the publication of The Spirit Level by Richard Wilkinson and Kate Pickett, no-one can have any doubt that the fundamental issue that needs to be tackled in order to address health inequality is the wealth inequality that exists in modern Scotland - an inequality that has widened under Tory, new Labour and coalition governments.
Since we know that health inequalities are related to the inequality in society, partly created by public policy, it follows that they are potentially avoidable and should be deemed unacceptable to civilised society.
Ensuring success in reducing health inequalities and improving health and well-being within our communities needs to rely on not just a struggling, resource-starved NHS but on a determination to address class inequality.
The STUC's There is a Better Way Campaign has spelled out the measures needed to start this process.
A progressive tax system, increases in wages for the majority of workers, access to decent affordable housing and leisure, a system of universal benefits and services are all needed.
Only then will the multi-agency approach, beloved by governments, of bringing together policy, planning, practitioners and integrated finances, focusing on health outcome measures, be able to make inroads on health performance statistics.
In the debate around the future of Scotland and the aspirations for a healthier country either independent or within Britain, it is political will that is required to match rhetoric and aspirations.
Today both public and private-sector organisations across the world are under greater pressure to improve their service delivery in times of chronic fiscal constraints.
People living longer are seen as a drain on resources, particularly as they often live longer in poorer health.
This not only increases demands for more money for health but also fuels calls for cuts in staff costs, rationing, means testing and inevitable growth of private provision for those who can afford it.
Without addressing the fundamental inequalities in society the enormous efforts of our NHS staff will be like trying to push a giant rock up a hill. No matter how hard they try it comes pressing back down on them.
Lilian Macer is convenor of Unison Scotland and chairwoman of Unison Lanarkshire NHS branch