Strategic priority two: Tackling inequalities

We have a key role to play in addressing inequality, in particular the health inequalities that represent thousands of unnecessary premature deaths every year in Scotland. The fundamental causes of health inequalities are an unequal distribution of income, power and wealth which can lead to poverty and the marginalisation of individuals and groups. These fundamental causes also influence the distribution of wider social determinants of health, such as the availability of good-quality affordable housing, green space, work, education and learning opportunities, access to services and social and cultural opportunities. These also have strong links to mental and physical health.

We are a member of the Edinburgh Partnership, the body responsible for community planning in the city. In 2019 the Edinburgh Partnership and City of Edinburgh Council set up the Edinburgh Poverty Commission to explore the extent and nature of poverty in Edinburgh.

In May 2020 the Edinburgh Poverty Commission published an interim report on Poverty and Coronavirus in Edinburgh. This was followed by a full report, A Just Capital: Actions to End Poverty in Edinburgh, on 30 September 2020. A supplementary data and evidence paper was also published.

These reports highlighted the extent of poverty across Edinburgh, with an estimated 77,600 people in poverty in Edinburgh in the year prior to the covid-19 outbreak (15% of the population compared with 19% for Scotland). Almost two thirds of people (65%) who are living in poverty do not live in the 20% most deprived datazones in Scotland, meaning poverty exists across Edinburgh.

Our grants programme aims to prevent poor health and wellbeing and reduce health inequalities by investing in projects that tackle the root causes of health inequalities and support those whose health is at greatest risk from inequality.

2020/21 was a difficult year for everyone, however the impact of covid-19 and the restrictions imposed have not been felt equally, with the most disadvantaged hit the hardest. The year saw a heightened reliance on digital technologies and the negative consequences of being digitally excluded were greater than ever. Funded organisations were quick to assist those that needed help in making the transition to the use of digital technology.

An annual Grant Monitoring and Evaluation Report is completed each year using monitoring returns from funded organisations. We have not yet finalised the comprehensive report for 2020/21, however returns demonstrate how grant funded organisations quickly adapted to the lockdown restrictions. Most recipients continued to provide their services, albeit in a different way, and some organisations quickly re-organised to provide emergency support. This included the delivery of food packages and assistance with shopping and prescriptions.

Many of the case studies contained in this report are from projects funded through our grant programme. These demonstrate how recipients have not only continued to improve the health and well-being of individuals in-line with the seven priorities of the programme but have, in some cases, been lifelines for many vulnerable individuals during this difficult time.

Case study – Cook Club

Katrina[1] is a mother of 5 children and has literacy issues, meaning she finds it hard to follow recipes or look for healthier options in the supermarket. She had very little experience of cooking from scratch. To help with weight management, her social worker referred her to the Cook Club, a project to support people to learn to cook homemade meals run by Edinburgh Community Food through the Edinburgh & Lothians Greenspace Trust Out & About healthy lifestyle programme. These sessions were run on Zoom throughout lockdown.

To enable her to participate fully in the sessions, Katrina was sent a pictorial, Easy Read version of the recipe. This resource shows step-by-step how to prepare the food with simple written instructions to familiarise the participant with key words. The online session was also run in such a way as to allow Katrina to cook the steps in a friendly and non-pressured environment.

In later weeks Katrina also encouraged two of her children to participate, demonstrating the positivity that Katrina was showing around her newfound abilities in the kitchen. At the evaluation at the end of the sessions Katrina said: “Making food from scratch is easier that I though. It’s good to learn new things and meet new people.”

[1] Name has been changed.

icon of person meditatingOur mental health and wellbeing strategy, Thrive Edinburgh, sets out the links between underlying societal inequalities and mental health as well as our roadmap for improving the support on offer in Edinburgh to promote good mental health and wellbeing for all. Our strategy is built on four pillars: Change the Conversation, Change the Culture; Partner with Communities; Act Early; and Use Data and Evidence to Drive Change.

In October 2020, we launched the i-Thrive website to support a change in the conversation and culture and provide advice to those in need. This was supplemented by the Thrive News Bulletin and “Thrive on Thursday Dialogue” sessions to share information and explore emerging issues and opportunities. We also launched the Thrive Exchange Community of Practice in June 2020, consisting of 55 people with an active interest in research.

With our community partners, we held the first Thrive Fest online arts festival for Mental Health Awareness Day on 10 October 2020 and took the 8th annual Out of Sight, Out of Mind artwork exhibition live and online. We have also developed an action plan to progress the Rights in Mind workstream and worked with Universities and Colleges to strengthen care pathways.

To support early intervention, we prototyped Thrive Welcome Teams, which integrate public and third sector teams in each of our localities. These received positive feedback from both staff and people using the teams and are now being rolled out more widely. The contracts for our newly commissioned Thrive Collective Services also commenced on 1 December 2020, with an annual value of £2.6m.

People from the LGBT community often face barriers to accessing good health and social care support and, even when they can access care, it sometimes fails to meet their specific needs. With our support, Scottish Care created Proud to Care: LGBT and Dementia, a good practice guide for health and social care workers and accompanying self-audit tool. This resource aims to support health and social care workers to better work with people with dementia receiving support, who also identify as being part of the LGBT community.

While the planned launch of this tool was cancelled due to covid-19, the Edinburgh Dementia Training Partnership sent out electronic copies to all care homes and care at home services and funded hard copies for all these services.