Maree Todd: We are ready to make the difficult choices to tackle inequalities

The SNP leadership race is in full swing as Maree Todd and I sit down for this interview. Once a winner is announced, there will inevitably be a reshuffle as the new first minister stamps their own mark on government. Todd is hoping she’ll retain her role as Minister for Public Health, Women’s Health and Sport.

She says that while there is “a lot of talent” in her party and any number of colleagues could do the job, it is an “absolutely privilege” as a former health professional to now be making changes where she once faced barriers. Indeed, it was the impact of UK policy decisions made in the early 2010s which pushed Todd into politics. At the time she was working as a pharmacist in a psychiatric hospital.

“I saw first-hand the impact that welfare reform had on some of the most vulnerable people in society,” she says. “And it’s one of the issues that impassioned me enough to come into politics, to leave a comfortable job I loved as a mental health pharmacist, to put my head above the parapet and stand in politics.”

 Todd says the pursuit of austerity was “life-shortening” for many Scots, and a decision which “we are still paying a very heavy price for”.

As an SNP member, she supports Scottish independence and has only become more convinced of it since becoming public health minister because of the constraints of the Scottish Parliament. She says that while the Scottish Government has been doing what it can to mitigate decisions at Westminster that have hit the poorest hardest, “the only way to fix this properly is independence”.

It’s quite hard to live healthily in the environment that we live in today

“There comes a point where you can’t mitigate against these policies any longer, and you have to be setting the budget and setting the direction. So, we spend money that’s intended for devolved issues on mitigating the bedroom tax – I’m very comfortable that we do that. But it’s money that we don’t have to spend on the issues that we’re responsible for. We can’t keep doing that. This is, for me, absolutely at the core of why we need to be an independent country.”

Later on, she admits she hadn’t meant to veer off of public health into issues around the constitution – but adds that, to her, the two are closely linked. Her comments speak to the challenge of her portfolio: that public health isn’t just about health services, but about wider society and ensuring people are able to make decisions which are best for them.

Despite the clear links between socio-economic deprivation and health outcomes, the Scottish Social Attitudes Survey recently revealed a high proportion of people still believe major public health issues – such as smoking and obesity – are matters of personal responsibility. I ask Todd about addressing this ‘only themselves to blame’ attitude and she says: “There is some personal responsibility, undoubtedly, but I think we need to, as a government, make it easier for people to make healthy choices.”

She continues: “We’ve created an obesogenic environment, it’s quite hard to live healthily in the environment that we live in today. And I think it is government’s role to take action to make it easier for people to live healthy lives. I genuinely do believe that. But I don’t think it’s the whole story. These issues are complex.”

One of the major pieces of work Todd and her team are currently looking at is a ban on junk food promotions. In theory, this would curb over-consumption of unhealthy food and promote healthier choices. But critics says such a tool is not helpful because it does nothing to make the healthier choice more affordable. “We’re still busy squirrelling away and working away and digesting consultations. I would expect to be able to set out policy on that in the course of this calendar year, definitely,” says Todd.

Maree Todd with her now former boss, Nicola Sturgeon

But with the cost-of-living meaning many families are already having to choose between heating and eating, it’s a difficult backdrop for any government to announce policy that would in effect make the weekly shop more expensive.

I ask whether rising bills and the knock-on impacts of inflation will cause a public health crisis. Todd says she is “absolutely certain” that it will, and the increases to energy costs is something she is particularly aggrieved about because of where she represents. “I live in the Highlands and Islands, and we pay four times more for our heat than people further south do… We are massive producers of renewable energy and we pay the highest prices for our electricity. That’s an injustice perpetuated by the UK Government, they turn a blind eye to it. I’ve written to them on exactly those terms as a Highland MSP, and they absolutely have no intention of tackling that injustice.”

While the UK Government has moved to limit the cost of households’ energy bills – and indeed chancellor Jeremy Hunt recently extended to support scheme to cover the next few months – analysis has found Scots pay an average £1000 more per year than the rest of the UK. The £2500 price guarantee only refers to average use, and Scottish households use more than average due to condition of housing, colder weather, and homes in rural areas being off-grid.

Todd continues: “So will that have an impact on people’s health? Yes, because people will not heat their house adequately. They’ll have more respiratory illnesses, elderly people will have more falls, worrying about money causes mental health problems. Of course it’ll have a public health impact.”

One potential way to alleviate some of the pressures on people’s health is through social prescribing, which Todd believes is “even more important” as the cost-of-living crisis continues. This model enables health professionals to refer patients to non-clinical services – such as financial support services or activity groups – for support. But she acknowledges there are “real challenges” in bringing these types of solutions in the “medical model” of the NHS.

“We need to put our heads to that and work out how to do that successfully. I think calling it social prescribing is probably one of the problems. It kind of fits with the medical model. But I think we all need to recognise that holistic, person-centred care is about more than prescribing,” she says.

What the cost-of-living crisis has done, though, is push inequality and affordability of basics up the agenda. Todd also thinks the pandemic helped to shine a light a “pre-existing health inequalities”. “I feel that the scales fell from people’s eyes and they’re not willing to tolerate that any longer. I think we’re at a moment in time where we are ready to make the difficult choices that mean that we tackle these inequalities, we’re not content to accept them anymore.”

When I was a kid at school and the boys said to me, ‘you’re not allowed to play football’ – well, blinking flip, did I go on and play football

But she is worried about the as-yet-unknown long-term effects the “collective trauma” of the pandemic will have on the population, and particularly on young people. Reflecting on her own lockdown experience, she says she ended up with a “pile of teenagers at home” who should have been out “kissing frogs” and enjoying life, but were instead stuck inside with their parents.

Todd managed to keep her own spirits up throughout this tough time by sticking to her running regime. Sport is the often ignored part of her job title, but it’s something she has a great deal of passion for. Indeed, she’s basically a walking advert for its benefits. She runs a mile every day and is often seen on mornings before parliament is sitting in Holyrood Park. She also spent her 50th birthday last month in Paris watching the Scotland V France Six Nations match and, a few weeks later, took part in the David Hill Memorial Quaich (named after the staffer who passed away last year) as part of the parliament’s rugby team.

But getting people as excited about exercise as her means improving the infrastructure around them, she says. “We really need to be thinking about making the environment more accessible for active transport and for leisure, exercise, walking, running, wheeling. We’ve done really well in Scotland actually on that front. We’re kind of bucking the trend of the Western world, in that our physical activity levels are increasing, but we need to do more. I always say to people, I do my daily mile not because I’m disciplined, I do my daily mile because it makes me feel good. We somehow need to make sure the whole population understand that this is about building this into your life.”

There is also a particular challenge getting women and girls involved in sport. She’s keen to tackle that too, including encouraging women in her own life to get active. When she joined Scottish Parliament RFC she was the only woman on the team but she’s since convinced other colleagues (and her daughter) to join.

Thinking back on her own childhood in the West Highlands, she reflects on how difficult it can be to go against the grain. “I grew up in a very gendered society where female leadership was not just not encouraged, but actively discouraged… All of us are subject to these cultural cues, it’s quite hard to lift yourself out of the culture that you’re immersed in, that you grew up in, and think, actually, that’s not fair.

“Although I was the kind of the kid who said, ‘that’s not fair’. When I was a kid at school and the boys said to me, ‘you’re not allowed to play football’ – well, blinking flip, did I go on and play football. And I’m also fairly sure that that’s one of the reasons why I took up rugby, you know. I thought, well, I’ll take on a full-on contact sport, thank you very much. I will not be told what girls and women can’t do.

“But it’s usually more subtle, isn’t it, than that overt opposition? And I think I reflect on my own your teenage years, I was such a science-y, geeky young person, I was mad passionate about physics, chemistry, maths, biology. I was science-y person, and not for a second did I consider becoming an engineer. I became a health professional. Now I’m a very people-person, I might have chosen that anyway, but I look back on that decision and I do wonder. We’re all conditioned this way… Times are changing, but they need to change more and faster.”