Colin Mair: measuring progress on inequality

Colin Mair, chief executive of the Improvement Service - Image credit: Holyrood

Reducing inequality has been a key policy focus in Scotland across the last decade and this commitment is now so embedded in policy narrative that it is quite possible to lose any clear sense of what it means, what precisely we are trying to achieve, and what success would look like. 

The Improvement Service has recently reviewed all public domain data on the 330 most deprived communities in Scotland, the 330 least deprived communities in Scotland, and the 330 communities precisely in the middle for the period 2001/02 to 2012/13.

We examined data on health outcomes, learning outcomes and safety outcomes across the period and the impact of employment/unemployment and household income level on outcomes.

The results are relatively unsurprising. Outcomes for all three groups improved on all measures across the period.

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For learning and educational attainment, the fastest rate of improvement was for the most deprived cohort, but there was still a substantial attainment gap between the most and least deprived cohort.

Life expectancy and healthy life expectancy could not be measured at community level, but national data indicates both were likely to have improved for all three groups.

The rate of improvement for the most deprived is likely to have been lower than for the less deprived but the compelling difference was in the way different groups accessed acute care.

The most deprived were far more likely to enter hospital by emergency admission whereas for the other cohorts, the majority of admissions were planned.

For health, therefore, outcomes in absolute terms improved for all cohorts, but, relatively, the inequality gap increased.

The pattern of access to hospital services becomes progressively differentiated across the period.

Safety outcomes for all communities markedly improved across the period (rates of crime and house fires) and the rate of improvement was faster in the most deprived communities.

However, a very substantial gap persisted across the period, highly associated with low household incomes and higher rates of unemployment and underemployment.

Clearly a wide range of factors shape these results, but for current purposes the interest lies in the light they throw on our commitment to reducing inequality and what that would look like.

If equality and inequality characterise the distribution of outcomes, and reducing inequality is about a more equal distribution, then this is a zero-sum game: some communities can become less disadvantaged only if other communities become relatively less advantaged.

This suggests that, if the policy interest is reducing inequality, then we should focus as much on the top of the distribution as on the bottom and the key policy mechanism would be redistribution (for example, progressive taxation of income and wealth and welfare support for these with low or no income).

While this makes sense for income and wealth, it is harder to see that this reading of reducing inequality makes much sense if applied to learning or health – how would we ‘redistribute’ health and would we really want to make some people less healthy so we can make others more so? 

It seems to make little political, practical or policy sense to talk about redistributing health outcomes on a zero-sum basis.

For that reason, it seems likely that commitments to reducing the attainment gap in education or reducing inequalities in health are at least initially shorthand ways of talking about improving outcomes for those currently most disadvantaged.

Realistically, local public services can target and improve local outcomes for people whose outcomes are currently poor, but it is hard to see how they could reshape the whole distribution of outcomes in an area.

For example, the most recent data on the qualifications young people achieve at the point of leaving school shows a 26 per cent improvement for the most deprived 20 per cent of pupils between 2012 and 2016, but there is still a huge ‘gap’, in part, because pupils from deprived backgrounds leave school earlier to pursue vocational options.

The circumstances in which people live structures their ability to use and get value out of public services (for example, an able pupil who needs to take the earliest opportunity to earn because of the financial stress in their household).

The focus to date has been on changing services, but much less on changing the circumstances that affect people’s ability to use services and get value from them.

This is in part because control of services was devolved, but other economic and fiscal levers were not.

That is now changing with greater fiscal and welfare devolution and a more balanced strategy of equality needs developed.

If we really wish to change the pattern of opportunities and outcomes, using fiscal and welfare powers to change people’s circumstances, as well as improving services, would be critical. 

The evidence reviewed by the IS supports qualified optimism, insofar as it shows that good public service provision can improve absolute outcomes and mitigate the impact of wider economic factors on outcomes for the most deprived communities.

However, public service improvement needs to be allied to economic development, fiscal and welfare policy if ingrained inequalities are to be addressed and all of Scotland’s communities are to have fairer opportunities and fairer choices in life.