Jen Gracie, Policy and Public Affairs Manager at Diabetes Scotland, reflects on the ALLIANCE manifesto launch event.

We’re a society that believes in fairness. That was clear from listening to cross-party representatives at the ALLIANCE’s recent manifesto hustings: no matter your political persuasion, there is a belief we must build back not only better but fairer. Yet your income, gender, ethnicity, age, or postcode still too often dictate your health outcomes in Scotland. If the commitment is there, then why is this still the case?

Health inequalities in Scotland are stark and persistent, however they can be solved. More than 500,000 people in Scotland are at risk of developing type 2 diabetes – yet, crucially, more than half of all cases of type 2 diabetes could be prevented or delayed. Poverty is closely linked to the risk of type 2 diabetes, with prevalence 40% higher among people in the most deprived areas of Scotland.

To see real reductions in type 2 diabetes then, there must be fundamental efforts to address the social determinants of health – including poverty.

And that’s the case across health inequalities. It is clear we all want everyone to access the right care and support for people to live healthy, happy lives. To do that, we must address the inequalities that lead to poorer outcomes. As one panellist noted, Scotland must value both prevention and crisis services.  We need to ensure that crisis services don’t quickly become the social norm or seen as the minimum standard of care.

At Diabetes Scotland, we’re acutely aware that the pandemic has only exacerbated inequalities. We know, for example, that having to continue to leave home for employment was a huge concern for people living with diabetes. Diabetes had a high level of COVID associated deaths and those living with diabetes were classed as clinically vulnerable – but not put on the shielding list, therefore not afforded those protections. Those on a low income, or from BAME communities, were often least able to either work from home or advocate for themselves to be added to the shielding list yet disproportionately impacted by the risk of COVID. Many felt that they were in effect choosing between their health and their income.

But, as Lucy Mulvagh of the ALLIANCE noted, the rights of those less able to speak up for themselves are too often overlooked. If we’re to tackle health inequalities, we must make the fundamental and crucial efforts to hear to those most impacted – and to value those contributions. Human rights must be at the centre of our efforts to build back better – and so too the lived experience of those people who can tell us what needs to change.

So, while health inequalities persist in Scotland, it’s heartening to hear political spokespeople tell us that they will value the voice of experience. At Diabetes Scotland, we’ll work to ensure that’s the case throughout the next Parliament, and that the diverse voice of people living with diabetes Scotland – all 312,000 of them – are equally valued.

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