The SNP's pursuit of independence has slowed progress in eradicating health inequalities, according to Scottish Labour's former leader.
Kezia Dugdale said a reluctance to implement progressive policies that "have winners and losers" was hampering efforts to reduce poverty and deprivation.
She said it was difficult to argue that the SNP was a party of "progressive radicals" but suggested this actually benefits the independence cause.
In her new role as Director of the John Smith Centre for Public Service at the University of Glasgow, Ms Dugdale was discussing progress made in the 23 years since devolution to create a more equal society.
Despite decades of effort, Glasgow still falls behind the rest of Scotland in terms of health outcomes and Scotland has a poor health profile
compared with the rest of the UK and Western Europe.
Life expectancy improvements have stalled, particularly in the most deprived communities, with mortality rates now starting to rise and Westminster austerity policies have been blamed for the increasingly bleak picture.
"It's very hard to do anything radical because that has winners and losers," said Ms Dugdale, "and some of the losers are people you are trying to court for the cause of independence.
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"Take for example the Scottish Government tax powers, which for a long time were un-used. They have been used in recent times to slightly moderate the thresholds of income tax.
"They are not insignificant sums but I would argue they are largely symbolic. Not the necessary sums that we might want to see generated from tax if we really want to transform public services.
"So if not prepared to use the tax powers you have to look at existing budgets and that really means cutting something and whenever you cut something you create a lobby against you.
"There's a really good example of that right now in the context of the government's relationship with trade unions. If you find yourself in the situation where you have to handle a pay dispute like we have with the train drivers, you have to be careful with the optics it creates - that you as a government are falling out with the leading trade union, what that looks like and what that means for the independence cause."
She said that for the SNP to consistently win elections requires "an enticing vision of independence" which appeals to centre and left of centre voters.
"But that vision of how to achieve it requires not upsetting anyone," she added.
"People who support independence need to be careful that they don't promote the idea that the government can do lots of progressive things because why then would you need independence.
"It suits people who support independence that if you want a socially democratic utopia, you have to vote for independence to get it.
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"There's a serious debate to be had about whether the Scottish parliament's powers - which have increased in recent years - have really been aligned to deliver that message.
"It's not in the interests of the parliament to prove its radicalism now."
She said Scotland as a county had for a long time been "more anti-Conservative" than radical.
She said: "Looking very closely at Margaret Thatcher, it's a very dangerous thing to say but in a way, it was economically positive but politically it was deeply negative.
"The reality was that public spending went up under Margaret Thatcher in Scotland and Scots liked some of the policies particularly around housing and [the right to buy] council houses policies which were absolutely devastating and hugely disruptive to eradicating poverty and inequality and giving people a safe home, a legacy which we are still dealing with now.
"We need to understand [it was] something that was very popular."
She said that when Scots "turned against" Thatcher "it was not for the reasons you might think."
She said: "They just thought that she didn't consider Scotland to be important.
"It wasn't necessarily a case for greater radicalism or greater state intervention of huge support for centre left politics."
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She said that ultimately led to support for devolution to "stop Thatcher at the border".
Drawing on research by Professor James Mitchell of Edinburgh University's Centre on Constitutional Change she said it was difficult to argue that the SNP are "progressive radicals in any real sense."
She said: "I would argue till I'm blue in the face that the SNP represents the centre ground of Scottish politics."
Ms Dugdale, who served as leader of the Scottish Labour Party from 2015 to 2017, said confusion amongst the public over which areas of government are devolved to the Scottish parliament creates "insulation" for policy makers.
"There's a very salient escape hatch for under-delivery," she said.
"The public do believe that the SNP manage the economy well but they don't know to what extent they have any control over it."
Speaking during a public seminar organised by Glasgow Centre for Population Health (GCPH) she said that the party's most successful strategy was to establish "standing up for Scotland" as a competency issue.
"Every time an election is framed that way, then the SNP win.
"If the second referendum doesn't come to pass, the clever political strategising leads us to a cliff-edge. I worry what happens from that point onwards, or it might be the point where were start to do the things that are politically difficult."
Kirsten Oswald, the SNP’s Deputy Westminster Leader said in response to Ms Dugdale’s comments: “Constitutional debate is not some abstract discussion – over the last few decades it has led to transformational change that has benefitted all of Scotland.
“It was only through a constitutional debate that the Scottish Parliament was established – allowing Scotland to introduce free personal care for the elderly, the smoking ban, minimum pricing for alcohol and free university tuition.
“And it was only as a result of the constitutional debate in 2014 that Scotland secured new tax and social security powers – and we’ve used them to introduce fairer taxes and allowed us to introduce transformational anti-poverty policies such as the Scottish Child Payment.
“Kezia Dugdale is right to highlight some of the deep-seated and longstanding issues that Scotland faces, but she needs to explain why she thinks that leaving key economic levers in the hands of the Tories at Westminster is the way to solve them.”
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