WHEN we at the Health Foundation began our review of health inequality in Scotland, we had a basic understanding that despite strong policy intent the country had lower life expectancy than the rest of the UK and was starting to fall behind other European countries. It was also clear that there was a wide and persistent gap between the health of the richest and the poorest people.

However our report has revealed two worrying trends. That a health gap is opening up between people living in the most deprived fifth of areas and the rest. And that stagnation in living standards, still-wide income inequalities and gradually rising poverty – especially for children – provide little indication of improvement in future.

We have found particular areas of concern that affect the health of all members of society: children, women and men. With regard to children, infant mortality is rising for people living in the fifth most deprived fifth areas but is static or falling among the rest. In the last decade, inequalities have also widened for infant immunisation uptake, low birth weight and childhood obesity.

When it comes to women, we found that avoidable mortality rates among females living in the most deprived fifth of areas have increased by eight per cent since 2010 despite reducing for the rest. Rates are now around 50 per cent higher in those living in the fifth most deprived areas than in the second most deprived.

Young to middle-aged men are the most likely to suffer from deaths related to drugs, alcohol or suicide. Drug-related death rates are 18 times higher in the most deprived areas compared to the least deprived fifth. This group engages less with health services and is the most likely not to attend hospital appointments. Being younger, single, white and male is most strongly associated with experiencing severe multiple disadvantages, and poor health.

Life expectancy varies greatly across Scotland. In the most deprived areas, men are dying more than 13 years earlier than their peers in the least deprived areas – and women almost a decade earlier.

A healthy community derives from a range of factors: stable jobs, good pay, quality housing and education. Poor health is almost inevitable when some or all of these factors are absent. Scotland's wide and sustained health inequalities are being driven by the accumulation of severe multiple disadvantages, a lack of improvement in living standards and public service fragility due to the ongoing impact of austerity.

So, we know what is wrong now, in more detail than ever. The question is, what can we do about it?

A radical shift in approach is needed. The Scottish Government, local authorities, businesses and the third sector must come together and collaborate closely with communities. Ultimately, we must shift focus from short-term measures to longer-term preventative interventions. This is a wiser use of the funding available which will create a healthier nation.

This is no longer about plans and strategies. It is about political will, and decisive action.

David Finch is Assistant Director of the Health Foundation