A Fairer, Healthier Scotland says Scotland's efforts to reduce its wide health inequalities are being undermined by an unequal distribution of power, money and resources, and by problems delivering change, including a lack of long-term funding.

Professor Sir Michael Marmot, director, UCL Institute of Health Equity said: ‘Scotland has been hit badly by the sluggish recovery from the economic crisis in 2008, which has affected salaries and, in turn, living conditions and health equity. Further, the pandemic, climate change and political instability in the UK Government have added to the challenge of addressing health inequalities.'

Men in Scotland's most deprived areas can expect to live 16.3 fewer years than men in the least deprived areas; for women the gap is 13.6 years.

Healthy life expectancy has fallen by 3.6 years for women and 2.8 years for men in the last decade. The biggest falls have been in the most deprived areas – there is now a gap in healthy life expectancy of more than 22 years for women and 20 years for men between the most affluent and most deprived councils.

The poorest 40% of people in Scotland hold less than 5% of the country's wealth, unchanged since 2006–08.

The report says differences in power, money and resources have shaped the conditions in which people live, such as their income, housing, work and communities, with public wealth having shrunk markedly while private wealth has increased, leaving less to invest in the things that keep people healthy.

In addition, short-term, fragmented funding and complex delivery arrangements have wasted resources and made it harder to help the people who need it most. Spending also often fails to reflect need.

The report calls for the full implementation of the eight Marmot Principles through six recommendations:putting health equity at the heart of Government; investing where need is greatest; shifting to long-term funding; creating total health equity places; strengthening accountability; and appointing a senior health equity lead in every council.

The report says topping up the 790,000 households who are living below the Minimum Income Standard would cost around £1.5 bn a year and add about a year to average life expectancy, and around 2.5 years in the most deprived areas, cutting the life expectancy gap between areas by about a fifth: 21% for women and 18% for men.

In addition, insulating poor quality housing for around 500,000 low-income households would potentially reduce the healthy life expectancy gap by 3.5% for women and 3.7% for men, with a social value of £26.2bn.

Expanding and sustaining childcare, home visits and health and nutrition checks for 100,000 under-fives in low-income communities could additionally reduce the healthy life expectancy gap by 10% - 15%, with a social value of £100 to £150bn.