Health inequalities are the biggest issue facing Scotland today and require a "pan-societal" response from all levels of the public sector, the country's top doctor has warned.
The inequalities are "astonishingly complex" and MSPs and others must show the political will to deliver consistent and nationally-scaled solutions to make a difference over the coming decade, Chief Medical Officer for Scotland Sir Harry Burns said.
Sir Harry was at Holyrood's Public Audit Committee to give evidence to MSPs on a recent report into health inequalities by Audit Scotland. The report found that despite general improvements in the health of the nation, deep-seated differences remain between the least and most deprived communities.
It found that it is not clear how, at local level, resources are targeted to the areas with the greatest need, while increased health spending actually tends to lead to greater benefits for richer areas.
Sir Harry told the committee that the report would have been "really helpful" if it had come out 20 years ago. He said, however, it did not pay much attention to the "complex science" that underlies inequalities.
"For me, health inequalities are the biggest issue facing Scotland just now, because not only are health inequalities a problem, but they are a manifestation of social inequalities and social disintegration that drives things like criminality, like poor educational attainment, and a whole range of things that we would like to be different in Scotland," he said.
"We now know, astonishingly, that it is possible for the experiences of a grandfather to imprint his genes in ways that are transmittable to sons and grandsons. The adverse experiences of people from years ago could still be operative, despite the fact that sons and grandsons are not exposed to those adverse experiences.
"So, this is an astonishingly complex problem. All of these issues are interrelated and you will not solve them by trying to persuade people to change their behaviour. You need to go to the root of all of it." Sir Harry told MSPs that a "pan-societal" response was needed. "The fundamental drivers lie outside the healthcare system," he said.
Conservative MSP Mary Scanlon said Audit Scotland had looked at Government strategies aimed at improving health since 2008 but the public spending watchdog had not found robust evidence of their effects.
"I would presume that you carried out research and you thought, this has got to target inequalities and deprivation, and this has to be of benefit, therefore we will come up with an action plan and a strategy, it comes to this Parliament and lots of money goes into it," she said. "What we have today is little or no evidence of impact."