The importance of social capital and involving people in decisions making have been highlighted as key issues in explaining why people living in cities like Liverpool and Manchester have much better health than those living in Glasgow. These cities, like Glasgow, have been through deindustrialisation and experience similar levels of poverty and inequality yet Glasgow has 30% excess for premature mortality and 15% excess for deaths of all ages.
The latest report from Glasgow Centre for Population Health: History, Politics and Vulnerability in Scotland and Glasgow is an important piece of work and anyone one looking at public sector reform in Scotland should be studying it in detail in order to avoid repeating the mistakes of the past.
Key features of Scotland’s health problems
Excess mortality compared with the rest of the UK
• is seen all over Scotland but it is greatest in the West of Scotland and in particular Glasgow
• It is increasing
• It exists across all social classes
• It exists for a broad range of causes of death but key issues for premature mortality are death from alcohol, drugs and suicide and for excess death at all ages from cancer, heart disease and stroke.
The figures are startling: In 2011-12 the “excess death for alcohol related disease was 2.3 times higher for Glasgow than for Liverpool and Manchester and 70% higher for suicide.
It has been clear for some time that poverty and inequality impact on health outcomes but the problems in Scotland and Glasgow in particular are more complex. The differences in poverty and deprivation no longer explain the mortality gap between Scotland and the rest of Britain. In other cities like Liverpool and Manchester where the population has and is experiencing poverty, inequality and deindustrialisation (and are at the wrong end of England’s health outcomes tables) people do not have health outcomes similar to Glasgow and Scotland.
The report’s finding indicate that Scotland’s population and Glasgow’s in particular have been “made more vulnerable” to the impact of poverty, inequality and deindustrialisation.
• Lagged effect of historical levels of deprivation: Glasgow has had notably higher levels of overcrowding from at least the middle of the twentieth century
• Impact of the New Town programme: these programmes relocated younger skilled workers and their families and encouraged growth of “modern lighter industries” away from Glasgow. The policy focus was therefore not on investing in Glasgow but in getting people out of it.
• Glasgow undertook substantially large slum clearances and building demolitions with a greater emphasis on creating within city peripheral social housing estates, more high rise development and much lower per capita investment in housing repairs
• Moving on to the 1980s: Glasgow prioritised inner city gentrification and commercial development whereas Manchester and Liverpool reacted to cuts differently. In particular the city level response in Liverpool was one of building participatory models of development leading to a focus on building new council houses and public amenities.
• The report found high levels of social capital (strong community ties) in Liverpool
• The team speculate that Manchester’s greater levels of ethnic diversity may also have been helped them withstand the effect of poverty and deprivation.
Implications for policy
The key point the report emphasises is that economic policies “matter for population health” and that if we are to improve Scotland’s health then we need to address three issues simultaneously
People need to be protected from poverty and deprivation
Work needs to be done to address the existing problems and mitigate against future vulnerabilities caused by the cuts to public services particularly though not exclusively social security.
Importantly Scotland while mitigating the impact is important reduce the inequalities in income and wealth are essential to narrowing health inequalities within Scotland.
Recommendations are grouped under four headings and detailed examples are included in the report.
Scottish Economic and social policy
The report urges all opportunities are taken to redistribute income and wealth across Scotland: including measures relating to ownership of capital, income and corporate taxation, wealth and asset taxation, and fair work.
Housing and physical environment
Examples include expanding the social house building programme and extending the Scottish Housing Quality Standard
Targeting cold and damp housing
Local government actions
Local government is encouraged to recognise impact of local decision making on population health. The report emphasises the role of local government plays in redistributing resources towards areas of greater need and so questions are raised about whether to review boundaries and/or the funding allocation for local government. A poverty proofing approach to local government policy making is also recommended
As ever they call for further research on the nature and experience of deprivation in Scotland
This is an extensive and important piece of work which should inform the process of public sector reform in Scotland. The finding indicates the value of community involvement in developing their own solutions. This means also challenging the role of “experts” making plans on what they think is best. This of course can be a challenge to and for policy makers, politicians and of course professional advisers on policy.
Public services in Scotland are reorganising and refocusing in response to both budget cuts and changing demands. We can’t afford to keep getting it wrong, as this report shows lives are at stake.