Carol Tannahill (Glasgow Centre for Population Health) Keynote Presentation at Scottish Leaders Forum plenary event on "Supporting Resilient Communities: the Role of Public Service Leaders".
2 November 2012
4. Life expectancy: the gap
Male Life Expectancy at Birth (years); West of Scotland Council Areas vs Scotland;
1991-1993 to 2001-2003
Source: Office for National Statistics
78
76
74
Life Expectancy at birth
Gap
between
best and
72 Gap
worst =
between
8.1
best and
years
worst =
70 6.5
years
68
66
1991-1993 1992-1994 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003
Council
Scotland Glasgow City East Renfrewshire East Dunbartonshire
5. Life expectancy trend
by deprivation
Estimates of male life expectancy, least and most deprived Carstairs quintiles, 1981/85 -
1998/2002 (areas fixed to their deprivation quintile in 1981)
Greater Glasgow
Source: calculated from GROS death registrations and Census data (1981, 1991, 2001)
85
Males -Dep Quin 1 (least deprived)
Males - Dep Quin 5 (most deprived)
Scotland Males
80
Estimated life expectancy at birth
76.2
75 73.9
73.3
72.2
71.2
69.4
70
65.3
64.8 64.4
65
60
1981-1985 1988-1992 1998-2002
8. In light of all this, how do we
think about causation and
response?
• Direct and specific causes: action on
individual features
• Fundamental determinants: perpetuate
systematic differences, operate
consistently over time regardless of
changes in causes
• Complex systems of causation: need to
understand relationships between
components
13. Social Protection
• Social protection has important and positive
effects on outcomes, even within societies that
remain highly unequal in other respects.
• Welfare benefit reforms will impact directly on
individuals, families, communities and
services.
• Responses?
– Organisation of advice services and communication
– Quantification of scale and of service implications
– Advocacy
– Mitigation
14. Income maximisation
• Even small-scale initiatives make an
important difference
• Healthier Wealthier Children:
Almost half of advice cases (664 out of 1347; 49%)
some £ gain
Average client gain: £3404
Range: £2,259 - £5,636
• Govanhill participatory budgeting pilot:
Still ‘at the edges’ – BUT
Process enabled dialogue between community and
public & third sectors
Decisions reflected acute understanding of local
issues
Community embraced the responsibility
16. All-cause SMRs, Glasgow
relative to Liverpool &
Manchester
Age 0-64, all-cause SMRs 2003-07, Glasgow relative to Liverpool & Manchester
Standardised by age, sex and deprivation decile
Calculated from various sources
160
150
135.6
140
131.4 124.4
130
Standardised mortality ratio
120
110
100
90
80
70
60
Both sexes Males Females
Gender
17. ‘Excess’ mortality by cause
• Compared to Liverpool & Manchester,
Glasgow experienced around 4,500 ‘excess’
deaths between 2003 and 2007
• Almost half were under the age of 65
• All deaths:
– 50% of the excess relates to deaths from cancer
and circulatory system diseases
– 20% relates to alcohol
• Deaths <65:
– 25% cancer and circulatory system diseases
– 32% alcohol + 17% drugs = 49% alcohol/drugs
related
18. Many hypotheses
• Artefact • Social capital
• Culture • Spatial patterning of
• Genetics deprivation
• Greater ‘vulnerability’ • Family/parenting
• Migration • Gender
• Psychological outlook • Political attack
• Substance misuse • Social mobility
cultures • Sectarianism
• Vitamin D • The weather…
19. Many hypotheses,
but to cut to the
current page in the story
• Artefact • Social capital
• Culture • Spatial patterning of
• Genetics deprivation
• Greater ‘vulnerability’ in • Family/parenting
Glasgow • Gender
• Migration • Political attack
• Psychological outlook • Social mobility
• Substance misuse • Sectarianism
cultures • The weather…
20. Lower social capital?
• Not in all aspects
– Some are ‘better’ in Glasgow (e.g.
environment, incivilities etc)
– Some are similar (e.g. contact with
neighbours)
• But significant differences in relation to:
reciprocity, volunteering, trust and other
‘proxies’ for social capital…
21. Volunteering
Unpaid help: at least one example in previous 12 months
40%
30.5%
35% 28.0%
30%
25%
18.1%
17.9%
16.8%
15.6%
20% 13.9%
12.4%
15%
9.0%
8.2% 7.7%
6.1%
10% 5.7%
2.7% 3.3%
5%
0%
Glas Liv Man Glas Liv Man Glas Liv Man Glas Liv Man Glas Liv Man
1 (Most) 2 3 4 5 (least)
22. Community resilience
To build collective resilience, communities must:
• Reduce inequalities (eg in risk and resources)
• Engage local people
• Create organisational linkages
• Boost and protect social supports
• Plan for not having a plan! – requires
flexibility, decision-making skills, and trusted
sources of information
[Norris et al. Am J Comm Psychol (2008)]
24. Community composition
Percentage of population under 16 &
ratio of adults to children under 16
% Ratio
Transformation 42 1.01
Local regeneration 38 1.18
Peripheral estates 35 1.34
MSF surrounds 26 2.14
Housing improvement 24 2.67
(Scotland 20)
In regeneration areas, 40% all households are single person,
and 65% older households are single person.
25. It matters
how things are done
• For those relocated to other areas,
satisfaction with area, home and fittings
showed a clear gradient of association
with the amount of choice given.
• Where ‘a lot’ of choice, over 95%
satisfied. Where ‘none’, approx 70%.
• There is also a gradient in people’s
perceived ability to influence (lowest in
relation to major decisions).
26. Consequences of
environmental improvement
• More positive ratings of home and
(slightly less so) neighbourhood
• More neighbourly behaviours
• Higher intentions to make changes to
health-related behaviours
• Evidence of the importance of
aesthetics for mental wellbeing
27. Encouraging trends
• The most recent survey findings
suggest that the Regeneration Areas
may be exhibiting more positive trends
than comparable areas in the city.
28. Local service providers respond
to the views of local people
100%
Percentage 'agree' or 'strongly agree'
80%
Regen area
60% (TRA/LRA)
Non-regen area
(WSA/HIA/PE)
40% Overall
20%
0%
2 3
Wave
29. Respondent feels part of the
community
100%
Percentage 'a great deal' or 'a fair amount'
80%
Regen area (TRA/LRA)
60%
Non-regen area
(WSA/HIA/PE)
40% Overall
20%
0%
2 3
Wave
30. Neighbourliness: borrows and
exchanges favours with
neighbours
100%
Percentage 'great deal' or 'fair amount'
80%
Regen area
60% (TRA/LRA)
Non-regen area
(WSA/HIA/PE)
40%
Overall
20%
0%
2 3
Wave
31. How should we think about
causation and response?
• All three approaches are necessary.
• There are broad causal mechanisms, but
not Newtonian laws. The effective
response varies from case to case:
– requires skill and latitude
– quality of relationship of central importance
– will be context-dependent
– workforce implications
• The second and third approaches are
essential in preparing for the future, and
clearly relate to preventive spend and
public sector reform agendas
32. Propositions
• The challenges will become more significant
• Social intelligence about the nature of our
communities is invaluable, and should inform how
we judge success
• Neighbourhood regeneration approach: some
encouraging findings
• The importance of how things are done: effects
are sensitive to skills and motivations
• Communities are changing, and systems are
needed to support innovation
• Resilient communities: engaged, organisationally
linked, socially supportive … how can your
organisations provide support for this?
33. Acknowledgements
• Thanks to my colleagues in the Glasgow
Centre for Population Health and the GoWell
programme
• GoWell is a partnership between the Glasgow
Centre for Population Health, the University of
Glasgow and the MRC/CSO SPHSU, sponsored
by the Scottish Government, GHA, NHS Health
Scotland and NHS GGC
• All reports and further information available
from www.gcph.co.uk,
www.understandingglasgow.com and www.
gowellonline.co.uk
Notes de l'éditeur
This illustrates the scale of the gap between the city and its neighbouring areas. And the fact that that gap is growing.
From LGF: Over twenty years the change in the populations of each quintile – whose areas were fixed to their 1981 positions – is both dramatic and contrasting. The population of the most deprived quintile was 203,677 in 1981, dropped to 150,821 in 1991 and then reduced further to 120,240 in 2001. This represents an overall drop of over 83,000 or 41% in the 20 year period. In contrast, the population of the most affluent quintile increased slightly over the period from 194,239 to 207,571, a rise of over 13,000 or 7%. Another way of describing this change is to note that, while in 1981 the population of each quintile, by definition, accounted for 20% of the population of the region, by 2001 the population of the most deprived areas (as defined in 1981) represented only 14% of the Greater Glasgow population and the population of the most affluent areas had risen to 24% of the total. These trends are open to a number of interpretations. However, it is safe to say that the population trends do reinforce the often-noted observation that the population of many of the deprived parts of Glasgow has dropped significantly. This pattern may also partly explain the worsening life expectancy trends of males in deprived areas if it is believed that those who left were generally in better health, with better education and better employment prospects.
2) Resources (such as money, knowledge, power, social connections, language) protect health no matter what mechanisms are relevant at any time
HWC – of those referred, 54% uptake of service; and of these 49% got financial gain
So, some disease-specific explanations, but also potentially a greater vulnerability across the population. Has led to a body of ongoing work to
Introduce GoWell – types of approach being adopted – lack of published evidence of health benefits from housing improvement or regeneration We are only part-way through – so this is interim
2) Ref Oxfam work as an example 4) Question about spill-over effects – though NB Popham work that population movement NOT cause of growing inequalities