Scottish Leaders Forum - Carol Tannahill - GCPH
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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". ...

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

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  • 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

Scottish Leaders Forum - Carol Tannahill - GCPH Scottish Leaders Forum - Carol Tannahill - GCPH Presentation Transcript

  • Supporting resilient communities:The role of public service leaders Carol Tannahill Director Glasgow Centre for Population Health
  • 18 5118 -18 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 55 5318 -18 59 5718 -18 63 6118 -18 67 6518 -18 71 6918 -18 75 7318 -18 79 7718 -18 83 8118 -18 87 8518 -18 91 8918 -18 95 9318 -18 99 9719 -19 03 0119 -19 07 0519 -19 11 0919 -19 15 1319 -19 19 1719 -19 23 2119 -19 27 2519 -19 31 2919 -19 35 3319 -19 39 3719 -19 43 4119 -19 47 45 Source: Human Mortality Database19 -19 51 4919 -19 55 5319 -19 59 5719 -19 63 61 Scotland in Europe19 -19 67 6519 -19 71 6919 -19 75 7319 -19 79 7719 -19 83 81 Male life expectancy: Scotland & other Western European Countries, 1851-200519 -19 87 8519 -19 91 8919 -19 95 9319 -19 99 9720 -20 03 01 -2 00 5
  • All cause death rates, Men 0-64, 2001 (Leyland et al, 2007)
  • 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 74Life 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
  • 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 80Estimated 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
  • -70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70
  • -70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70
  • 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
  • Understanding Glasgow: the Glasgow Indicators project
  • Risk of death - by level of hopelessness4.5 43.5 3 Low2.5 Moderate 2 High1.5 10.5 0 All cause CVD Non CVD Cancer Everson et al 1996
  • Issue-specific responsesThe example of welfare reform
  • 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
  • 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
  • Fundamental causesAn example from ‘The three cities’
  • 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 130Standardised mortality ratio 120 110 100 90 80 70 60 Both sexes Males Females Gender
  • ‘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
  • 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…
  • 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…
  • 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…
  • Volunteering Unpaid help: at least one example in previous 12 months40% 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)
  • Community resilienceTo 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)]
  • Holistic approachThe example of neighbourhood regeneration
  • Community composition Percentage of population under 16 & ratio of adults to children under 16 % RatioTransformation 42 1.01Local regeneration 38 1.18Peripheral estates 35 1.34MSF surrounds 26 2.14Housing improvement 24 2.67(Scotland 20)In regeneration areas, 40% all households are single person, and 65% older households are single person.
  • 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).
  • 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
  • Encouraging trends• The most recent survey findings suggest that the Regeneration Areas may be exhibiting more positive trends than comparable areas in the city.
  • 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
  • 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
  • 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
  • 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
  • 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?
  • 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