Public Health in Scotland - Harry Burns


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  • Antonovsky described the sense of coherence, something children developed if the parenting they experienced allowed them to understand that the world was predictable and explicable, that they had the resilience to cope with what the world threw at them and that the effort of coping was worthwhile expending
  • Public Street Improvements and Infill Development COLFAX AVENUE, DENVER, COLORADO: Done in association with Space Analytics, LLC for Colfax on the Hill, Inc., funded in part by the Denver Foundation 1 - Existing conditions 2 - Mixed-use buildings on one corner 3 - Public street improvements: street trees, street lamps, decorative traffic signals, sidewalk bulbouts 4 - Additional mixed-use development, remodeling of existing buildings
  • Self-control gradient. Children with low self-control had poorer health (A), more wealth problems (B), more single-parent child rearing (C), and more criminal convictions (D) than those with high self-control.
  • Public Health in Scotland - Harry Burns

    1. 1. The Strategic Narrative <ul><li>Challenges </li></ul><ul><li>Demography </li></ul><ul><li>Scotland’s public health </li></ul><ul><li>Economic outlook </li></ul>
    2. 2. Life expectancy trends Portugal Scotland
    3. 3. Life expectancy trends Portugal
    4. 4. Trends in male life expectancy: Scotland Richest 20% Poorest 20%
    5. 5. Public health in Scotland
    6. 6. Public health in Scotland - turning 5 decades of failure into success!
    7. 7. Public health in Scotland - turning 5 decades of failure into success -with some lessons from riots along the way!
    8. 8. Health Deficits approach <ul><li>We focus on problems, needs and deficiencies </li></ul><ul><li>We design services to fill gaps and fix problems </li></ul><ul><li>We make people passive recipients of services </li></ul><ul><li>We do things to people rather than with them. </li></ul>
    9. 9. Sense of coherence.... “ .....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable , that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement . &quot;
    10. 10. Health Assets <ul><li>A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain their health and sustain wellbeing. The assets can operate…as protective and promoting factors to buffer against life’s stresses </li></ul>Morgan and Ziglio 2009
    11. 12. Health <ul><li>Everyday experience tells us health is NOT a state </li></ul><ul><li>It is the outcome of a set of processes which are continually at work as we interact with others and our external environment </li></ul>
    12. 15. Diagnosed disease Underlying risk factors
    13. 16. Health improvement or life improvement? <ul><li>Health is a property which emerges in individuals living in a fair and civilised society. </li></ul><ul><li>Individuals who live in such a society understand how it works, can manage the challenges they face and participate fully in the life of the community. </li></ul><ul><li>Such individuals are likely to feel in control of their lives and are likely to be healthy and feel well. </li></ul>
    14. 19. Horst Rittel and Melvin Webber
    15. 20. Wicked Problems Rittel and Webber 1973 <ul><li>There is no definitive formulation of a wicked problem. </li></ul><ul><li>It is not clear when wicked problems are resolved </li></ul><ul><li>Solutions to wicked problems are not true-or-false, but better or worse. </li></ul><ul><li>Every attempted solution to a wicked problem counts significantly because it changes the problem. </li></ul><ul><li>The planner has no right to be wrong (planners are liable for the consequences of the actions they generate). </li></ul>
    16. 21. Tackling wicked problems – Australian style <ul><li>Authoritative or collaborative strategies? </li></ul><ul><li>Narrow or broad approach? </li></ul><ul><li>Firm trajectory or innovative “hunches?” </li></ul><ul><li>Organisational focus or cross organisation? </li></ul><ul><li>Tight governance or “project review?” </li></ul><ul><li>Regulation or persuasion? </li></ul>
    17. 22. Management of complex systems <ul><li>The importance of instability – “never waste a good crisis” </li></ul><ul><li>Order generating rules – develop a common vision of what you want the future to be </li></ul><ul><li>Emergence of solutions – accept that the outcome may not be exactly what you anticipate </li></ul>
    18. 24. Building on assets <ul><li>Economic assets </li></ul><ul><ul><li>Government and the private sector </li></ul></ul><ul><li>Environmental assets </li></ul><ul><ul><li>Local government, community </li></ul></ul><ul><li>Social networks as assets </li></ul><ul><ul><li>Community, 3 rd sector </li></ul></ul><ul><li>Personal sense of control </li></ul><ul><ul><li>Community, 3 rd sector </li></ul></ul>
    19. 27. Places for people
    20. 28. Places for people?
    21. 29. Building on assets <ul><li>Economic assets </li></ul><ul><ul><li>Government and the private sector </li></ul></ul><ul><li>Environmental assets </li></ul><ul><ul><li>Local government, community </li></ul></ul><ul><li>Social networks as assets </li></ul><ul><ul><li>Community, 3 rd sector </li></ul></ul><ul><li>Personal sense of control </li></ul><ul><ul><li>Community, 3 rd sector </li></ul></ul>Relevance to people
    22. 30. Transforming lives <ul><li>Prolonged, non judgemental relationship builds trust </li></ul><ul><li>Individual learns of alternative lifestyles </li></ul><ul><li>Realises he is free to choose </li></ul><ul><li>Supported while he realigns his life </li></ul><ul><li>Supports others in turn </li></ul><ul><li>Success lies in the quality of the interactions between the individual and his supporters </li></ul>
    23. 31. Types of communication <ul><li>Debate - winners and losers </li></ul><ul><li>Discourse - persuasion </li></ul><ul><li>Dialogue – joint pursuit of a new insight </li></ul>
    24. 32. Types of communication <ul><li>Who are you lookin’ at? </li></ul><ul><li>Debate - winners and losers </li></ul><ul><li>Discourse - persuasion </li></ul><ul><li>Dialogue – joint pursuit of a new insight </li></ul>
    25. 33. A common vision? <ul><li>A healthy society </li></ul><ul><li>Low criminal conviction rate </li></ul><ul><li>Low teenage pregnancy rate </li></ul><ul><li>High educational attainment </li></ul><ul><li>Economically active </li></ul>
    26. 34. Self-control gradient and adult outcomes Moffitt T E et al. PNAS 2011;108:2693-2698 ©2011 by National Academy of Sciences
    27. 38. Numbers to remember <ul><li>700 per second – the numbers of new neuronal connections in babies </li></ul><ul><li>18 months – the age at which speech disparities begin to appear </li></ul><ul><li>90-100% - the chance of developmental delays when a child experiences 6/7 adverse experiences </li></ul><ul><li>3:1 – the odds of heart disease in adulthood when experiencing 7/8 adverse experiences </li></ul><ul><li>£5-£10 – the amount returned in childhood for every £1 invested in early programmes </li></ul>
    28. 39. Developmental delay and adversity
    29. 40. Risk of heart disease and early adversity
    30. 41. Vocabulary and social class
    31. 42. Compassion <ul><li>Are we ready to plan for a compassionate society? </li></ul>
    32. 43. Jimmy Reid 1971
    33. 44. Rectorial Address <ul><li>“ Let me right at the outset define what I mean by alienation. It is the cry of men who feel themselves the victims of blind economic forces beyond their control. It's the frustration of ordinary people excluded from the processes of decision making. The feeling of despair and hopelessness that pervades people who feel with justification that they have no real say in shaping or determining their own destinies....” </li></ul>