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

1. Supporting resilient communities:
The role of public service leaders
Carol Tannahill
Director
Glasgow Centre for Population Health

2. 18
51
18 -18
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
55 53
18 -18
59 57
18 -18
63 61
18 -18
67 65
18 -18
71 69
18 -18
75 73
18 -18
79 77
18 -18
83 81
18 -18
87 85
18 -18
91 89
18 -18
95 93
18 -18
99 97
19 -19
03 01
19 -19
07 05
19 -19
11 09
19 -19
15 13
19 -19
19 17
19 -19
23 21
19 -19
27 25
19 -19
31 29
19 -19
35 33
19 -19
39 37
19 -19
43 41
19 -19
47 45
Source: Human Mortality Database
19 -19
51 49
19 -19
55 53
19 -19
59 57
19 -19
63 61
Scotland in Europe
19 -19
67 65
19 -19
71 69
19 -19
75 73
19 -19
79 77
19 -19
83 81
Male life expectancy: Scotland & other Western European Countries, 1851-2005
19 -19
87 85
19 -19
91 89
19 -19
95 93
19 -19
99 97
20 -20
03 01
-2
00
5

3. All cause death rates,
Men 0-64, 2001
(Leyland et al, 2007)

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

6. -70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70

7. -70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70

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

9. Understanding Glasgow:
the Glasgow Indicators project

11. Risk of death
- by level of hopelessness
4.5
4
3.5
3 Low
2.5 Moderate
2 High
1.5
1
0.5
0
All cause CVD Non CVD Cancer
Everson et al 1996

12. Issue-specific responses
The example of welfare reform

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

15. Fundamental causes
An example from ‘The three cities’

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)]

23. Holistic approach
The example of neighbourhood
regeneration

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