Scottish Leaders Forum - Carol Tannahill - GCPH
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Transcript of Scottish Leaders Forum - Carol Tannahill - GCPH
Supporting resilient communities:The role of public service leaders
Carol TannahillDirector
Glasgow Centre for Population Health
Male life expectancy: Scotland & other Western European Countries, 1851-2005Source: Human Mortality Database
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1851
-185
3
1855
-185
7
1859
-186
1
1863
-186
5
1867
-186
9
1871
-187
3
1875
-187
7
1879
-188
1
1883
-188
5
1887
-188
9
1891
-189
3
1895
-189
7
1899
-190
1
1903
-190
5
1907
-190
9
1911
-191
3
1915
-191
7
1919
-192
1
1923
-192
5
1927
-192
9
1931
-193
3
1935
-193
7
1939
-194
1
1943
-194
5
1947
-194
9
1951
-195
3
1955
-195
7
1959
-196
1
1963
-196
5
1967
-196
9
1971
-197
3
1975
-197
7
1979
-198
1
1983
-198
5
1987
-198
9
1991
-199
3
1995
-199
7
1999
-200
1
2003
-200
5
Male life expectancy: Scotland & other Western European Countries, 1851-2005Source: Human Mortality Database
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1851
-185
3
1855
-185
7
1859
-186
1
1863
-186
5
1867
-186
9
1871
-187
3
1875
-187
7
1879
-188
1
1883
-188
5
1887
-188
9
1891
-189
3
1895
-189
7
1899
-190
1
1903
-190
5
1907
-190
9
1911
-191
3
1915
-191
7
1919
-192
1
1923
-192
5
1927
-192
9
1931
-193
3
1935
-193
7
1939
-194
1
1943
-194
5
1947
-194
9
1951
-195
3
1955
-195
7
1959
-196
1
1963
-196
5
1967
-196
9
1971
-197
3
1975
-197
7
1979
-198
1
1983
-198
5
1987
-198
9
1991
-199
3
1995
-199
7
1999
-200
1
2003
-200
5
Scotland in Europe
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
66
68
70
72
74
76
78
1991-1993 1992-1994 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003
Council
Lif
e E
xp
ec
tan
cy
at
bir
th
Scotland Glasgow City East Renfrewshire East Dunbartonshire
Gap between best and worst =
6.5 years
Gap between best and worst =
8.1 years
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)
72.2
76.2
65.364.8 64.4
69.4
71.2
73.373.9
60
65
70
75
80
85
1981-1985 1988-1992 1998-2002
Es
tim
ate
d li
fe e
xp
ec
tan
cy
at
bir
th
Males -Dep Quin 1 (least deprived)
Males - Dep Quin 5 (most deprived)
Scotland Males
-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 hopelessness
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
All cause CVD Non CVD Cancer
Low
Moderate
High
Everson et al 1996
Issue-specific responses
The 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 causes
An example from ‘The three cities’
All-cause SMRs, Glasgow relative to Liverpool &
ManchesterAge 0-64, all-cause SMRs 2003-07, Glasgow relative to Liverpool & Manchester
Standardised by age, sex and deprivation decileCalculated from various sources
60
70
80
90
100
110
120
130
140
150
160
Both sexes Males Females
Gender
Sta
ndar
dise
d m
orta
lity
ratio
Age 0-64, all-cause SMRs 2003-07, Glasgow relative to Liverpool & Manchester Standardised by age, sex and deprivation decile
Calculated from various sources
131.4
60
70
80
90
100
110
120
130
140
150
160
Both sexes Males Females
Gender
Sta
ndar
dise
d m
orta
lity
ratio
Age 0-64, all-cause SMRs 2003-07, Glasgow relative to Liverpool & Manchester Standardised by age, sex and deprivation decile
Calculated from various sources
131.4
135.6
124.4
60
70
80
90
100
110
120
130
140
150
160
Both sexes Males Females
Gender
Sta
ndar
dise
d m
orta
lity
ratio
‘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• Culture• Genetics• Greater ‘vulnerability’• Migration• Psychological outlook• Substance misuse
cultures• Vitamin D
• Social capital• Spatial patterning of
deprivation • Family/parenting• Gender• Political attack• Social mobility• Sectarianism• The weather…
Many hypotheses, but to cut to the
current page in the story
• Artefact• Culture• Genetics• Greater ‘vulnerability’ in
Glasgow • Migration• Psychological outlook• Substance misuse
cultures
• Social capital• Spatial patterning of
deprivation • Family/parenting• Gender• Political attack• Social mobility• Sectarianism• 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 months
30.5%
28.0%
5.7%
17.9%
15.6%
12.4%
13.9%
16.8%
3.3%
9.0%
7.7%8.2%
2.7%
18.1%
6.1%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Glas Liv Man Glas Liv Man Glas Liv Man Glas Liv Man Glas Liv Man
1 (Most) 2 3 4 5 (least)
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)]
Holistic approach
The 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
0%
20%
40%
60%
80%
100%
2 3
Wave
Pe
rce
nta
ge
'ag
ree
' or
'str
on
gly
ag
ree
'
Regen area(TRA/LRA)
Non-regen area(WSA/HIA/PE)
Overall
Respondent feels part of the community
0%
20%
40%
60%
80%
100%
2 3
Wave
Pe
rce
nta
ge
'a g
rea
t de
al'
or
'a fa
ir a
mo
un
t'
Regen area (TRA/LRA)
Non-regen area(WSA/HIA/PE)
Overall
Neighbourliness: borrows and exchanges favours with
neighbours
0%
20%
40%
60%
80%
100%
2 3
Wave
Pe
rce
nta
ge
'gre
at
de
al'
or
'fair
am
ou
nt'
Regen area(TRA/LRA)
Non-regen area(WSA/HIA/PE)
Overall
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