Social circumstances and healthSocial circumstances and health

Insanity as defined by EinsteinInsanity as defined by Einstein

““Doing the same thing all Doing the same thing all the time and expecting the time and expecting different resultsdifferent results””

Income deprivation - GlasgowIncome deprivation - GlasgowGlasgow merged DZs: income deprivation distribution

Source: GCPH, based on SIMD/DWP data

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Total city: 24.8%

Income deprivation - LiverpoolIncome deprivation - LiverpoolLiverpool LSOAs: income deprivation distribution

Source: DWP

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Total city: 24.6%

SMRs by cause, all ages: SMRs by cause, all ages: Glasgow relative to Liverpool & ManchesterGlasgow relative to Liverpool & Manchester

All ages, both sexes: cause-specific standardised mortality ratios 2003-07, Glasgow relative to Liverpool & Manchester, standardised by age, sex and deprivation decile

Calculated from various sources

112.2 111.9126.7

248.5

131.7

168.0

229.5

0

50

100

150

200

250

300

350

All cancers(malignantneoplasms)

Circulatory system Lung cancer External causes Suicide (inc.undetermined intent)

Alcohol Drugs-relatedpoisonings

Sta

ndar

dise

d m

orta

lity

ratio

Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010

Aaron Antonovsky 1923-1994Aaron Antonovsky 1923-1994

““.....expresses the extent to which one has a .....expresses the extent to which one has a feeling of confidence that the stimuli deriving feeling of confidence that the stimuli deriving from one's internal and external environments from one's internal and external environments in the course of living are in the course of living are structured, structured, predictable and explicablepredictable and explicable, that one has the , that one has the internal resources internal resources to meet the demands posed to meet the demands posed by these stimuli and, finally, that these by these stimuli and, finally, that these demands are seen as demands are seen as challengeschallenges, worthy of , worthy of investment and engagementinvestment and engagement ."."

Sense of coherence....Sense of coherence....

For the creation of health....For the creation of health....

....the social and physical environment must ....the social and physical environment must be:be:

ComprehensibleComprehensible ManageableManageable MeaningfulMeaningful ......or the individual would experience ......or the individual would experience

chronic stresschronic stress

Salutogenesis….Salutogenesis….

Highlights factors which create and Highlights factors which create and support human health rather than support human health rather than those which cause diseasethose which cause disease

It focuses on resources and It focuses on resources and capacities which impact positively capacities which impact positively on health and aims to explain why, in on health and aims to explain why, in adverse circumstances, some stay adverse circumstances, some stay healthy and others don’t.healthy and others don’t.

00-046

-1.2

-1

-0.8

-0.6

-0.4

-0.2

0 10 20 30 40 50

Months of Orphanage Rearing

*linear trendline

Evening Cortisol Levels Increase withMonths of Orphanage Rearing *

The Founders’ Network

Copyright restrictions may apply.

Walsh, D. et al. Eur J Public Health 2010 20:58-64; doi:10.1093/eurpub/ckp063

Male life expectancy at birth West Central Scotland and 10 post-industrial regions

Health Deficits approach We focus on problems, needs and deficiencies in

a community We talk of “ deprivation”, illness and health damaging behaviours. We design services to fill the gaps and fix the problems. We talk of “clients.” As a result, communities can feel disempowered. People become passive recipients of services rather than active agents in their own lives. We do things to people rather than with them.

Health Assets

A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain their health and sustain wellbeing. These assets operate as protective and promoting factors to buffer against life’s stresses

Morgan and Ziglio 2009

The Assets ApproachThe Assets Approach

Begins by building a trusting relationship – Begins by building a trusting relationship – regardless of how long it might take regardless of how long it might take

Helps individuals rediscover the skills and Helps individuals rediscover the skills and strengths they may have forgotten they havestrengths they may have forgotten they have

Supports them in putting them into practiceSupports them in putting them into practice Builds networks and trusting communities in Builds networks and trusting communities in

which people help otherswhich people help others

Beacon and Old Hill Estate (Falmouth)

Between 1996 and 2004….– Crime down by 50%– Post natal depression down by 70%– Unemployment down by 70%– Child protection registrations down 65%– Teenage pregnancies down from 14%

to<1%

Beacon Hill – the processBeacon Hill – the process ““The most significant aspect of the regeneration The most significant aspect of the regeneration

process on the Beacon and Old Hill estate was process on the Beacon and Old Hill estate was that, from the outset, there was that, from the outset, there was no initial funding, no initial funding, no hierarchy, no targets, no business plan, only a no hierarchy, no targets, no business plan, only a shared vision of what the community wanted to shared vision of what the community wanted to bebe, rather than an obsession with what it had to , rather than an obsession with what it had to do. Thus, the regeneration process was not a do. Thus, the regeneration process was not a result of a predetermined plan.”result of a predetermined plan.”

Beacon Hill – the processBeacon Hill – the process

““Rather, the process Rather, the process emergedemerged as a as a consequence of the interactions between the consequence of the interactions between the members of the community, and between the members of the community, and between the community and its environment, namely the community and its environment, namely the statutory agencies, the police, the council, and statutory agencies, the police, the council, and so forth. As the community evolved, so also so forth. As the community evolved, so also the agencies and professional bodies co-the agencies and professional bodies co-evolved with the community.”evolved with the community.”

When people care enough to act When people care enough to act

Institutions have reached the limit of their Institutions have reached the limit of their problem solving potential. They are problem solving potential. They are stretched thin and need more skilful stretched thin and need more skilful engagement with communitiesengagement with communities

They are servants. Ask what people need, They are servants. Ask what people need, offer help, step back, create opportunity for offer help, step back, create opportunity for actionaction

http://www.mike-green.org

When people care enough to actWhen people care enough to act

There are unrecognised capacities in every There are unrecognised capacities in every community. Find them and provide community. Find them and provide opportunities for people to offer themopportunities for people to offer them

Relationships build a community. See Relationships build a community. See them, build them and utilise themthem, build them and utilise them

Citizens are at the centre. Engage them as Citizens are at the centre. Engage them as actors, not recipientsactors, not recipients

http://www.mike-green.org

When people care enough to actWhen people care enough to act

Leaders involve others as active membersLeaders involve others as active members People care about something. Find out what People care about something. Find out what

motivates individualsmotivates individuals A listening conversation is the way to A listening conversation is the way to

discover what motivates peoplediscover what motivates people Asking questions rather than giving answers Asking questions rather than giving answers

invites stronger participationinvites stronger participation

http://www.mike-green.org

Jimmy Reid 1971Jimmy Reid 1971

Jimmy Reid and alienationJimmy Reid and alienation ““Let me right at the outset define what I mean by Let me right at the outset define what I mean by

alienation. It is the cry of men who feel themselves alienation. It is the cry of men who feel themselves the victims of blind economic forces beyond their the victims of blind economic forces beyond their control. It's the frustration of ordinary people control. It's the frustration of ordinary people excluded from the processes of decision making. The excluded from the processes of decision making. The feeling of despair and hopelessness that pervades feeling of despair and hopelessness that pervades people who feel with justification that they have no people who feel with justification that they have no real say in shaping or determining their own real say in shaping or determining their own destinies....”destinies....”

Fair society, healthy livesFair society, healthy lives

1. Giving every child the best start in life2. Enabling all children, young people and adults to maximize their capabilities and have control over their lives3. Creating fair employment and good work for all4. Ensuring a healthy standard of living for all5. Creating and developing sustainable places and communities6. Strengthening the role and impact of ill-health prevention.

Giving every child the best start in lifeGiving every child the best start in life

Improve infant mortalityImprove infant mortality Improve social and intellectual Improve social and intellectual

development before arriving in development before arriving in Primary 1Primary 1

Support learning and physical and Support learning and physical and social development during schoolsocial development during school

Provide opportunity to encourage Provide opportunity to encourage aspiration on leaving schoolaspiration on leaving school

Infant mortality rates – Infant mortality rates – Scandinavia and ScotlandScandinavia and Scotland

A step change in infant mortality?A step change in infant mortality?

Early involvement in antenatal careEarly involvement in antenatal care No smoking during pregnancyNo smoking during pregnancy No alcohol during pregnancyNo alcohol during pregnancy Parenting support before and after birthParenting support before and after birth !00% breastfeeding!00% breastfeeding Continued support until age of 1+Continued support until age of 1+ Universal serviceUniversal service

Making assets workMaking assets work

Listen, build trust. Show people their Listen, build trust. Show people their views matterviews matter

Build a common vision based on Build a common vision based on individuals’ aspirations and abilitiesindividuals’ aspirations and abilities

Create the conditions which support actionCreate the conditions which support action See citizens as the actors in this process, See citizens as the actors in this process,

not passive recipientsnot passive recipients

Theory of Moral SentimentsTheory of Moral Sentiments

““How selfish soever a man may be How selfish soever a man may be supposed, there are evidently some supposed, there are evidently some principles in his nature which principles in his nature which interest him in the fortunes of others interest him in the fortunes of others and render their happiness and render their happiness necessary to him, though he derives necessary to him, though he derives nothing from it except the pleasure nothing from it except the pleasure of seeing it.”of seeing it.”

Adam Smith