This month, SANE was invited to participate in a People’s Health Assembly. Organised by the People’s Health Movement Scotland, the main aim of this assembly was to build a stronger public health movement campaigning to overturn an ongoing paradox. This is one in which there is long-standing policy apparently committed to tackling poor health from both the Scottish Government, Glasgow City Council and the NHS in Glasgow, yet health inequalities in both Scotland and in the city remain stubbornly unaffected. Further, Glasgow suffers from excess mortality overall as compared with other similar cities in the UK.
One of the keynote speakers at the assembly, Kat Smith, Professor of Public Health Policy, highlighted some important areas of concern as to why the mismatch between policy rhetoric and reality occurs. A significant problem, she argued, was that policy paradigms become fixed and institutionalised. Medical evidence informs health policy quite well but evidence about the impact of the social, political and economic determinants of health struggle to be heard. More explicitly, three dominant policy paradigms in Scotland create barriers to the forms of systemic change that might be needed to really improve health and tackle health inequalities.
The first of these is that the commitment to a traditional model of economic growth is so entrenched into policy and practise that it is difficult to move to alternative models which focus on wellbeing. The second paradigm is the persistence of a medical model of health and an expectation the main responsibility for addressing health inequalities lies with the Health Department and the NHS. Lastly, using economic and social levers to improve health is extremely complex and the default position is to use more straightforward data to design health programmes. Added to these policy challenges is the power of certain vested interests for whom health is not a priority to push political decision making in a certain direction.
Glasgow is a living example of the way that certain policy paradigms when put into practice either limit progress on health or even make matters worse. Research by the Glasgow Centre for Population Health (GCPH) has shown how the health of the Glasgow population was made worse historically by an industrial strategy in the 1960s and 70s, which moved investment away from the city and stimulated the movement of skilled young workers into new towns, creating an imbalance in the population with older, sicker people left behind. More recently, there is accumulating evidence of the impact of austerity which has affected Glasgow disproportionally because of the numbers of people experiencing poverty and other forms of disadvantage. Death rates for both women and men in the most deprived areas show a clear up tick since 2010, whereas there has been an improvement in death rates for males in the least deprived areas. This has widened the inequality gap further. For women, the inequality gap has also widened but to a lesser extent.
SANE’s interests lie in the way that current political and economic systems (neoliberalism) limit the lives of so many people and the environment. As our understanding grows that good health for the entire population can only be realised when certain conditions are met, our concern is that current policy making in Glasgow is going to add to the health burden. Similar to the Scottish Government, Glasgow City Council is wedded to an economic model that is focussed on growth, albeit one that they claim is inclusive. This has led to a focus on bringing private finance, technology, retail and tourism into the city (we have covered this in more detail in a series of reports) which, at best, will allow the better off to flourish, leaving those in disadvantage further behind. Income inequality drives health inequality and our prediction is that politicians will still be wringing their hands in five years time about the state of Glasgow’s health.
As usual, we welcome your thoughts and views on the effects of current policies that are being implemented in Glasgow and their implications for health. It is also our hope that further collaboration with the Peoples Health Movement Scotland will examine this problem in more detail.
For more information about the People’s Health Assembly
Glasgow Centre for Population Health reports