Tag Archives: mortality

Public health in Scotland … problems and solutions

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scotpho logoBy Stacey Dingwall

On Friday 11 September 2015 I attended the annual seminar of the Public Health Information Network for Scotland (PHINS) at Glasgow Royal Concert Hall. Now in its 16th year, the event provides an opportunity to keep up to date with the latest developments in public health related issues and research at both the local and national level.

This year’s sessions were focused around two themes: health inequalities in Scotland, and active travel.

Health inequalities in Scotland: causes and interventions

The first speaker of the day was David Walsh of the Glasgow Centre for Population Health (GCPH). David outlined the findings of research he’s been involved in, looking at explanations for excess mortality in Scotland compared to the rest of the UK and Europe, and in Glasgow particularly. Currently, there are still 5,000 ‘extra’ deaths in Scotland than in England each year, i.e. excess mortality.

The session particularly focused on the findings of the 2013 study, Exploring potential reasons for Glasgow’s ‘excess’ mortality: results of a three-city survey of Glasgow, Liverpool and Manchester. These three cities are home to the highest levels of deprivation in the UK and consequently, the lowest life expectancies, with Glasgow being the worst of the three. David explained that over 40 potential causes for this were synthesised as part of the research, with the following identified as among the most plausible explanations:

  • The scale of urban change post World War 2 had a larger impact on Glasgow, in the form of slum clearances, the construction of poorer housing and large amounts of high rise flats, and limited investment in maintenance of this housing.
  • The ‘socially selective’ new towns programme created social divisions, with only the wealthier and higher-skilled able to move there.
  • Different responses at the local political level – Manchester and especially Liverpool vehemently resisted the Conservative policies of the time, however this was not the case in Glasgow.

The morning also saw a presentation from Jim McCormick from the Joseph Rowntree Foundation (JRF) on rising poverty levels in Scotland and the UK since the recession. Jim suggested that the increasing casual nature of work now seen in the UK is what is driving the rise of poverty. He highlighted the hourglass shaped economy we now have, due to the disappearance of mid-level semi-skilled jobs alongside a rise in higher- and lower-skilled jobs.

An analysis of whether a National Living Wage would bring different groups up to the JRF’s annual Minimum Income Standard by 2020 was also presented; according to their findings, the only group that will be close to it is single people without children.

Physical activity and active travel in Scotland and the UK

The first session after the break saw another presentation from GCPH – this time from Bruce Whyte on trends and challenges in active travel in Scotland (i.e. walking and cycling).

It was highlighted that travelling by car remains the most popular mode for people to travel to work, despite the fact that most of the journeys undertaken are short (i.e. less than two miles long). Bruce highlighted successful initiatives in this area in Glasgow, however, including the cycle hire scheme and the development of the Kelvingrove-Anderston cycling and walking route, on which GCPH published a report earlier this year. His presentation included comment from those who use the route on its health and safety benefits, and it was suggested that its success has led to impetus for similar projects in the city.

The following presentation came from Niamh Shortt of the Centre for Research on Environment, Society and Health (CRESH) at the University of Edinburgh. She looked at the findings from research into whether the physical environment has an impact on inequalities in physical activity and active travel. Tying in with the first theme of the day, this session noted the impact of health and income inequalities on physical activity rates and travel mode choices.

The morning was rounded off by Stuart Hay of Living Streets Scotland, a charity working to promote the benefits of walking and ensure that the country’s streets are fit to do so. Stuart praised the work of the Scottish Government in this area, highlighting the development of a separate walking strategy for the country. He concluded that we have the policy infrastructure in place, and it’s now time to ensure it is implemented.

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Read our other recent articles on public health issues:

The Idox Information Service can give you access to a wealth of further information on health inequalities and active travel, to find out more on how to become a member, contact us.

Fighting the cold: working to reduce excess winter deaths

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Image from Flickr user FranTaylor under Creative Commons License

Image from Flickr user FranTaylor under Creative Commons License

We may have all breathed a sigh of relief when last week’s cold snap finally eased, but for those working in public health the consequences of the cold weather are still playing out.

Cold weather poses a significant risk to health. There is a notable rise in deaths, and also illnesses and injuries, during the winter period. Indeed, in England and Wales there were 11.6% (18,200) more deaths in 2013/14 during the winter period (December to March) compared with the non-winter period (known as “excess winter deaths”).

Older people, particularly those aged over 75 years old, are most vulnerable to cold weather-related illness. The majority of excess winter deaths occur within this age group and those living on their own or who are socially isolated are most at risk. Other groups at risk include those experiencing chronic or severe illnesses, particularly heart conditions or circulatory disease, children under the age of five, and homeless people /street sleepers.

The reasons why cold weather has such a negative impact on health are complex and interlinked with fuel poverty, poor housing and health inequalities. There can be an increase in circulating infectious diseases, particularly flu and norovirus, and snow and ice can cause falls. Cold weather has also been linked to increased cases of hypothermia, carbon monoxide poisoning (from faulty heating appliances), and mental health problems such as depression and anxiety.

However, there is evidence to suggest that many of these ill effects are preventable. In some northern European countries, such as Finland, the rate of winter deaths is far lower than that in England, despite experiencing much lower temperatures.

To help address this, the Government has published an annual ‘Cold Weather Plan’ (CWP) since 2011 aimed at local authorities, health and social care staff and any professionals working with vulnerable people. The plan operates a system of cold weather alerts, comprising five levels (Levels 0-4), from year-round planning for cold weather, through winter and severe cold weather action, to a major national emergency. Each alert level aims to trigger a series of appropriate actions, which are detailed in the plan. The latest CWP was published in October 2014.

It stresses the importance of year round planning and all-winter action for reducing excess winter deaths and relieving the additional pressures on the NHS and social care which occur during the winter months. Recommended all-year actions include:

  • addressing fuel poverty
  • improving housing and energy efficiency measures
  • raising awareness of preventative actions among staff.

All-winter actions (November to March) include:

  • communicating with the public about what they can do to reduce the risk of cold weather to their health
  • identifying vulnerable clients
  • supporting vulnerable clients to seek appropriate help.

There are also key public health messages which should be communicated with residents/patients, relating to flu vaccinations, keeping homes adequately heated and ventilated, available financial support, and looking after vulnerable older neighbours and relatives.

A guide to communicating effectively with the public during periods of extreme weather was published recently by the Local Government Association (LGA). The LGA have also provided guidance for local authorities on how they can help to reduce the negative effect of cold weather on health. It highlights examples of innovative schemes, including the installation of free temperature sensors and a volunteer ‘winter squad’ to care for vulnerable residents.

Investing in cold weather planning is important – although the media focuses on travel disruption during cold weather, for many of the most vulnerable in our society it can be a death sentence.

Further reading

The Information Service has a number of resources on cold weather planning – a selection are listed below.

Cold weather plan for England 2014: making the case – why long-term strategic planning for cold weather is essential to health and wellbeing

A turn for the better (Liverpool’s Healthy Homes Programme), IN Property Journal, Jul/Aug 2014, pp42-44 (Ref No. A51407)

Staying in touch (social media), IN Local Government News, Vol 36 No 2 Mar/Apr 2014, pp44-45 (Ref No. A49753)

Behind cold doors: the chilling reality for children in poverty

Reducing harm from cold weather: local government’s new public health role

N.B. Abstracts and access to journal articles are only available to members.