Tackling health inequalities: what does the data tell us and how can it help?

Health inequalities in Scotland are significant. Every year we hear about how Scotland has some of the biggest gaps in the health and wellbeing of the poorest and richest in society. In some cases, Scotland has the largest gaps in equality in the whole of Europe. And in many instances, they are rising. Scotland also has the lowest life expectancy of all UK countries.

A number of studies and research projects have been commissioned to try to identify the key indicators and factors that are creating and reinforcing these inequalities, and what sorts of interventions would work best to try and reduce or eradicate them altogether. It is hoped that by conducting research, and compiling data, policymakers can use this to identify groups and geographic areas where health inequalities are significant, and to intervene to reduce them, with data to help back up and evaluate the effectiveness of these interventions. In Scotland, work is being done by a number of organisations including the Scottish Government, Glasgow Centre for Population Health (GCPH) and Public Health Innovation Network Scotland (PHINS).

What indicators and factors are being measured?

Income inequality has a related impact on health inequalities, and the scale of low pay is significant. The relationship between health inequalities, poverty and household income is one which has been explored at length and is often highlighted as one of the main factors which influences health inequalities. Studies which look at income, and also at relative levels of deprivation can provide useful comparison points, with comparable datasets on employment status and income readily available at a national and local level. Data also considers trends over time, comparing pre- and post-economic crash data, as well as relative earnings and expenditure relative to inflation and the rising cost of living. Other factors include age (those under 25 and earning a lower minimum wage for example) and by gender, with more women in lower paid, lower skilled and part time or insecure work.

How usable is the research being created?

The research which examines health inequalities explores a whole range of interrelated factors, and highlights just how complex the landscape of inequalities is. Creating a clear and holistic picture of all of the factors which contribute to health inequalities is not easy. Many studies, while detailed and effective, are niche, and focus on a very limited number of factors across a limited demographic source. As a result, questions have been raised about the utility of this research and its applicability and scalability at a national level. In an attempt to tackle this, combined data sets are being produced which provide opportunities for comparison across data from a range of studies.

The “Triple I” tool from NHS Health Scotland is designed to help policy designers to create effective interventions to reduce health inequalities. A second edition of the tool is due to be released in 2018/19. Triple I aims to provide national and local decision makers with practical tools and interpreted research findings about investing in interventions to reduce health inequalities in Scotland. It does this by modelling the potential impact of different interventions and policies on overall population health and health inequalities.

 

What can be done to act on the data?

While the research being produced is high quality, and thorough in relation to findings, the real question is what can actually be done with the research, and what steps can policymakers and practitioners take to use the findings to inform their own practice.

There are, researchers suggest, significant opportunities presented by the recent research which has been done on income inequality. In particular, they cite the public sector and public sector pay as a key way to reduce the income, and therefore the inequality gap, particularly among higher earners and those who would be considered “working poor” or “just about managing”. In Scotland, significantly more people are employed in the public sector than in any other part of the UK, and there is, researchers suggest, an opportunity to better align and increase low wages to help to reduce the gap.

The adoption of new initiatives, such as the “housing first model”, which is due to be rolled out in Glasgow to help homeless people break the cycle of homelessness, are also opportunities not only to address inequalities, but to ensure that long term help and support is in place to prevent any relapse into chaotic or risky behaviour. In relation to housing first, the savings on front line services such as emergency admissions to hospital, or contact with the police after committing a crime are significant, and while more in depth research is needed to create a full cost benefit analysis model of the scheme and its effectiveness, early studies show that the impact on health and wellbeing on those who had previously been homeless is huge in terms of reducing inequalities and improving wellbeing. However further data on homelessness in Scotland shows how far we have to go, and that housing first is only one mechanism which can be used to begin this process of reducing inequalities among the most and least deprived communities in Scotland.

Alternatively, some have suggested a more radical overhaul of how we distribute welfare and wealth within the country. Research has been coming thick and fast on the subject of a “citizens basic income”, particularly following the trial which was rolled out in Finland (the findings of which have not yet been published). Research on how this could impact on inequalities is not widespread yet, as pilots have been small scale, However, it is suggested that a total overhaul of welfare, replacing it instead with a citizen’s basic income would be a more effective way to reduce inequalities across the board, including in health.

Summing up

Health inequalities are significant in Scotland. Much of the research focuses on the impact of deprivation, poverty and low income on health inequalities and how, in order to tackle health inequalities in Scotland we must also tackle some of the other significant social problems within our communities, including low income and insecure work, and the impact of homelessness or chaotic lifestyles on health.

Data can be used in a number of ways to help inform policy decisions, some more radical than others. But creating a complete understanding of inequality in Scotland is challenging. It is up to researchers and policymakers to work together to create a better understanding of the conditions and factors which contribute to inequality, and what can be done to help tackle systemic and entrenched inequalities in our communities through policy levers and evidence based policy making.

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SURF conference 2017 – What Scotland has learned from 25 years of regeneration

Mural of a taxi being elevated by ballons, Glasgow

Fantastical floating taxi mural, part of Glasgow’s City Centre Mural Trail

By Steven McGinty

If regeneration has been so successful, why are there still so many pilots?

This was just one of the many thought-provoking points raised at the Scottish Urban Regeneration Forum’s (SURF) 25th Anniversary Conference, where the very activity of regeneration was put under the microscope.

In a packed room of delegates, the day opened with two opposing views.

  • The first argued that although regeneration had undoubtedly had its failures, there had been a number of important successes, which had resulted in better places and opportunities for both communities and individuals.
  • The second – and more pessimistic perspective – was that regeneration policy had entirely failed, and that the areas experiencing poverty and deprivation had barely changed over the past 25 years (particularly in Glasgow, where much of the regeneration activity has been focused).

This provided a useful lens through which to view regeneration, as we moved onto a day of workshops and debates on 25 years of regeneration policy, starting from New Life for Urban Scotland all the way up to City Region Deals.

Below I’ve outlined some of the most interesting points to come from these sessions.

Universal income

There was broad agreement that regeneration was about more than building homes, and that one of its core purposes was to tackle inequality.

Universal Basic Income is a policy in which everyone in society is given a sum of money, without any conditions. This policy – likely to be popular – was proposed by a delegate, highlighting its potential for addressing increasing levels of income inequality. A pilot study is already underway in Finland, with participants reporting lower stress levels and greater incentive to work. The Scottish Government has also recently committed to funding local experiments in Fife, Glasgow and North Ayrshire Councils.

Communities need assets

In many of the debates, it was felt that community ownership of buildings and land was key to ensuring a fairer distribution of society’s wealth. Other benefits of community ownership include protecting key local services/facilities (which may have otherwise been lost) and offering better stewardship, as the community have a greater understanding of local needs.

Research has also shown that local communities – who have replaced private landlords – have outperformed the landlords they have replaced. In the past two decades, the value of their land has increased by almost 250%.

Distinctiveness of place

Delegates highlighted that local areas often need local solutions.  For instance, a representative from the Bute Island Alliance noted that addressing their declining population was key to their regeneration goals.

Community consultation

There was a strong feeling that communities had to be consulted. A representative from a local charity explained that “if you are working for a community, then it must include the community”. Others, suggested that some communities would not have the capacity to make decisions on regeneration projects. Yet, this was quickly deemed patronising, with many noting the series of failures by public officials.

Charrettes were seen as an ideal tool for consulting with communities. The Scottish Government define a charrette as:

an interactive design process, in which the public and stakeholders work directly with a specialised design team to generate a community vision, masterplan and action plan.”

The representative from the Bute Island Alliance highlighted that this process had been very helpful in the development of their regeneration plans.

Bringing communities together

It was widely acknowledged that communities are becoming more diverse, and that it’s important to include all members of society. One delegate recounted her experience of Social Inclusion Partnerships (SIPs) – an initiative which aimed to reduce social exclusion – explaining that this model was very successful at engaging with black and minority ethnic (BME) groups. We’ve also seen the Scottish Government recognise the need to encourage young people to get involved in local planning decisions.

Building an inclusive economy

Regeneration has always found it difficult to respond to wider political, economic, social and technological factors. Over decades, deindustrialisation and the change to a more knowledge-based economy has caused significant challenges for communities. For regeneration policy to be successful, it was suggested that people would need to be equipped with the skills to take part in future industries; otherwise we may see inequalities widen. Cities such as Dublin have seen rents increased dramatically due to the inward migration of highly-skilled technology workers, putting pressure on household budgets and showing the challenge for regeneration.

Final thoughts

In the past 25 years there has been an important shift in regeneration, moving from house building programmes to a more holistic approach, which includes policy areas such as health, employment, and the environment. However, the most recent Scottish Government regeneration strategy was published in 2011. It might therefore be time to revisit this strategy and provide a new vision for regeneration, taking recent learning and the changing environment into account. Maybe then, in the next 25 years, there will be no doubt over the successes of regeneration.


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