“Same storm, different boats”: addressing covid-19 inequalities and the ‘long term challenge’

MS Queen Elizabeth in Stornoway

The coronavirus pandemic has impacted upon almost every aspect of life.  However, this impact has not been felt by everyone equally. Some groups of people have been particularly badly affected – both by the virus itself and by the negative social and economic consequences of social distancing measures.  The phrase ‘same storm, different boats’ has been used widely to emphasise this.

The pandemic has exposed and deepened many of the deep-rooted inequalities in our society, including gender, ethnicity and income.  It has also shone a light on more recent inequalities too, such as the growth of precarious employment among sections of the population.

As we move out of lockdown, the long term consequences of the pandemic will continue to be felt unevenly across different sections of society, with those on the lowest incomes being most vulnerable.

As thoughts turn to recovery, there is a growing sense that now is the time to consider how we can create a more equitable society that benefits those most in need.

 

The long-term challenge

During a recent Poverty Alliance webinar, ‘Build Back Better: Poverty, Health and Covid-19: emerging lessons from Scotland’, Dr Gerry McCartney, Head of the Public Health Observatory at Public Health Scotland noted that the coronavirus pandemic was causing three concurrent public health crises:

  • the direct impact of the virus (through ill health and/or death);
  • the indirect impacts on health and social care services (e.g. reduced hospital admissions/referrals, delayed diagnoses); and
  • the long term unintended consequences of physical distancing measures

Dr McCartney’s recent research sets out the different groups at particular risk from covid-19 and outlines a number of ways in which the unintended consequences of physical distancing measures may negatively impact upon health via a complex set of pathways – including reduced physical activity, fear, anxiety, stress, boredom and loneliness, economic stresses related to reduced income and unemployment, the impact of the loss of education, as well as the risk of abuse and exploitation of children not in school, substance abuse, and domestic abuse and violence.

Dr McCartney has also been involved in a project that sought to quantify the direct impact of the pandemic in terms of years of life lost.  The results showed that, over 10 years, the impact of inequality on life expectancy is actually at least six times greater than the direct impact of the pandemic itself.

Dr McCartney referred to this as the “long-term challenge” and argues that in order to address these inequalities, it is crucial that society aims to ‘build back better’ following the pandemic.

Build Back Better

But what does this mean?  Put simply, Build back better argues that pandemic offers an unprecedented opportunity to refocus society on the principles of equity and sustainability.

A recent paper by the Wellbeing Economy Alliance (WEAll) sets out 10 key principles for ‘building back better’, covering a range of environmental, social and governance issues:

It highlights international examples of each of these principles in action, for example, speeding up the adoption of the doughnut economics framework in Amsterdam in response to the pandemic, and through the wellbeing principles implemented by the Wellbeing Economy Governments (WEGo) group, consisting of Iceland, New Zealand and Scotland (and recently joined Wales).

Indeed, in Scotland, the independent Advisory Group on Economic Recovery, established by the Scottish Government, have recently published their findings on how to support Scotland’s economy to recover from the pandemic.  It states that “establishing a robust, wellbeing economy matters more than ever”.

Unequal employment impact

One of the guiding principles set out by the Advisory Group on Economic Recovery is to “tackle inequality by mitigating the risks of unemployment, especially among groups hit hard by the crisis”.

Indeed, unemployment following the pandemic is unlikely to affect everyone equally – women, young people, BAME individuals and the low-paid are predicted to suffer the brunt.

In a subsequent Poverty Alliance webinar, ‘Addressing unemployment after Covid-19’, Tony Wilson from the Institute for Employment Studies (IES) highlights the scale of the problem.  He states that unemployment is rising faster than at any point in our lifetimes (barring a blip in 1947), and is likely to increase by 3 million as a result of the pandemic.

Again, the impact of this will be uneven.  Anna Ritchie Allan, director of Close the Gap, discusses the impact upon women in particular.  As well as being more likely to work in a sector that has been shut down, women are also more likely to have lost their job, had their hours cut, or been furloughed. As women are also usually the primary carers of their children, they have disproportionately affected by the closure of schools and home learning.

A recent report by Close the Gap highlights how the impending post-covid downturn is different than previous recessions, as the restrictions imposed to tackle the virus have impacted most heavily upon sectors that employ large numbers of female (e.g. hospitality, retail, care), as well as services that enable women’s participation in the labour market (e.g. nurseries, schools, and social care). Young and Black and minority ethnic (BME) women have been particularly affected.

For example, Kathleen Henehan, Research and Policy Analyst at the Resolution Foundation, considers how young people’s employment prospects have been affected by the pandemic. She notes that young people leaving education are likely to be worst affected.  However, again, inequalities exist – with those with lower levels of qualifications being particularly affected, and women and BME individuals within those groups affected most of all.

According to Anna Allan, policy to address unemployment as a result of the pandemic needs to be both gender-sensitive and intersectional – taking account of the fact that women are not one homogenous group, and ensuring that any job creation is not just providing more ‘jobs for the boys’.  For example, recent research by the Women’s Budget Group shows that investing in care would create 7 times as many jobs as the same investment in construction: 6.3 as many for women and 10% more for men.

Building forwards

In a third webinar, ‘Disability, rights and covid-19: learning for the future’, Dr Sally Witcher, CEO of Inclusion Scotland, suggests that as well as exposing and deepening existing inequalities, the coronavirus pandemic has created the scope for new inequalities to be created – ‘faultlines’ created by the differing impacts of the virus.

Dr Witcher questions the term ‘build back better’ – she asks whether indeed we should want to build back, when the old normal didn’t work for a large proportion of people, particularly those with disabilities. Dr Witcher also questions ‘who’ is doing the building, and whether the people designing this new future will have the knowledge and lived experience of what really needs to change.

Dr Witcher suggests that for any attempt to ‘build back better’ to be meaningful, it needs to reach out to the people that don’t currently have a voice – the people who have been most heavily affected by the virus.  Not only do these groups need to be involved, but they need to be leading the discussion about what a post-covid future looks like.

A post-covid future

Whilst the coronavirus pandemic has had a massive, devastating impact on people and economies around the world, it has created an opportunity to reflect on what is important to us as individuals and as a society.

There is strong public demand for change. According to a new YouGov poll, only 6% of the public want to return to the same type of economy as before the coronavirus pandemic.

Building back better recognises that addressing the causes of the deep-rooted and long-standing inequalities in our society is critical to a successful post-covid recovery.

There is also a need to protect and enhance public services, address issues of low-pay and insecure work, and prioritise wellbeing and the environment through a ‘green recovery’.

As Tressa Burke, of the Glasgow Disability Alliance, states:

History will recount how we all responded to the coronavirus outbreak.  We need to ensure that the story told demonstrates our commitment, as a society, to protecting everyone from harm, particularly those most at risk of the worst impacts of covid.”


For further discussion of the wellbeing economy, you may be interested in our blog post ‘How well is your economy? Moving beyond GDP as an indicator of success

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The three keys to successful home working

wfh

by Scott Faulds

Over the past few weeks, we have all had to make massive changes to the way we live our lives in order to protect ourselves and those around us from Coronavirus. From the closure of gyms to the socially distanced queues outside of supermarkets, it really is impossible to imagine a single aspect of our daily lives that has not been altered in some way. Until a viable treatment or vaccine is found, it appears that we will need to get used to this, “new normal”, with social distancing measures likely to be in place for the foreseeable future. As a result, many of us are now coming to terms with working from our homes for an indefinite period of time.

The sudden shift from working in an office to working from home has required many of us to quickly adapt and get to grips with new ways of working, such as conducting meetings virtually via Zoom. A survey conducted, during the first two weeks of the UK’s “lockdown” by the Institute for Employment Studies, has found that workers who are new to working from home are more likely to be experiencing poor mental health and 50% of those surveyed are now no-longer happy with their work-life balance. Additionally, the survey revealed that a majority of workers are concerned that they are no longer getting enough exercise and have reported a variety of new physical health issues, such as loss of sleep; back/neck pain; eye strain and headaches. 

The issues raised in the Institute for Employment Studies survey are concerning, especially when it is not clear when we will be able to return to our places of work. Therefore, it is vital that we consider what actions we can take to ensure that we are able to successfully work from home, without compromising our physical and mental health. 

1. Routine

Although working from home can be challenging there are some benefits, such as significantly shorter commutes to the office, which allows us to have a little bit longer in bed. Even though it may be tempting to get up at a different time each day and get straight to work, this irregularity in your normal day-to-day routine may be having a negative impact on your mental wellbeing. 

Research has shown that sticking to a daily routine can help to reduce stress and alleviate anxiety. Therefore, even though we may no longer have as long a commute to the office, ensuring that you are waking up and getting ready for work at a regular time each day, can help to put you in the right mindset to have a productive day. 

Although it might seem like a good idea to stay in your pyjamas all day, getting dressed for work (even putting on informal clothes) helps us to psychologically prepare to start our working day. Consequently, getting changed back into comfy clothes at the end of the workday can have the opposite effect and help us enter a more relaxed state of mind. The simple act of changing our clothes can help to create a mental separation between work and home, which is important when our physical environment remains the same.

2. Breaks

Ensuring you have a good routine is clearly important when working from home. However, being sedentary and staring at a computer screen all day can negatively impact your physical and mental health. Taking regular breaks, even just to make a cup of tea, can help to break up the monotony of the working day. Research has shown that frequent short breaks are more beneficial than less frequent ones, and can improve your overall productivity. In particular, it is important not to eat lunch at our desks, as research by the University of Surrey has found that food eaten whilst you are distracted does not fill you up and can lead to overeating.

Although our morning commutes may sometimes be annoying, they did at least ensure that we were leaving the house once a day. Breaking-up your working day by doing some exercise, such as going for a short walk or following an online exercise class, can help to improve your mood. Regular exercise has even been proven to boost the body’s immune system.

3. Boundaries

Undoubtedly, working from home does involve some degree of boundary blurring between our places of work and our homes. For many this has translated into working longer hours and feeling less rested and more anxious throughout the day. As previously discussed, the physical act of getting ready and commuting to work allows our brains to shift from “home” to “work” mode. Setting out clear boundaries regarding when, where and how we work is vital to maintaining our wellbeing and maximising our productivity.

For example, although it may be tempting to work from your bed or couch, these areas are predominantly associated with relaxation. Blurring the lines between work and home in these spaces may reduce your productivity when you are trying to work and prevent you from relaxing when work is over.

Additionally, working from your bed or couch may cause you physical health problems. If you have to sit in front of a computer for an extended period, the NHS advises that you should be sitting in a chair which supports your lower back, your feet should be on the floor and your screen should be at eye level.

Final thoughts

Working from home for an indefinite period of time may not be ideal, however, it is vital in order to stop the spread of the Coronavirus. During this period of uncertainty, it is important that we look after our physical and mental health and recognise the ways in which we can improve our “new normal”.

Although it may be tempting to work from the couch in our pyjamas, research has shown that in order to maintain our wellbeing, it is vital to retain a sense of division between our home and work lives. Therefore, we can protect our wellbeing and ensure we remain productive through following a regular routine, taking frequent breaks when required and ensuring there are clear boundaries in place between home and work.

If you require any advice regarding how to work from home, you can find useful resources at ParentClub.Scot and on the NHS website.


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Living life in full colour: exploring the relationship between colour, design, behaviour and emotion

Seeing red…. green with jealousy….. feeling blue. Associating colours with emotions is not new, but increasingly, psychologists are being asked to explore the relationship between colour, emotion and its impact in a number of different settings, including learning in classroom settings, the design of the built environment, including work spaces and travel hubs, and improving wellbeing as a result.

Colour is a powerful tool. It can be used to get attention, enhance clarity, establish a code, label and differentiate items, as well as to influence behaviour or learning outcomes. For example in schools we are often told to use blue or black ink. Red ink is supposed to be used by teachers to correct assignments, notebooks, and class work. This is a deliberate tool to draw our attention to the mistake we make, designed to help enhance our learning outcomes, in the sense that by drawing attention to the mistake we will remember not to repeat the points highlighted.

“Bad” and “good” colours

Studies have disagreed on how exactly our association between colour and emotions develops. Some have suggested it is an instinctive reaction, something primal which suggests to us that things that are red in colour are dangerous or negative, while blues and yellows signal happier less aggressive colours.

However, others have suggested that the connotations we associate with colour are learned, albeit from a very young age. We associate some colours as being “good” and others as “bad” and this impacts how we interact around them in spaces like classrooms and workspaces. The meaning of colours is culturally-specific and differs around the world in different societies and groups.

However, a third view is that colour theory is much more complex than simply yellow = happy and blue = sad. Colours can have several meanings, and can encourage an audience to feel or act in certain ways depending on when and how they are used, and in some instances depending on personal experiences which people link to specific colours. This is the reason why the literature on colour is so contested; in many instances it blurs the boundary between our instinctive associations of colours and those associations we create ourselves through experiences.

Image “Harvey_Nash_13″ by K2 Space is licensed under CC BY 2.0

How colours are impacting on the design of our spaces

Knowing how colour can affect behaviours is informative for designers and psychologists in a number of environments, including in schools, offices or hospitals. In a learning context, such as in a school using “engaging” hues (warm colours such as red, orange, and yellow) to prevent learners from getting bored, and passive hues (cold colours such as green and blue) to keep learners calm can help with learning, but getting this balance right is important.

A number of studies have looked at the impact of classroom design, including use of colour on the learning and behavioural outcomes of both neurodiverse, and neurotypical children, with many emphasising that overstimulation, particularly of young children through excessive use of bright colour can create a disruptive classroom environment and make it difficult to encourage concentration and staying on task. However, some colour in specific areas of the classroom is good to help with engagement and stimulation.

Similarly, colours have been used by architects and designers in their choice of building material or building design to help encourage feelings of calm or reflection. This is particularly the case in transport hubs like airports and in hospitals or care facilities. Using fresh and calming colours which relate strongly to nature is also a technique used by office designers to help create the feeling of open calm and fresh spaces to help improve working environments and improve productivity.

The design of the built environment and how “green” and “blue” features which incorporate natural materials (green spaces and water have a positive impact on mental and physical wellbeing) has been widely discussed by planners and architects. The evidence generally supports the view that the inclusion of green spaces, promotes health and wellbeing across the life course. This combination of colour and the integration of nature into spaces is being used increasingly in the design of buildings and  in master planning for large urban projects.

Final thoughts

Colour and emotion both play important roles in our capacity to learn and be productive. The association between colour and our emotions and actions is complex and a source of disagreement for some psychologists. Colour has been found to affect how people feel both psychologically and physically. Understanding how colour and emotion relate and how colour can be used to change environments to encourage particular feelings of calmness or concentration, particularly in schools and workplaces is something that will be further explored by designers.

Colour should be understood as part of a wider “toolkit” used by designers and architects to ensure that we are building better places that create environments which support and promote wellbeing, encourage positive emotions and create more effective spaces for us to work, learn and interact in.


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An ageing workforce and growing emotional demands call for more sustainable employment

People Turning in Gears - Synergy

As a result of the global demographic challenge of an ageing population and the increasing diversity of working life, there has been a growing focus on sustainable work over the life course which has also placed greater emphasis on the importance of the quality of work and working conditions. As more and more people are having to work longer before retirement, it is important that they are able to do so.

A recent Eurofound report examined working conditions and their implications for worker’s health. Its findings confirmed a clear link between working conditions and the health and well-being of workers, highlighting the need to make work more sustainable.

Working conditions, health and wellbeing

Eurofound’s report found that this relationship can be depicted in a model based on the European Working Conditions Survey (EWCS), showing that health outcomes are the result of two processes: health-impairing processes (exhaustion) and motivational processes (engagement).

Health-impairing processes are associated with exposure to adverse work demands which tend to increase exhaustion, while motivational processes are associated with access to work resources that support engagement.

Such demands can include:

  • physical risks
  • work intensity
  • work extensity (long working hours)
  • emotional demands
  • social demands

Such resources can include:

  • social resources
  • work resources
  • rewards

It is noted in the report that the demand and resources model partly explains how well-designed jobs – characterised by high rewards, high work and social resources and suitable levels of demands – translate into better health: “Whereas job demands are linked to higher levels of exhaustion (which, in turn, are related to poorer health), job resources are associated with higher levels of work engagement (which, in turn, are related to better health and well-being).”

It is therefore suggested that as job control, social resources and rewarding working experiences all have positive effects, employers should be encouraged to introduce initiatives that focus on motivational aspects of work.

As recently highlighted, the discipline of worker health has traditionally focused on worker exposures to various workplace hazards. However, this has more recently broadened to include the concept of worker well-being, which is seen as increasingly important. Not only is it important for the individual but it is an important determinant of productivity for enterprise and society as well. Indeed, the Eurofound report highlights this growing importance.

Emotional demands

While the report notes that physical hazards have a direct effect on worker’s health and wellbeing and are undoubtedly remain important, these have not increased, but emotional demands have. This, it is argued, underlines the growing importance of psychosocial risks. It argues:

“In the context of ageing societies and services-dominated economies, it becomes more pressing to address these risks as the incidence of exposure increases.”

Other research has also highlighted the significance of emotional demands at work in relation to health. One recent study in the Danish workforce, for example, found emotional demands at work predicted a higher risk of long term sickness absence.

With the growing need for long-term care in ageing societies, it is argued that these demands are likely to increase further and, therefore, require particular attention. Different groups of people also face varying demands and are considered in the report. In particular, gender differences are considered throughout – highlighted as significant in some areas

Gender

The report found that men tend to report better health and wellbeing, and fewer health problems and better sleep quality than women. Men were also found to report fewer days of sickness absence and fewer days of presenteeism.

This is consistent with other research findings that show ill-health is more prevalent in women. One study exploring the association between work-related stress in midlife and subsequent mortality, and whether sense of coherence (measured as meaningfulness, manageability and comprehensibility) modified the association, found that occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence – a result that was stronger in women than in men.

The Eurofound report findings show that as women often work in sectors like health or education, they are especially exposed to the psychosocial risks associated with these emotionally demanding jobs.

The report also notes that workers under 25 are most likely to face high demands while having the least access to work resources, and health sector employees in particular, face high emotional and social demands. It is therefore suggested that there should be investment in working conditions for particular risk groups, such as occupations requiring lower skills levels, reporting job insecurity, or witnessing workplace downsizing. Measures to promote high union density, good employment protection and gender equality which are likely to improve working conditions and contribute to workers’ health and wellbeing are also highlighted.

Way forward

The findings of the Eurofound report, and indeed other research, highlight the need to look beyond the ‘traditional’, narrower framework of occupational health and safety to include the psychosocial risks such as emotional demands, along with motivational aspects of work. This calls for a reduction in health-impairing conditions and a fostering of health-promoting ones.

Of course, the world of work will continue to change, particularly in an increasingly digital world. However, striking the right balance between demands and resources through coordination between different policy fields could contribute to a higher quality of working life that is sustainable, regardless of the ever changing environment.


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How well is your economy? Moving beyond GDP as an indicator of success

by Scott Faulds

Since the early 20th century, the predominant method of evaluating the success of a country has been through the metric of Gross Domestic Production (GDP). This measurement is based upon the assumption that economic growth is the key indicator of a successful country.

In recent years, this assumption has been challenged, with politicians and economists, arguing that the focus on GDP has led to the development of policy which values economic growth at the expense of the wellbeing of society.

Following the 2018 OECD World Forum, Scotland, Iceland and New Zealand, have formed a group known as the Wellbeing Economy Governments, to share best practice of how to build an economic strategy that will foster societal wellbeing.  Additionally, organisations such as the OECD, European Commission and United Nations, are all conducting research into the development of policy beyond GDP. Therefore, it is clear that the previously held consensus surrounding the use of GDP has begun to break down, with countries across the world searching for different ways to evaluate the success of policy.

We must forge ahead with progressive economic policies that defy common stereotypes about costs and benefits and keep on promoting gender equality as part of a forward-looking social justice agenda

Katrín Jakobsdóttir
Prime Minister of Iceland

 

What’s wrong with GDP?

According to the International Monetary Fund (IMF), GDP is the measurement of the monetary value of all final goods and services produced within a country during a given period. However, it should be noted that this measure excludes unpaid work and the economic activity of the black market. Simon Kutzents, the modern-day creator of GDP, argued that whilst GDP was effective as a measure of productivity, it should have never been used as an indicator of the welfare of a nation.

Critics of GDP contend that the measure is overly simplistic, due to its interpretation of a successful country as one which is experiencing economic growth, arguing that some countries with growing economies have many social problems. For example, in China GDP grew by 6.6% last year whilst levels of inequality rose faster than in other countries, and society faces a great deal of political oppression. Therefore, it can be said that GDP does not provide a true picture of the success of a country, as it fails to consider societal problems, such as inequality and political freedom.  

The wellbeing approach

As a result of growing criticism of the use of GDP, several countries have started to look at alternative approaches of measuring success which considers factors beyond economic growth. This has led to international interest around the concept of wellbeing, a desire to create policy to improve the wellness of society.

This can manifest in a variety of different forms, from Scotland’s National Performance Framework to New Zealand’s Wellbeing Budget –  both policies designed to help improve the health of society rather than solely increasing economic growth.

However, this should not be interpreted as a movement away from encouraging businesses to grow; rather the Wellbeing Economy Governments believe that by improving the wellbeing of society they will indirectly stimulate sustainable economic growth.

“We need to address the societal well-being of our nation, not just the economic well-being

Jacinda Ardern
Prime Minister of New Zealand

As a result of creating a budget justified by improvements in societal wellbeing, New Zealand has invested record levels of funding into supporting the mental wellbeing of all citizens, with a special focus on under 24s. Additionally, the budget prioritises measures to reduce child poverty, reduce inequality for Māori and Pacific Islanders and enable a just transition to a sustainable and low-emissions economy. New Zealand believes that by tackling these inequalities, economic growth can be stimulated in ways that benefit all New Zealanders, where improvements in mental health alone could lead to an increase in GDP of 5%.

Therefore, whilst GDP isn’t the main priority of policy making under the wellbeing approach, it is possible for economic growth to occur as a result of implementing policy designed to improve the wellbeing of society. After all, according to the World Health Organisation, a healthier and happier society is a more productive society.

How well is well?

It is evident that the use of GDP as a measure of a country’s success has faced a great deal of criticism in recent years. However, some economists are not ready to give up on GDP quite yet. They argue that whilst GDP is not a perfect representation of a country’s success, neither is the wellbeing approach as it can be incredibly difficult to quantify societal wellness.

For example, if we compare one citizen who is in poor health and lives in an area experiencing low-levels of crime with another citizen who is healthy and lives in an area with high-levels of crime, how can we quantify which citizen has the better level of wellbeing?

In short, critics of the wellbeing approach argue that whilst it is vital that society’s wellbeing is considered during the policy-making process, basing policy solely around wellbeing is ineffective and would be incredibly difficult to measure, due to the personal nature of what constitutes wellbeing.

“Growth in GDP should not be pursued at any or all cost … the objective of economic policy should be collective well-being: how happy and healthy a population is, not just how wealthy a population is.”

Nicola Sturgeon
First Minister of Scotland

Final Thoughts

In summary, whilst there is a great deal of international interest in the possibility of a movement away from GDP, no consensus has yet formed as to whether the wellbeing approach is the way forward. With all new forms of policy, other countries often wait to see if early adopters succeed before following their lead. Perhaps it will be left up to smaller countries to prove that an economic policy focused on wellbeing can be successful.

Until then expect to see a great deal of interest in New Zealand’s implementation of the Wellbeing Budget and the results of the second meeting of the Wellbeing Economy Governments in Iceland this autumn.


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Good enough is not enough: International Making Place Conference

International Making Place Conference, Glasgow. Image: Jason Kimmings

There is now a growing body of evidence to indicate that our physical environment – the places where we live, work and socialise – affects our health and wellbeing and contributes to creating or reducing inequalities. But even without the research, it’s plain to see how a neighbourhood with lots of facilities for pedestrians and cyclists, a choice of shops and good public transport connections could benefit health in ways that one with an excess of pubs, fast food shops and car traffic would not.

The importance of place-based approaches to improving health and reducing inequalities was the theme of an international conference held in Glasgow last week.

The venue for the conference – Glasgow’s Old Fruitmarket building – is a shining example of how a great place can be repurposed and reinvented. Originally a wholesale fruit market, the building has been reborn as a unique setting for cultural and business events, but has retained many of its original features, including a lofty vaulted roof and a cast iron balcony.

David Crichton, Chair NHS Scotland
Image: Jason Kimmings

Facing up to the challenge of place

In his introduction, David Crichton, Chair of NHS Scotland, pointed to the sobering statistics that throw the importance of place into sharp focus. He noted that while the health of Scotland’s population was generally improving, people living in 10% of the country’s poorest areas are four times more likely to die prematurely than those in more prosperous places. The city of Glasgow knows all too well about these stark health inequities. A person living in the deprived area of Calton has an average life expectancy of 54 years, while someone growing up in affluent Lenzie, just 12km away can expect to live to 82.

Glasgow Lord Provost Eva Bolander
Image: Jason Kimmings

Glasgow’s Lord Provost, Eva Bolander, acknowledged the challenges facing the city, but also noted that Glasgow is at the vanguard of place making. The city council’s Avenues Project aims to transform 17 key streets, prioritising space for cyclists and pedestrians, introducing sustainable green infrastructure and improving public transport connections. Glasgow is also investing £20m in its Community Hubs programme to bring multiple support services together in areas experiencing high levels of poverty.

Aileen Campbell, the Scottish Government’s Cabinet Secretary for Communities and Local Government, highlighted projects such as Clyde Gateway in Glasgow and the Bellsbank Initiative in East Ayrshire as successful examples of placemaking. Their success, said the minister, lies in focusing on what’s important to the people and communities of these areas, with the support of government and local authorities.

This international conference also heard from Monika Kosinska from the World Health Organisation, who noted that the problems facing Scotland are not unique. Around the world, countries and communities are experiencing the challenges associated with ageing populations and health inequalities. In this sense, she observed, all countries are developing countries.

Sir Harry Burns
Image: Jason Kimmings

A sense of coherence

The World Health Organisation’s assertion that health is a complete state of wellbeing, not merely the absence of disease, was at the heart of a powerful presentation delivered by Sir Harry Burns, Director of Global Public Health at the University of Strathclyde.

His research has underlined that poverty is not the result of bad choices. The real problem is that, without a sense of coherence and purpose, people are not in a position to make good choices.

As Sir Harry explained, a child experiencing chaotic early years (featuring parental substance abuse and/or domestic violence) is already on a path to mental health problems which can culminate in a loss of control and long periods of worklessness and poverty. But the implications can be even more serious: “The more adverse experiences you have as a child, the more likely you are to have a heart attack.”

A eureka moment for Sir Harry Burns occurred when he read a book by an American sociologist. Aaron Antonovsky spent the latter half of his career in Israel studying adults who as children had been in concentration camps. He found that the children who survived had developed what he termed a “sense of coherence” – a feeling of confidence that one has the internal resources to meet the challenges of life, and that these challenges are worth engaging with.

That sense of coherence, Sir Harry believes, lies in giving people in poverty greater control over their own resources: “People who have a sense of purpose, control and self esteem are more positive and secure about the places they live in, and a greater ability to make the right choices.”

He concluded that rather than being passive recipients of services, all of us have to be given the opportunity to become active agents in our own lives: “‘Ask people to take control of their lives, build their trust, and people can make choices that support their health. We must create places that do that’.

Woodside Health Centre
Image: Jason Kimmings

Placemaking in action

This theme of active engagement in placemaking was demonstrated during a site visit to a new health centre in Woodside, one of the most deprived parts of Glasgow. The aim of the new health centre is to reshape health services from the patient’s point of view, helping them to manage their own health and improve the care they receive. The new centre will bring together GP services, along with dental, pharmacy and physiotherapy services.

The health centre and its surroundings have been created by engaging with the local community. Using ideas from local people, the exterior of the building features designs reflecting the natural and industrial history of the area. Natural light from large windows in the roof floods the centre of the interior, giving a sense of brightness and tranquility, while wooden slats feature designs linking the centre with natural features nearby.

Claypits Local Nature Reserve. Image: Jason Kimmings

That connection with the natural environment will be reinforced with the development of a community green space close to the new health centre. The Forth and Clyde Canal is just a few minutes’ walk from the health centre, and a new foot and cycle bridge linking the centre to the local nature reserve is under construction. Other features will include new and improved pathways and new wildlife habitats. The natural space is already attracting walkers, joggers, families and cyclists, and local people report feeling they can now visit this area in greater safety than ever before.

Mark Beaumont and Glasgow Disability Alliance. Image: Jason Kimmings

The Place Standard

One of the threads running through this conference was the Place Standard, a practical tool developed in Scotland to help communities assess and redesign their own places.

For the final session of the afternoon, round-the-world cyclist Mark Beaumont introduced members of the Glasgow Disability Alliance (GDA) who shared results from their day as the Place Making Team using The Place Standard Tool. The results highlighted some of the elements of place that are important to people with disabilities – but also to others: lack of accessible toilets, poor transport links, networking events with no seating, inaccessible information, no social care support.

Final thoughts

This conference provided some important ideas on what’s wrong with our places, and some examples of places that are getting it right. And even for those that are on the right track, everyone was left with a clear message: when it comes to placemaking, good enough is not enough!

Merchant City, Glasgow
Image: Jason Kimmings

Museums as facilitators of health and wellbeing in communities

GNM Hancock, Newcastle

Great North Museum Hanckock, Copyright Rebecca Jackson

It’s estimated that there are over 2500 museums in the UK, ranging from world-famous collections in major cities to small local ones on niche themes. Over 50% of adults have visited a museum or gallery in the last year and there were an estimated 7.5 million visits by children and young people under the age of 18 to the major museums in England.

As well as their educational and leisure value, and their role as drivers of the tourism economy, there is a growing body of research which is considering the wider societal role of museums and in particular, their potential positive impact on health and wellbeing.

Museums and the rise of social prescribing

Within health and social care, we have seen increasing recognition and interest in the role of psycho-social and socio-economic determinants on health and wellbeing. Treatments now often look at the whole person and their lifestyle, not just at the specific medical condition to be treated. This awareness of the impact of lifestyle has led us to view spaces like museums and theatres in a new way and consider how they can be used as a tool to help people to live well.

March 14th was social prescribing day in the UK. And Museums on Prescription is one of a number of culture-led projects which encourage people to use assets in their local communities such as museums, galleries and theatres to help manage conditions linked to depression and social isolation, in combination with traditional clinical medicine.

Arts-for-health settings can have an impact across a number of different areas, including supporting children who have been exposed to trauma and abuse, helping communities integrate and improve social cohesion through the co-production of exhibitions, and helping support people with mental or cognitive illnesses, as well as those who suffer from dementia and Alzheimer’s.

V&A Dundee

V&A Dundee, Copyright Rebecca Jackson

Helping people feel better

As the number of projects increase so does the evidence of positive benefits. There is a growing body of literature highlighting examples of how cultural experiences are supporting both physical and mental health.

A report from Art Fund looking at the calming impact of museums and galleries found that 63% of people surveyed have (at some point) used a visit to a museum or gallery to ‘de-stress’, however, only 6% visit a museum or gallery regularly (at least once a month). Over two thirds of survey respondents (67%) agreed that taking time out for ourselves and choosing to pursue a leisure activity is good for our personal wellbeing and this is where museums and galleries, along with a whole host of other providers like theatres, music venues, public gardens and parks can step in.

Funding is a challenge

A report (2018) from the English Civic Museums Network highlights that services often deemed  “non-essential” (like museums and libraries) actually encourage and foster personal and communal resilience: they stop the crime, the illness, the loneliness from happening in the first place.

However, despite the significant and positive preventative role that participation in cultural activities can play, over the past five years spending on culture in England and Wales has fallen by over 30%, and this has had an impact on museums and the services they can provide.

Natural History Museum, London

Natural History Museum, London, Copyright Rebecca Jackson

Galleries and museums must keep striving to do more

The growing realisation of the potential of museums and galleries to have a positive impact on the health and wellbeing of communities presents a significant opportunity for them to develop programmes and exhibitions which reflect the diversity of experiences within communities and look to develop new ways to engage new audiences. Ensuring that people feel represented and that exhibitions appeal to a broad base of the community is also important in making sure people feel they are able to visit exhibitions and can feel the benefits of doing so.

In their 2015 report, the National Alliance for Museums, Health and Wellbeing, led by UCL, outlined the priorities of the alliance and showcased some examples of the work being done by partner organisations. In February 2019 it was announced that some schools in London are planning to give pupils “theatre vouchers” which entitles them to one free theatre visit per year. Museums themselves are also trying to do more to help engage members of the community and encourage them to engage with new exhibitions.

Are healthy people more culturally active, or does being culturally active make people healthier?

Museums and galleries have the potential to make an enormous contribution to improving people’s lives and enhancing physical health and mental wellbeing. The body of research around the role cultural activities like attending museums can have on health and wellbeing is growing, but there is still scope to do more, and work is ongoing with a number of high profile museums across the UK to promote the link between cultural activities and health and wellbeing.

The question of which comes first – being well initially which allows you be more culturally active, or cultural activities facilitating wellbeing in their own right – will be discussed and disputed by academics and clinicians. But the existing studies highlight the significant positive impact that engaging with museums and exhibitions has had on study participants, particularly those who suffer from mental ill health or degenerative cognitive diseases like dementia.

Museums and galleries, it is clear, have a far greater communal role to play and can evidence their value far beyond being a source of knowledge transfer or a leisure activity. Museum curators and funders need to recognise this as they prepare and plan for exhibitions and outreach projects in the future and clinicians need to be aware of the potential positive impacts for patients when considering care and treatment plans.


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“The ‘frustrated’ housing aspirations of generation rent”

house prices

A key change in the UK’s housing market over the past twenty years has been the growth of the private rented sector (PRS), with more living in the sector than ever before. This growth has led to the view that there is now a ‘generation rent’ who are priced out of home ownership and stranded in insecure short-term lets for prolonged periods of their lives – fuelling concerns about intergenerational inequality.

At a recent seminar, hosted by the Public Services and Governance research group at the University of Stirling, Dr Kim McKee, a co-investigator for The UK Collaborative Centre for Housing Research (CaCHE), presented the key findings from her research on ‘generation rent’ and precarity in the contemporary housing market.

Who are ‘generation rent’?

The UK 2011 Census highlighted that 40% of private renters were young people under the age of 35. With a challenging labour market, rising student debt and welfare reforms, home ownership and social housing is increasingly out of reach for these young people, who end up stuck private renting for much longer than the previous generation.

It was noted by Dr McKee that there is a clear age dimension to the recent shifts in housing tenure, but that the ‘generation rent’ label is more complex than portrayed. Income and family support were emphasised as just as critical in the understanding of young people’s experiences and future plans, as was geography.

Indeed, other research has highlighted that income and family background have a huge impact on young people’s housing market experiences. The Resolution Foundation’s recent report highlights that young people from wealthier families are more likely to become homeowners, suggesting that there are also intra-generational inequalities.

Dr McKee’s study focused on the inequalities facing these young people through qualitative research with 16 young people aged 35 and under living in the PRS in Scotland or England. Those on low incomes were explicitly targeted with the aim of giving them a voice, which was considered to be largely absent in previous research.

Aspirations vs expectations

There was a long-term aspiration for home ownership among the majority of participants, with a smaller number aspiring to social housing. But private renting was seen as the only short-term option as a host of challenges thwart them from realising their ambitions:

  • mortgage finance
  • family support
  • labour markets
  • student debt
  • welfare reform

The fact that housing tenure was highlighted by respondents rather than housing type or location, as previous research has highlighted, suggests there is a general dissatisfaction with living in the PRS. Indeed, it was noted that the PRS was discussed largely negatively, perceived as the ‘tenure of last resort’.

Despite the continued aspirations for home ownership, there was a marked difference between aspirations and expectations. There was a levelling down of expectations to own and a gap emerging between what the young people aspired to as their ideal and what they expected to achieve. A small minority even remarked that a more realistic goal may in fact be improvements in the PRS. The study showed that such expectations were due, mainly, to low earnings and insecure employment, combined with a lack of family financial support.

While the short-term nature of private renting makes it a very flexible rental option, it also makes it insecure and precarious, creating barriers for tenants who want to settle into a home and community. This is particularly worrying for families with children, who can be greatly affected by the upheaval of having to regularly move.

Emotional impacts

The study was particularly interested in the more intangible and emotional impacts on ‘generation rent’ and how the frustrations in realising their aspirations impacted negatively on their wellbeing.

It was stressed that issues in the PRS are having serious negative impacts on the wellbeing of young people – insecure, expensive and poor quality housing are contributing to depression, stress and anxiety. Moreover, for those on the lowest incomes, such issues are even contributing to homelessness.

Not only is mental wellbeing affected but their physical health has also been impacted by poor quality housing. Problems with rodents, damp and mould, broken white goods and poor quality accommodation in general were all reported by participants.

The experiences of the young people in the study were described as a “sad reflection of housing in the UK today” and raises questions over whether the PRS can really meet the needs of low income groups in particular.

Geography matters 

Another key finding was that where people live really matters, not only because of the spatial nature of housing and labour markets, but also as tenancy rights and regulations vary across the UK.

Recent reforms in Scotland have provided tenants with greater security of tenure and more predictable rent increases. England was highlighted as lagging behind the rest of the UK in terms of regulation and tenants’ rights as it lacks any national landlord registration scheme. Letting agent fees in England were also highlighted as a real issue in relation to affordability.

It was suggested that the rest of the UK could learn much from the Scottish experience, although there is a need to go further, particularly in relation to affordability.

Way forward

A key message from the study was that security of tenure really matters for those living in the PRS but reform of the housing system can only go so far. Participants identified more affordable housing, more protection for renters and income inequalities as areas where the government could intervene to improve things.

Based on the findings, six key policy recommendations were made:

  • ensure security of tenure;
  • take action on rents;
  • provide better education for tenants on their rights, and indeed for landlords;
  • provide more affordable housing; and
  • ensure greater understanding of intra-generational inequalities.

If the wider inequalities within society are also addressed, perhaps the PRS could become an aspiration rather than the ‘tenure of last resort’.


If you enjoyed reading this, you may also be interested in our previous posts on build to rent and meeting demand and improving data in the private rented sector.

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“For many children we are the first point of contact”: supporting children’s mental health in schools

A 2018 evidence review from Public Health England reported that one in 10 young people have some form of diagnosable mental health condition. This, the report suggests, equates to as many as 850,000 children and young people with a diagnosable mental health disorder in the UK. It also reported that half of all mental health problems emerge before the age of 14, and children with persistent mental health problems face unequal chances in life.

Research has also highlighted the impact of “key factors” like poverty and adverse childhood experiences (ACEs), including emotional trauma, abuse or neglect (which people living in higher areas of deprivation are more likely to experience) on an individual’s chance of developing a mental illness. However, an additional factor often cited in surveys around child mental health and wellbeing is the impact of school, including exam stress, and bullying. Mental ill health has also been found to have an impact on attainment, behaviour and a child’s ability to learn. As a result, teachers are often part of the front line of supporting adults for children who are suffering from mental ill health, with increasing pressure being placed on teachers and schools to identify and signpost children to other services.

Schools, as well as teachers,  are increasingly becoming a focus for the delivery of Child and Adolescent Mental Health Services (CAMHS) in their community. Often schools are at the centre of their local community, so it is logistically convenient to coordinate services there; it can for some be a less intimidating or stigmatising environment than attending a clinic at a GP surgery, for example. School is the primary developmental space that children encounter after their family, and children’s learning and development and their mental health are often interrelated, so it makes sense for teachers to take an interest in terms of attainment and progress in learning. In December 2017, the Department of Health and Department for Education (DfE) published the Green Paper Transforming children and young people’s mental health provision which highlighted the role of schools as key in promoting a positive message about mental health and wellbeing among school age children and young people.

Good work is already being done, but how can we do more?

Research has shown that there is already a lot of good and effective practice being done in schools around children’s mental health. Many schools already work in partnership with local health teams to provide in house CAMHS support in the form of mental health nurses and social workers who are posted on site for children to access. One of the major recommendations in a 2018 Audit Scotland report on child mental health in Scotland was to encourage more of this type of partnership working. The report stressed the importance of joint working between public services if child mental health is to be improved, and where possible to include as wide a spectrum of public services in the delivery of CAMHS support, including criminal justice and housing practitioners, as well as health and social care and education staff.

In some schools senior pupils and designated members of staff are being offered mental health first aid training, and wear lanyards to help students identify them should they ever need to talk to someone. While it is important – particularly for students who participate in mental health first aid programmes – to be made aware of the challenges the role may entail, it can be a rewarding experience for young people to participate in and can also be a vital in-road to support for some students who would otherwise feel uncomfortable talking to a member of staff.

Other programmes like those developed by the Anna Freud National Centre for Children and Families, Centre for Mental Health and the ICE PACK and Kitbag tools (which have been used widely in UK schools) look at resilience building  and promoting coping mechanisms among young people, as well as encouraging the creation of trusting relationships which focus on nurturing and normalising mental illness to encourage children and young people to feel comfortable discussing their feelings and thoughts. These programmes also integrate early intervention and prevention approaches, hoping to identify children and young people who are suffering from mental illness as early as possible and signpost them to appropriate support.

The specific role of teachers

Teachers need to remember that they are not health or social care professionals and that – as much as they would like to completely solve all of the problems of their students – they can only do what they can, and that is enough.

It is also very important for teachers to practise what they preach in as much as teacher self-care is as important as signposting children and young people who are struggling with mental health issues. A 2016 survey by the National Union of Teachers (NUT) found almost half of teachers had sought help from their doctor for stress-related condition. Teacher stress and burnout and those leaving the profession due to conditions like stress do not help to create an environment that is supportive of good mental health in the classroom. Teacher wellbeing is so important and building their own resilience is one way that teachers can start to embed good mental health in their practice. If you are doing it yourself it will be easier to help and show children how to do it if they come to you for advice!

Teachers simply being there and offering a safe space and first point of contact for many children is important. Listening and signposting can be so valuable for those pupils taking the first step and teachers should not be put off by any personal perception of a lack of expertise in mental health – a small amount of knowledge or understanding of what to do next is more than enough. In some respects, teachers should feel almost privileged that a student has chosen to come to them, someone they feel they can trust and talk to.

A poll conducted as part of a webinar held for educational practitioners found that rather than requiring more information about mental illness, what teachers actually wanted was more practical examples of how to apply support in the classroom and how to embed mental health into their teaching and the learning of their students.

A unique opportunity

Schools and teachers are on the front line of public services and have a unique opportunity through regular contact with children to help to build and promote resilience among pupils, and embedding this within the whole school can be an effective way of ensuring pupils feel the benefit without being singled out. Taking nurturing approaches to learning and teaching, and promoting the creation of trusting relationships is key to some of the already effective practice going on in schools. Sharing the learning and best practice that is already happening will be vital to ensuring that support for children suffering from mental ill health improves and adapts to changing needs in the future.


If you liked this article, you may also be interested in reading:

Writing and recovery: creative writing as a response to mental ill health

Addressing social mobility through education – is it enough?

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

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Creating caring places: placemaking in our town centres

What do caring places look like? How can planners, developers and project organisers contribute to the discourse around creating caring places? And what responsibility do they have to communities to help develop places that put people at their heart?

They are just some of the questions being increasingly raised by organisations in Scotland, trying to identify if there is a new way to focus on place and wellbeing in Scotland’s towns. Projects such as Carnegie Trust’s Kindness, Scottish Towns partnerships’ Town Centres First, or Architecture and Design Scotland’s Creating Caring Places are all exploring the importance of the quality of a place to the wellbeing of people who live there. But what does this mean for people who actually plan these areas, and what could they consider in the future to help develop more caring places?

The 3 P’s: place, people, practice

Many of the discussions around creating places which foster wellbeing and wellness centre around 3 key concepts:

Place: Understanding place and the impact that it has on wellbeing is a significant part of this agenda. The environment in which people live day-to-day has a significant impact on individuals and can be both a positive or negative influence. It can help to facilitate positive community interaction, creating stronger community ties and helping organisations and people to feel more valued within their community.

In order for places to be caring a number of factors have been identified, and these are common across research done by a number of organisations including Architecture and Design Scotland and the Carnegie Trust. These include: a sense of support (from people); a sense of purpose (stuff to do); a sense of place (familiar surroundings); and a sense of worth (feeling wanted).

People: Loneliness or social isolation has the same impact on health and mortality as smoking 15 cigarettes a day. Traditionally, it has often been assumed that older people are most often victims of social isolation (as they are less mobile and less willing or able to participate in community activities). Recently however more research has been produced which highlights the growing isolation of younger people. Understanding the nature of isolation, which impacts across the whole community, can help us to identify effective solutions which benefit and engage multiple groups.

Practice: This particularly relates to care within communities. The process of deciding where and how we care for the old or ill is a vital part of how we function as a society. Effective care extends far beyond the physical act of caring for someone, although this is obviously a key element. It also includes creating more and better jobs within the sector, and encouraging people to enter the profession as a worthwhile career choice; shifting the focus from acute to primary care settings and away from hospital-based emergency care; and giving people greater choice about how and where they receive care through increasing and improved personalisation of services.

There is a responsibility on both spatial and community planners to identify need and to create places which facilitate wellness, choice and care at home. This could be through the building of new infrastructure or more effective transport, or it could be through the creating of a community centre which offers recreational classes to someone who would otherwise have no contact with the outside world. Putting place at the centre of discussions provides an opportunity for a community approach to wellbeing, with strategies on placemaking being linked to other approaches such as asset-based, or strengths-based, planning.

Thinking about people like we think about the environment

Even as little as 10 years ago, the prevalence of environmental impact assessments for development projects was limited. Now we take for granted that we measure the impact of a project on the environment. What if we thought about people and in particular the risk of isolation, in the same way during planning processes? What if developers, planners and project organisers considered the “isolation impact” of a project, how it would impact the people of a local area, and whether it would specifically impact one group more than another (either for good or for bad), and reported on the steps they were taking to mitigate any adverse impact?

It is a striking notion, but creating a set of criteria to measure the social impact of developments, may be hugely useful if we are trying to place an increasing emphasis on inclusion and community within our town centres.

In fact, planners are beginning to realise the critical role they play in connecting services to people, and the necessity of understanding which services are needed in an area and how to make them as accessible for the whole community as possible. And while it is down to the community to use the resources they are given by planners to create connections and networks that help to combat things like poor mental health and social isolation, the decisions that planners make about how and where to plan in services and infrastructure can be the difference between someone leading an active and engaged life, and someone living a life where the only human contact they have in a day is a carer.

Planners can and should recognise the significant role they can play in making someone’s life more livable.

Final thoughts

Creating caring places for people to live and grow old in is vital to the success of our communities. Effective and thoughtful decisions on investments such as infrastructure and community planning projects can have a significant positive impact on wellbeing and reduce loneliness not only among older people, but throughout the community.

Increasingly, policy makers in Scotland are being asked to consider the human element of planning in their work. Creating places that allow people to feel safe, valued and happy is key for planners to help bridge the gap between the creation of places, and the wellbeing of people who live in them.


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