Tuesday, 25 October 2016

The social determinants of health

"The relationship between poverty and health inequality has been clearly established and well documented (Hirsch, 2005; Roberts, 2002). Children born into low-income households are more likely to experience developmental and health problems from birth, and to accumulate health risks as they grow older (Roberts, 2002)."
The Scottish Government`s answer is to pay particular attention to the early years of life.
"We have always known the earliest years of life are crucial to a child’s development. However, it is increasingly evident that it is in the first years of life that inequalities in health, education and employment opportunities are passed from one generation to another. The early years framework signals local and national government’s joint commitment to break this cycle through prevention and early intervention. In short we aim to give every child in Scotland the best start in life."


A report into the `Glasgow Effect` which is often extrapolated to the `Scottish Effect` explores a wider range of social issues which depress communities. Its conclusions draw doubt on the wisdom of the Scottish Government`s focus.

Although Glasgow shares many socioeconomic characteristics with cities like Liverpool and Manchester, the health inequalities are greater. Certainly poverty will weaken any community but the `Glasgow Effect` cannot be explained simply in terms of poverty or deindustrialisation; there must be other factors too.

One of those factors was the establishment of new towns in the greenbelt like East Kilbride and Cumbernauld which took a large proportion of young people, particularly families, from the decaying city. Investment was channelled into the new towns but little was available to bring new jobs into Glasgow.

Overcrowding has always been a serious problem in the city which has very serious health consequences. Part of the answer was to build high rise flats - hardly suitable for children - and huge housing estates on the periphery. These estates had few amenities, no jobs and hardly a bus out of the place after a certain time at night. They became dumping grounds full of demoralised people. That in itself has health implications. Meanwhile the city dressed itself up along the Clyde so that visitors could enjoy going into its new shopping malls.

The point is that these decisions were taken at the macro-level. The individuals who were at the receiving end of these policies had little to do with decision making. Any government that focuses on the first few years of life as if that explains everything about poverty and health is reneging on its responsibilities.

It is nonsense to blame parenting. The cycle of deprivation has higher order explanations.

Read the report:

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