Social circumstances and health

Insanity as defined by Einstein u “ Doing the same thing all the time and expecting different results ”

Income deprivation - Glasgow

Income deprivation - Liverpool

SMRs by cause, all ages: Glasgow relative to Liverpool & Manchester Source: Walsh D, Bendel N., Jones R, Hanlon P. It’s not ‘just deprivation’: why do equally deprived UK cities experience different health outcomes? Public Health, 2010

Aaron Antonovsky

“.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement." Sense of coherence....

For the creation of health the social and physical environment must be: u Comprehensible u Manageable u Meaningful u......or the individual would experience chronic stress

Salutogenesis…. u Highlights factors which create and support human health rather than those which cause disease u It focuses on resources and capacities which impact positively on health and aims to explain why, in adverse circumstances, some stay healthy and others don’t.

Copyright restrictions may apply. Walsh, D. et al. Eur J Public Health :58-64; doi: /eurpub/ckp063 Male life expectancy at birth West Central Scotland and 10 post-industrial regions

Health Deficits approach u u We focus on problems, needs and deficiencies in a community We talk of “ deprivation”, illness and health damaging behaviours. We design services to fill the gaps and fix the problems. We talk of “clients.” As a result, communities can feel disempowered. People become passive recipients of services rather than active agents in their own lives. We do things to people rather than with them.

Health Assets   A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain their health and sustain wellbeing. These assets operate as protective and promoting factors to buffer against life’s stresses Morgan and Ziglio 2009

The Assets Approach u Begins by building a trusting relationship – regardless of how long it might take u Helps individuals rediscover the skills and strengths they may have forgotten they have u Supports them in putting them into practice u Builds networks and trusting communities in which people help others

Beacon and Old Hill Estate (Falmouth) u u Between 1996 and 2004…. – –Crime down by 50% – –Post natal depression down by 70% – –Unemployment down by 70% – –Child protection registrations down 65% – –Teenage pregnancies down from 14% to<1%

Beacon Hill – the process u “The most significant aspect of the regeneration process on the Beacon and Old Hill estate was that, from the outset, there was no initial funding, no hierarchy, no targets, no business plan, only a shared vision of what the community wanted to be, rather than an obsession with what it had to do. Thus, the regeneration process was not a result of a predetermined plan.”

Beacon Hill – the process u “Rather, the process emerged as a consequence of the interactions between the members of the community, and between the community and its environment, namely the statutory agencies, the police, the council, and so forth. As the community evolved, so also the agencies and professional bodies co- evolved with the community.”

When people care enough to act  Institutions have reached the limit of their problem solving potential. They are stretched thin and need more skilful engagement with communities  They are servants. Ask what people need, offer help, step back, create opportunity for action

When people care enough to act  There are unrecognised capacities in every community. Find them and provide opportunities for people to offer them  Relationships build a community. See them, build them and utilise them  Citizens are at the centre. Engage them as actors, not recipients

When people care enough to act  Leaders involve others as active members  People care about something. Find out what motivates individuals  A listening conversation is the way to discover what motivates people  Asking questions rather than giving answers invites stronger participation

Jimmy Reid 1971

Jimmy Reid and alienation u “Let me right at the outset define what I mean by alienation. It is the cry of men who feel themselves the victims of blind economic forces beyond their control. It's the frustration of ordinary people excluded from the processes of decision making. The feeling of despair and hopelessness that pervades people who feel with justification that they have no real say in shaping or determining their own destinies....”

Fair society, healthy lives 1. Giving every child the best start in life 2. Enabling all children, young people and adults to maximize their capabilities and have control over their lives 3. Creating fair employment and good work for all 4. Ensuring a healthy standard of living for all 5. Creating and developing sustainable places and communities 6. Strengthening the role and impact of ill-health prevention.

Giving every child the best start in life u Improve infant mortality u Improve social and intellectual development before arriving in Primary 1 u Support learning and physical and social development during school u Provide opportunity to encourage aspiration on leaving school

Infant mortality rates – Scandinavia and Scotland

A step change in infant mortality? u Early involvement in antenatal care u No smoking during pregnancy u No alcohol during pregnancy u Parenting support before and after birth u !00% breastfeeding u Continued support until age of 1+ u Universal service

Making assets work u Listen, build trust. Show people their views matter u Build a common vision based on individuals’ aspirations and abilities u Create the conditions which support action u See citizens as the actors in this process, not passive recipients

Theory of Moral Sentiments u “How selfish soever a man may be supposed, there are evidently some principles in his nature which interest him in the fortunes of others and render their happiness necessary to him, though he derives nothing from it except the pleasure of seeing it.” Adam Smith