1. Cuts, Community Resilience and the new relationship between the state and citizens’ Dominic Harrison @BWDDPH

2. Issues Food Poverty & Wellbeing: A Case study of emerging challenges Cuts in NHS and Local Government Who are our ‘citizens’ anyway? Inequalities Resilience perspectives Inter-generational resilience State, citizens & problem solving ‘defaults’ Conclusions

3. Food Poverty

4. BwD: Community Wellbeing 2012/13

5. Local Authority Cuts & Risks to Community Resilience Barr et al (2013) BMJ Letters; BMJ 2013;347:f4208 doi: 10.1136/bmj.f4208 Higher premature mortality ( deaths under age 75) in Local Authority areas with higher budget cuts & Local Authority budget cuts are systematically higher in north than south

6. BwD : A growing population… White Indian Pakistani population set to grow by 3% by 2021 biggest growth in the 65+ age group (+17%) Key: changing population structure and projected increase in number of older people

7. BwD: Births and deaths 2012

8. A diverse population by birth... More than 70 main languages spoken - most common English, Gujerati, Urdu, Punjabi Polish

9. Diverse by Ethnicity …..(2011 Census)

10. BwDAge breakdown by Country of Birth BwD - 2011 Census (Table DC2103EW )

11. BwD: Female Life Expectancy

12. BwD: Male Life Expectancy

13. Burnley Life Expectancy 2005/7 – 2010-12

14. Economic, social & health inequalities

15. Healthy Life Expectancy estimates for 2009-11 by upper-tier local authority, based on the Annual Population Survey Healthy Life Expectancy is the number of years an individual can expect to spend in ‘good’ or ‘very good’ general health, based on answers to the following question: How is your health in general? Is it… : Very Good, Good, Fair, Bad, Very Bad?

16. US army spends $117m on soldiers' psychological resilience A scheme to build the emotional resilience of American soldiers has been established as rates of suicide and depression rise. UK Telegraph August 2013 Type 1 and Type 2 ‘Resilience Narratives’ Resilience Type 1 Resilience for the ‘dispossessed’ to cope with the ‘hollowing out of the state’ Resilience Type 2 Resilience for the ‘challenged’ to cope with increasingly rapid societal fracture, stress and dysfunction

17. Where does community resilience best reside? Individual Collective Connection to the State Weak Strong Most Resilience ? Least Resilience ? Resilience Agents & Capacities

18. Resilience, Recession and Social Outcomes

21. Intergenerational Resilience in Blackburn with Darwen (2012) Adverse Childhood Experience (ACE) & Adult Health Outcomes Pregnant or got someone accidently pregnant Under 18 x 4.5 Liver or digestive disease x 2.3 Stayed overnight hospital in last 12 months x 1.5 Had a sexually transmitted infection x 30.6 Morbidly Obese x 7.2 Heroin or Crack user x 9.7 Regular Heavy drinker x 3.7 Been hit in last 12 month x 5.2 Hit someone last 12 months x 7.9 Been in prison or cells x 8.8 Increased risk (adjusted odds ratio) having health behaviours and conditions in adulthood for individuals experiencing four or more ACEs in childhood.

22. Public Services Policy Community State & Citizens & ‘problem solving’ defaults? Do with others Do ourselves Get others to do Lobbying & advocacy? (hold others to account?) Invest in CVF Sector?

23. Cuts, Communities & Resilience 1.Change in civic problem solving ‘defaults’. 2.Most communities are already wonderfully resilient in ways professionals and the state poorly understand-but key determinants of community resilience are being undermined by the current ‘hollowing out of the state’. 3.Resilience has a major temporal (inter-generational ) dimension. 4.The key role of public services & the community faith & voluntary sector at this time in supporting community resilience is to: – Support : work to maintain access to the 4 ‘capitals’ required by communities to maintain their resilience - across all local public sector spend (4 Capitals are: Mental, Financial, Human, Social) – Prevent: Re-direct significant resource & programme investment away from investment in problem consequences towards strengthening community resilience and self autonomy – Take a Generational Perspective : Review evidence for inter-generational resilience determinants. 5.Public services should be both an agent of community resilience transformation and disclosure ( i.e. making visible the consequences of loss of community resilience capacity that are ‘hidden’ outcomes of public policy decisions). 6.Develop wider community asset-based approaches. 7.Integrate around citizens and ‘align’ public community and voluntary sector infrastructure/ services/ skills – develop a ‘one community’ approach.