Health Inequalities in Scotland: looking beyond the blame game - Gerry McCartney and Chik Collins
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Health inequalities in Scotland: looking beyond the blame game March 2011 Gerry McCartney Chik Collins
description
Dr Gerry McCartney, head of the Public Health Observatory Division at NHS Health Scotland, and Dr Chik Collins, senior lecturer in the School of Social Sciences at the University of the West of Scotland, talk about health inequalities.Stephen Boyd, Assistant Secretary of the Scottish Trade Unions Congress, talks about how the Scottish economy works.The Whose Economy? seminars, organised by Oxfam Scotland and the University of the West of Scotland, brought together experts to look at recent changes in the Scottish economy and their impact on Scotland's most vulnerable communities.Held over winter and spring 2010-11 in Edinburgh, Inverness, Glasgow and Stirling, the series posed the question of what economy is being created in Scotland and, specifically, for whom?To find out more and view other Whose Economy? papers, presentations and videos visit:http://www.oxfamblogs.org/ukpovertypost/whose-economy-seminar-series-winter-2010-spring-2011/
Transcript of Health Inequalities in Scotland: looking beyond the blame game - Gerry McCartney and Chik Collins
Health inequalities in Scotland: looking beyond the blame game
March 2011
Gerry McCartney
Chik Collins
Health: the blame game
The Black report
• Artefact• Health selection• Behavioural or cultural• Structural
0
10
20
30
40
50
60
70
80
90
1751 1801 1851 1901 1951 2001
Year
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Historical international trends in life expectancy
Data extracted from the Human Mortality Database for all available nations: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.
0
10
20
30
40
50
60
70
80
90
1751 1801 1851 1901 1951 2001
Year
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Historical international trends in life expectancy
Data extracted from the Human Mortality Database for all available nations: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.
0
10
20
30
40
50
60
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90
1751 1801 1851 1901 1951 2001
Year
Life
exp
ecta
ncy
at b
irth
(yea
rs)
60
65
70
75
80
85
1971 1976 1981 1986 1991 1996 2001 2006
Year
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Higher overall mortality than comparable nations
Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales, Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Spain, Sweden, Switzerland, Taiwan & West Germany.
60
65
70
75
80
85
1971 1976 1981 1986 1991 1996 2001 2006
Year
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Higher overall mortality than comparable nations
Scotland
Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales, Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, Spain, Sweden, Switzerland, Taiwan & West Germany.
60
65
70
75
80
85
1971 1976 1981 1986 1991 1996 2001 2006
Year
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Higher overall mortality than comparable nations
Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Canada, Chile, Denmark, England & Wales, Finland, France, Germany, Ireland, Iceland, Israel, Italy, Japan, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Portugal, Scotland, Spain, Sweden, Switzerland, Taiwan, West Germany & USA.
USAScotland
USASloveniaScotlandCzech R.PolandSlovakiaHungaryEstoniaBulgariaLithuaniaLatviaBelarusUkraineRussia
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75
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85
1971 1976 1981 1986 1991 1996 2001 2006
Year
Life
exp
ecta
ncy
at b
irth
(yea
rs)
Higher overall mortality than comparable nations
Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.
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70
75
80
85
1971 1976 1981 1986 1991 1996 2001 2006
Year
Life
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ecta
ncy
at b
irth
(yea
rs)
PortugalN. IrelandScotland
Higher overall mortality than comparable nations
Data extracted from the Human Mortality Database for: Australia, Austria, Belgium, Belarus, Bulgaria, Canada, Chile, Czech Republic, Denmark, East Germany, England & Wales, Estonia, Finland, France, Germany, Hungary, Ireland, Iceland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Northern Ireland, Norway, Poland, Portugal, Russia, Scotland, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan, West Germany, Ukraine & USA.
Source: Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.
Glasgow City
Inverclyde
West Dunbartonshire
Dundee City
RenfrewshireEilean Siar
North Ayrshire North Lanarkshire
All cause death rates, men 0-64y, 2001
Jordanhill
Charing Cross
HyndlandPartick
Anderston
Exhibition Centre
CENTRAL
Argyll St.
Bridgeton
QUEEN STREET
Govan
Hillhead St George’s Cross
Buchanan Street
Life expectancy data refers to 2001-5 and was extracted from the GCPH community health and well-being profiles. Adapted from the SPT travel map by Gerry McCartney.
Males - 75.8yFemales - 83.1y
St Enoch
Males - 61.9yFemales - 74.6y
Ibrox
Cessnock
Each stop on the Argyll line travelling East represents a drop of 1.7 years in male life expectancy
Toxic policies and toxic politics
• The UK was exposed to an intensity of neoliberalism not seen elsewhere in Europe
• Deindustrialisation was managed and mitigated in other countries
• Parallels with transitions in Eastern Europe and USA
• Accommodation in Scotland not seen in England • Linked to alienation, disempowerment and
democratic deficit
Sources:
Collins C, McCartney G. Is a ‘political attack’ an explanation for the ‘Scottish Effect’ in health outcomes? . International Journal of Health Services (in press).
Stuckler D, King L, McKee M. Mass privatisation and the post-communist mortality crisis: a cross-national analysis. Lancet 2009;373:399-407.
Boyle M, McWilliams C, Rice G. The spatialities of actually existing neoliberalism in Glasgow, 1977 to present. Geografiska Annaler; series B, Human Geography 2008;90:313-25.
Phillips J. The industrial politics of devolution: Scotland in the 1960s and 1970s. Manchester: Manchester University Press; 2008.
Health inequalities are not inevitable…Ratio of standardised mortality ratios (0-64years), UK local authorities, 1921-2007 (Thomas, Dorling and Smith, 2010)
1
1.2
1.4
1.6
1.8
2
2.2
1921-1930
1931-1939
1950-1953
1959-1963
1969-1973
1981-1989
1990-1998
1999-2007
Year
Rati
o of
bes
t to
wor
st d
ecile
s fo
r are
a-ba
sed
mor
talit
y
Why we do care and why we should care
• Human loss• Injustice• In everyone’s interests
Conclusion
• Our health is determined by the type of society we live in
• Toxic policies and toxic politics are endemic in Scotland leading to entrenched income, wealth and power inequalities
• Equalizing institutions are constantly under attack• Health and inequalities have changed in other
times and other countries when the politics and policies have
• We should care about inequalities because of our humanity, the injustice and in self-interest
• It is time to create a change
To view all the papers in the Whose Economy series click here
To view all the videos and presentations
from the seminars click here
