Supporting resilient communities:The role of public service leaders

Carol TannahillDirector

Glasgow Centre for Population Health

Male life expectancy: Scotland & other Western European Countries, 1851-2005Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Male life expectancy: Scotland & other Western European Countries, 1851-2005Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Scotland in Europe

All cause death rates, Men 0-64, 2001

(Leyland et al, 2007)

Life expectancy: the gap

Male Life Expectancy at Birth (years); West of Scotland Council Areas vs Scotland;1991-1993 to 2001-2003

Source: Office for National Statistics

66

68

70

72

74

76

78

1991-1993 1992-1994 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003

Council

Lif

e E

xp

ec

tan

cy

at

bir

th

Scotland Glasgow City East Renfrewshire East Dunbartonshire

Gap between best and worst =

6.5 years

Gap between best and worst =

8.1 years

Life expectancy trend by deprivation

Estimates of male life expectancy, least and most deprived Carstairs quintiles, 1981/85 - 1998/2002 (areas fixed to their deprivation quintile in 1981)

Greater Glasgow Source: calculated from GROS death registrations and Census data (1981, 1991, 2001)

72.2

76.2

65.364.8 64.4

69.4

71.2

73.373.9

60

65

70

75

80

85

1981-1985 1988-1992 1998-2002

Es

tim

ate

d li

fe e

xp

ec

tan

cy

at

bir

th

Males -Dep Quin 1 (least deprived)

Males - Dep Quin 5 (most deprived)

Scotland Males

-70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70

-70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70

In light of all this, how do we think about causation and

response?

• Direct and specific causes: action on individual features

• Fundamental determinants: perpetuate systematic differences, operate consistently over time regardless of changes in causes

• Complex systems of causation: need to understand relationships between components

Understanding Glasgow: the Glasgow Indicators project

Risk of death - by level of hopelessness

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

All cause CVD Non CVD Cancer

Low

Moderate

High

Everson et al 1996

Issue-specific responses

The example of welfare reform

Social Protection

• Social protection has important and positive effects on outcomes, even within societies that remain highly unequal in other respects.

• Welfare benefit reforms will impact directly on individuals, families, communities and services.

• Responses? – Organisation of advice services and communication– Quantification of scale and of service implications– Advocacy – Mitigation

Income maximisation

• Even small-scale initiatives make an important difference

• Healthier Wealthier Children: Almost half of advice cases (664 out of 1347; 49%)

some £ gain Average client gain: £3404 Range: £2,259 - £5,636

• Govanhill participatory budgeting pilot: Still ‘at the edges’ – BUT Process enabled dialogue between community and

public & third sectors Decisions reflected acute understanding of local

issues Community embraced the responsibility

Fundamental causes

An example from ‘The three cities’

All-cause SMRs, Glasgow relative to Liverpool &

ManchesterAge 0-64, all-cause SMRs 2003-07, Glasgow relative to Liverpool & Manchester

Standardised by age, sex and deprivation decileCalculated from various sources

60

70

80

90

100

110

120

130

140

150

160

Both sexes Males Females

Gender

Sta

ndar

dise

d m

orta

lity

ratio

Age 0-64, all-cause SMRs 2003-07, Glasgow relative to Liverpool & Manchester Standardised by age, sex and deprivation decile

Calculated from various sources

131.4

60

70

80

90

100

110

120

130

140

150

160

Both sexes Males Females

Gender

Sta

ndar

dise

d m

orta

lity

ratio

Age 0-64, all-cause SMRs 2003-07, Glasgow relative to Liverpool & Manchester Standardised by age, sex and deprivation decile

Calculated from various sources

131.4

135.6

124.4

60

70

80

90

100

110

120

130

140

150

160

Both sexes Males Females

Gender

Sta

ndar

dise

d m

orta

lity

ratio

‘Excess’ mortality by cause

• Compared to Liverpool & Manchester, Glasgow experienced around 4,500 ‘excess’ deaths between 2003 and 2007

• Almost half were under the age of 65• All deaths:

– 50% of the excess relates to deaths from cancer and circulatory system diseases

– 20% relates to alcohol

• Deaths <65:– 25% cancer and circulatory system diseases– 32% alcohol + 17% drugs = 49% alcohol/drugs

related

Many hypotheses

• Artefact• Culture• Genetics• Greater ‘vulnerability’• Migration• Psychological outlook• Substance misuse

cultures• Vitamin D

• Social capital• Spatial patterning of

deprivation • Family/parenting• Gender• Political attack• Social mobility• Sectarianism• The weather…

Many hypotheses, but to cut to the

current page in the story

• Artefact• Culture• Genetics• Greater ‘vulnerability’ in

Glasgow • Migration• Psychological outlook• Substance misuse

cultures

• Social capital• Spatial patterning of

deprivation • Family/parenting• Gender• Political attack• Social mobility• Sectarianism• The weather…

Lower social capital?

• Not in all aspects– Some are ‘better’ in Glasgow (e.g.

environment, incivilities etc)– Some are similar (e.g. contact with neighbours)

• But significant differences in relation to: reciprocity, volunteering, trust and other ‘proxies’ for social capital…

Volunteering

Unpaid help: at least one example in previous 12 months

30.5%

28.0%

5.7%

17.9%

15.6%

12.4%

13.9%

16.8%

3.3%

9.0%

7.7%8.2%

2.7%

18.1%

6.1%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Glas Liv Man Glas Liv Man Glas Liv Man Glas Liv Man Glas Liv Man

1 (Most) 2 3 4 5 (least)

Community resilience

To build collective resilience, communities must:

• Reduce inequalities (eg in risk and resources)• Engage local people • Create organisational linkages• Boost and protect social supports• Plan for not having a plan! – requires flexibility,

decision-making skills, and trusted sources of information

[Norris et al. Am J Comm Psychol (2008)]

Holistic approach

The example of neighbourhood regeneration

Community composition

Percentage of population under 16 & ratio of adults to children under 16

% RatioTransformation 42 1.01Local regeneration 38 1.18Peripheral estates 35 1.34MSF surrounds 26 2.14Housing improvement 24 2.67(Scotland 20)

In regeneration areas, 40% all households are single person, and 65% older households are single person.

It matters how things are done

• For those relocated to other areas, satisfaction with area, home and fittings showed a clear gradient of association with the amount of choice given.

• Where ‘a lot’ of choice, over 95% satisfied. Where ‘none’, approx 70%.

• There is also a gradient in people’s perceived ability to influence (lowest in relation to major decisions).

Consequences of environmental improvement

• More positive ratings of home and (slightly less so) neighbourhood

• More neighbourly behaviours • Higher intentions to make changes to

health-related behaviours• Evidence of the importance of

aesthetics for mental wellbeing

Encouraging trends

• The most recent survey findings suggest that the Regeneration Areas may be exhibiting more positive trends than comparable areas in the city.

Local service providers respond to the views of local

people

0%

20%

40%

60%

80%

100%

2 3

Wave

Pe

rce

nta

ge

'ag

ree

' or

'str

on

gly

ag

ree

'

Regen area(TRA/LRA)

Non-regen area(WSA/HIA/PE)

Overall

Respondent feels part of the community

0%

20%

40%

60%

80%

100%

2 3

Wave

Pe

rce

nta

ge

'a g

rea

t de

al'

or

'a fa

ir a

mo

un

t'

Regen area (TRA/LRA)

Non-regen area(WSA/HIA/PE)

Overall

Neighbourliness: borrows and exchanges favours with

neighbours

0%

20%

40%

60%

80%

100%

2 3

Wave

Pe

rce

nta

ge

'gre

at

de

al'

or

'fair

am

ou

nt'

Regen area(TRA/LRA)

Non-regen area(WSA/HIA/PE)

Overall

How should we think about causation and response?

• All three approaches are necessary.• There are broad causal mechanisms, but

not Newtonian laws. The effective response varies from case to case:– requires skill and latitude– quality of relationship of central importance– will be context-dependent– workforce implications

• The second and third approaches are essential in preparing for the future, and clearly relate to preventive spend and public sector reform agendas

Propositions

• The challenges will become more significant• Social intelligence about the nature of our

communities is invaluable, and should inform how we judge success

• Neighbourhood regeneration approach: some encouraging findings

• The importance of how things are done: effects are sensitive to skills and motivations

• Communities are changing, and systems are needed to support innovation

• Resilient communities: engaged, organisationally linked, socially supportive … how can your organisations provide support for this?

Acknowledgements

• Thanks to my colleagues in the Glasgow Centre for Population Health and the GoWell programme

• GoWell is a partnership between the Glasgow Centre for Population Health, the University of Glasgow and the MRC/CSO SPHSU, sponsored by the Scottish Government, GHA, NHS Health Scotland and NHS GGC

• All reports and further information available from www.gcph.co.uk, www.understandingglasgow.com and www.gowellonline.co.uk