Let Glasgow Flourish Hanlon,Hanlon, Walsh Walsh and and Whyte Whyte AprilFebruary 2006 2006 Acknowledgements Acknowledgements The information used to compile this report has come from a wide variety of national and local organisations. We are indebted to the many individuals in these organisations who have helped to compile the data and who in many instances have also provided their own advice and knowledge. The length of this list indicates the range of organisations who can provide public health relevant data and underlines the collaborative nature of this work. We hope that those who provided data will in turn derive useful information from the report for their own uses. It is simply not possible to mention every individual who has assisted in the compilation of this report. Those not listed here, however, are acknowledged through the listing of their organisations from whom we have obtained information. The authors are grateful to the following: x ISD Scotland – and in particular Laura Kelso (one of the authors of the NHS Health Scotland Community Profiles on which a significant amount of the presented data is based, and who also helped in some of the initial analyses for this report); also, Julie Kidd, Richard Lawder, Kenny McIntyre, Nadiya Choudhry, Samantha Clarke and Joanne Hattie. x Colleagues at the Glasgow Centre for Population Health – in particular Valerie Millar, Russell Jones and James Arnott. x Glasgow City Council – in particular Neil Hunter (Addictions Services) and Iain Paterson (Social Work Services). x NHS Greater Glasgow – in particular David McCall and Allan Boyd. x University of Glasgow, especially Gordon Hay, Maria Gannon, Neil McKeganey of the Centre for Drugs Misuse Research. x Graeme Busfield and Neil McKinnon of Communities Scotland. x Fiona Marrison, MSc student in Geographical Information Systems, University of Edinburgh, Institute of Geosciences. x Strathclyde Police – in particular Chris Mooney, Carol McLeod and Will Linden. x Roger Houchin, Glasgow Caledonian University. x Kate Lang, HESA. x Edith Young, Glasgow and Clyde Valley Structure Plan Joint Committee. x Health Protection Scotland – in particular Ian Henton. 3 x David Leon, London School of Hygiene and Tropical Medicine. x Newhaven Research. x Various departments and individuals within the Scottish Executive. x Scottish Neighbourhood Statistics. x General Register Office for Scotland – in particular Paula Lopez. x Department of Work and Pensions. x Glasgow Housing Association. x Keep Scotland Beautiful. x Office for National Statistics (ONS). x Finally, we are grateful to colleagues at NHS Health Scotland, particularly those who commented on various drafts of the report. Note. Ordinance Survey maps reproduced in Figures 6.21 – 6.26 (Chapter 6): © Crown Copyright. All rights reserved. Glasgow City Council, 100023379, 2006. 4 Chapter 1: Introduction “If fresh insights are to be generated into Glasgow’s health we need a detailed and comprehensive understanding of how health is being pro- moted or harmed in our city.” “This is the most comprehensive description of health and its determinants ever created for Glasgow and West Central Scotland.” “An analysis of what is getting better in Glasgow is illuminating and chal- lenges a number of stereotypes.” Let Glasgow Flourish A comprehensive report on health and its determinants in Glasgow and West Central Scotland written by Phil Hanlon1, David Walsh2 and Bruce Whyte3 for the Glasgow Centre for Population Health 1 Professor Phil Hanlon, Professor of Public Health, University of Glasgow 2 David Walsh, Public Health Information Manager, NHS Health Scotland 3 Bruce Whyte, Public Health Information Manager, NHS Health Scotland Published by the Glasgow Centre for Population Health Chapter 1: Introduction 1.1 The Glasgow Centre for Population Health The Glasgow Centre for Population Health (GCPH) is a research and development facility that generates insights and evidence, provokes discussion and debate, and mobilises action to improve health and tackle inequality. It provides a setting where academics, policy-makers, practitioners and local people can come together to confront problems facing population health in Glasgow and beyond. The Glasgow Centre is a collaboration between NHS Greater Glasgow, Glasgow City Council and Glasgow University supported by the Scottish Executive. Other partners also play an important role. For example, NHS Health Scotland contributed the time of two of the authors of this report. 1.2 The ‘Observatory Function’ within the GCPH If fresh insights are to be generated into Glasgow’s health problems we need a detailed and comprehensive understanding of how health is being promoted or harmed in our city. To achieve this aim an interdisciplinary group has been assembled from a variety of organisations. This group will create and maintain a detailed description of health and its determinants in Glasgow, conduct detailed analyses of major determinants of health and develop new techniques to enhance our understanding of how routinely collected data can be used for planning and evaluation. This report is the first from the observatory group but more will follow. 1.3 Health and how it is created and destroyed Health is a resource for living. It is not an end in itself but the lack of good health diminishes life for many. Health is multidimensional. We can recognise physical, mental, social and perhaps even spiritual dimensions to health. We are aware of poor health (concepts like disease or compromised function) as well as good health (well being and good function). It is also important to recognise subjective as well as objective measurements of health. One way of thinking about the factors that determine health in a population is the phrase ‘it all matters’. What this means is that health in populations emerges from a complex interplay between the physical environment, social environment, individual response and behaviour, genetic endowment and the provision of services interacting with economic and other influences from which the health status of a city emerges. These factors interact and combine over the human life-span to create or destroy health. These influences also give rise to the patterns of inequality that are now observed. They also provide the intellectual framework that should allow us to devise strategies to improve health. It is clear, therefore, that health is a complex construct and that the determinants of health are multiple, interactive and complex, but we understand enough of this complexity to devise detailed strategies to confront the system as a whole and to target specific determinants of health. 8 1.4 How we use data – the strength of holistic data A full description of how we developed our approach to public health data is provided elsewhere1. The key idea is to reflect the description of health and how it is created and destroyed (set out briefly above) in the way data are analysed and presented. Consequently, we have tried in this report to provide data on many aspects of health and its determinants so that, taken together, they paint a picture of what is happening. Although it is possible to highlight weaknesses in each individual source of data, these individual weaknesses are rendered less important by the strength and consistency of patterns that emerge throughout this report. For example, our understanding of the determinants of health in communities highlights the difficulty of focusing on only a small number of indicators. Community health profiles2 have demonstrated that the least healthy communities fare less well on a whole spectrum of indicators. These factors are mutually reinforcing, meaning that improvement in one small area is unlikely to bring about transformative improvement in others. In fact, it appears that a significant number of determinants of health have to change in a community for the health of that community to improve significantly. The comparison, shown in Figure 1.1 overleaf, between the two postcode sectors covering Newton Mearns and Dalmarnock demonstrates this clearly. The key point is that the least healthy communities in Glasgow have concentrations of problems, not only less good health outcomes, and many (if not all) of these other factors will need to change before health outcomes significantly improve. The example shown in Figure 1.1 has been created from data for two defined areas - in this case postcodes that overlap fairly well with Newton Mearns and Dalmarnock. In other parts of the report data will be presented for different geographies. Often this will be for local authority areas – for example, Glasgow City compared with other West of Scotland local authorities. Sometimes data will be presented for NHS Board areas or parliamentary constituenciesi. Overall, a picture will emerge of the health of people in the whole of the West of Scotland but with a central focus on Glasgow. Each Figure and Table is carefully labelled to indicate the geographic area being considered and the source of the data. 1.5 The purpose of this report This is the most comprehensive description of health and its determinants ever created for Glasgow and the West of Scotland. Our aim is to increase understanding, provoke debate and stimulate action. The intended audience is ‘anyone in a position to influence health in Glasgow and the West of Scotland’. In a very real sense that means everyone so the report will be widely circulated and also published on the GCPH web site – www.gcph.co.uk. Copies of the report will also be disseminated to key policy makers and practitioners who work in sectors highlighted by the report. We expect that the press will cover the issues it raises too. It is vital that this report generates public debate. The result we are seeking is a ‘civic conversation’ that leads to a new consensus about what needs to be done to transform the overall health of Glasgow’s population and to effectively address existing health inequalities. i The range of large and small scale geographies that have been used in the report are explained in more detail in the ‘Preface to Chapters 2-12’.