Health inequalities in Scotland: looking beyond the blame game March 2011 Gerry McCartney Chik Collins
Sep 08, 2014
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
70
80
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
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, 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.
60
65
70
75
80
85
1971 1976 1981 1986 1991 1996 2001 2006
Year
Life
exp
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
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