Guest blog by John Beattie – Healthier Scotland Conversation Event attendee.
Scotland is the ‘sick man’ of Europe. It is well documented in academic research into our lagging health outcomes (McCartney, Walsh, Whyte and Collins, 2011). What causes this is largely debatable. For some reason, we seem to be worse off than our European counterparts. In areas of Glasgow, life expectancy is as low as 54 (ibid, 2011). Why is this happening to us?
After accounting for deprivation and all of the other usual determinants of health, Scotland is left with what is called an “excess mortality”, something that is contributing to our early demise (McCartney, Collins, Walsh and Batty, 2011). Even when we compare Glasgow to other areas in the UK that faced similar levels of deindustrialization, such as Liverpool and Manchester, we seem to fare much worse (Collins and McCartney, 2011). So our poor health outcomes are well documented and nothing new.
What must also be highlighted is that since the 1980s, we faced new emerging social health challenges in the form of drug and alcohol abuse, suicides and violent deaths. Research has shown the drastic increase in deaths from these ‘new’ health problems (Leyland, Dundas, McLoone and Boddy, 2007). There is no doubt that these newly developing social health concerns were exacerbating our already faltering health outcomes.
At the recent Scottish Government consultation ‘Towards a Healthier Scotland’, the public were given the opportunity to join in the conversation and give our opinions to the Scottish Government on the issue of health and what can be done to improve health in Scotland. I attended the event in Glasgow on the 23rd of November.
I arrived with skepticism believing this was just a ‘box-ticking exercise’ and that the Scottish Government would filter out all of the things that they don’t like and adopt the things they wanted to hear. Time will tell whether that skepticism will be proved right, but I must say I actually thoroughly enjoyed the event and the level of conversations that took place.
The first question was; “What support do we need in Scotland to live healthier lives? Personally, I approached this question from a viewpoint that we need to do more for various reasons. Firstly, literally over 117,689 people (we know about) in Scotland last year used food banks for an emergency three-day supply of food. The issue of food poverty is one that is only getting worse, with recent Trussell Trust statistics showing that more than 60,000 people in Scotland used food banks this year (2015) between April and September alone. Why is this important? This is important because in order to live healthier lives, people need to be able to afford good quality food, especially fruit and vegetables. A significant number of those getting fed via food banks are children. So what we have is a large number of people and their children barely being able to eat nutritious and healthy foods. This will only impact on their health and lead to health problems relating to poor dietary intake further down the line.
My proposition was that the Scottish Government must ensure that all children, if not all then particularly those in low-income families in deprived areas, must be provided with fresh fruit and vegetables. This could greatly enhance their chances of leading healthier lives. In particular we need to catch those in nurseries and schools. The long-term benefits to their lives, society and the health service as a whole far outweigh the argument of ‘costs’ that we come up against. We cannot put a price on the lives and health of our children.
There were other issues brought up, such as personal responsibility, issues that tended to look at the problem from an ‘agency’ perspective. However, it can be strongly argued that we need to look at the problem from a structural perspective. People can’t buy healthy foods if they can barely afford to survive. Something had to be done and it is morally imperative that we act as soon as possible in these very difficult times for our families.
The second question, what areas of health and social care matter most to you?, was clearly a more personal question. I won’t address this because the first question is of more fundamental importance to the collective than my personal preferences of health and social care.
The final question of the day was thinking about the future of health and social care services, where should our focus be?. I feel that health and social care should be more integrated. We need to look at health in this country from a holistic perspective. One of the big concerns in our country is the lack of and failure of mental health services. This ultimately impacts on the physical health of the individual. We need to ensure all government departments are working in tandem with each other to address all the social issues that can potentially impact on the health of the individual, be it physical or mental health. Having previously worked in the NHS and with the homeless, it was evident that mental health issues were a significant factor for people accessing these services. The problem was, there was not sufficient support for those who needed it, and what would happen would be a continuous recycling of the problem as people kept leaving and then re-entering the system.
From my time working in the NHS, I was always concerned that the NHS was virtually being ripped off by some of its suppliers. We hear talk of limited budgets and need to cut costs, but no one ever seems to speak about the gross overpayments at hugely inflated prices the NHS has to pay for drugs, equipment, and supplies. Anyone who works in an NHS hospital in Scotland that does the inventory for their ward knows exactly what I’m talking about.
The final issue I highlighted was the need to be more bold and radical in terms of planning ahead. We know that the population is getting older and that people are going to live longer. As of this moment there is no proper set up in our system to deal with this. Previously, the NHS had long-term elderly wards where those needing long-term care were looked after. They were disbanded when I started working in the NHS in 2003. What was expected to happen was the private sector e.g. nursing homes, would take on this role. In my opinion this has been a failure. What has since happened is elderly people now needing long-term care have to sell their homes to finance this care. If they do not have a home to sell, the State funds this care. So the private sector sucks up public money to provide very basic care at grossly over-inflated prices in the pursuit of profits. We need greater scrutiny as to whether the private sector is providing us value for money, not the other way round.
Overall, my final point was that we need to ensure that NHS services remain in the public sector. This is vitally important. We often take our NHS for granted. All we have to do is look over the Atlantic to America to see just how concerning privatization can be. It is estimated around 56 million Americans are uninsured and have no access to health care. That is ten-times the population of Scotland. As for social services, we also need to look at bringing these back into the public domain. Contracting out social services to private companies raises concerns over whether the emphasis is on quality of service or the need to make a profit. Some things are more important than money. We shouldn’t put a price on our peoples’ heads. If financing is the problem, then we need to look at ways of creating more revenue e.g. increased taxation. The benefits to society far outweighs the risks.
Collins, C. and McCartney, G. (2011) “The Impact of Neoliberal “Political Attack” on Health: The Case of the “Scottish Effect”, International Journal of Health Services, Vol. 41, 3, pp. 501 – 523
Leyland, A. H., Dundas, R., McLoone, P. and Boddy, F.A. (2007) Inequalities in Mortality in Scotland 1981-2001, Medical Research Council: Social and Public Health Sciences Unit
McCartney, G., Collins, C., Walsh, D. and Batty, D. (2011b) Accounting for Scotland’s Excess Mortality: Towards a Synthesis, Glasgow Centre for Population Health
McCartney, G., Walsh, D., Whyte, B. and Collins, C. (2011a) “Has Scotland always been the ‘sick man’ of Europe? An observational study from 1855 to 2006”, European Journal of Public Health, 1-3
Trussell Trust Food bank statistics; http://www.trusselltrust.org/stats