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					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
  Historical international trends in life expectancy
                                               90
                                               80
            Life expectancy at birth (years)


                                               70
                                               60
                                               50
                                               40
                                               30
                                               20
                                               10
                                               0
                                                1751   1801   1851              1901                1951               2001
                                                                         Year
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.
  Historical international trends in life expectancy
                                                 90
                                                90
                                                 80
                                                80
             Life expectancy at birth (years)
            Life expectancy at birth (years)


                                                 70
                                                70
                                                 60
                                                60
                                                 50
                                                50
                                                 40
                                                40
                                                 30
                                                30
                                                 20
                                                20
                                                 10
                                                10
                                                00
                                                  1751
                                                1751      1801
                                                         1801     1851
                                                                 1851            1901
                                                                                 1901               1951
                                                                                                    1951               2001
                                                                                                                       2001
                                                                          Year
                                                                         Year
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.
 Higher overall mortality than comparable nations
                                                   85
                Life expectancy at birth (years)
                                                   80


                                                   75


                                                   70


                                                   65


                                                   60
                                                        1971   1976   1981   1986   1991   1996   2001    2006

                                                                                    Year
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.
 Higher overall mortality than comparable nations
                                                  85
               Life expectancy at birth (years)
                                                  80                                                                      Scotland


                                                  75


                                                  70


                                                  65


                                                  60
                                                       1971   1976   1981   1986   1991   1996   2001     2006

                                                                                   Year
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.
 Higher overall mortality than comparable nations
                                                  85
               Life expectancy at birth (years)
                                                                                                                          USA
                                                  80                                                                      Scotland


                                                  75


                                                  70


                                                  65


                                                  60
                                                       1971   1976   1981   1986   1991   1996   2001     2006

                                                                                   Year
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.
 Higher overall mortality than comparable nations
                                                  85
               Life expectancy at birth (years)
                                                                                                                          USA
                                                                                                                          Slovenia
                                                                                                                          Scotland
                                                  80
                                                                                                                          Czech R.
                                                                                                                          Poland
                                                                                                                          Slovakia
                                                  75
                                                                                                                          Hungary
                                                                                                                          Estonia
                                                                                                                          Bulgaria
                                                  70
                                                                                                                          Lithuania
                                                                                                                          Latvia
                                                                                                                          Belarus
                                                  65
                                                                                                                          Ukraine
                                                                                                                          Russia

                                                  60
                                                       1971   1976   1981   1986   1991   1996   2001     2006

                                                                                   Year
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.
 Higher overall mortality than comparable nations
                                                  85
               Life expectancy at birth (years)                                                                            Portugal
                                                                                                                           N. Ireland
                                                  80
                                                                                                                           Scotland


                                                  75


                                                  70


                                                  65


                                                  60
                                                       1971   1976   1981   1986   1991   1996   2001    2006

                                                                                   Year
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.
All cause death rates, men 0-64y, 2001

                                                               Glasgow City


                                                               Inverclyde
                                     West Dunbartonshire
                                                                  Dundee City
                                        Eilean Siar
                                                                  Renfrewshire
                                           North Ayrshire       North Lanarkshire




    Source: Alastair H Leyland, Ruth Dundas,Philip McLoone & F Andrew Boddy. Inequalities in
    mortality in Scotland 1981-2001. Glasgow, MRC SPHSU, 2007.
Each stop on the Argyll line travelling East represents a
drop of 1.7 years in male life expectancy
 Males - 75.8y
 Females - 83.1y
                                 Hillhead       St George’s
                                                   Cross
                                                              Buchanan
Jordanhill                                                     Street

     Hyndland
              Partick                            Charing
                                Exhibition        Cross                         QUEEN
                                 Centre                                         STREET
                                      Anderston                               Argyll St.
             Govan
                                                                               St Enoch          Bridgeton
             Ibrox                                      CENTRAL
                                                                                           Males - 61.9y
        Cessnock
                                                                                           Females - 74.6y

      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.
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)


                                      2.2
     Ratio of best to worst deciles
       for area-based mortality




                                       2

                                      1.8

                                      1.6

                                      1.4

                                      1.2

                                       1
                                                0


                                                9


                                                3


                                                3


                                                3


                                                9


                                                8


                                                7
                                              93


                                              93


                                              95


                                              96


                                              97


                                              98


                                              99


                                              00
                                           -1


                                           -1


                                           -1


                                           -1


                                           -1


                                           -1


                                           -1


                                           -2
                                        21


                                        31


                                        50


                                        59


                                        69


                                        81


                                        90


                                        99
                                      19


                                      19


                                      19


                                      19


                                      19


                                      19


                                      19


                                      19
                                                 Year
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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