In this second seminar in Seminar Series 20, we reviewed how health inequalities have changed in Scotland over the past 20 years since the establishment of the Glasgow Centre for Population Health, our understanding of those changes, and what that means for ongoing efforts to improve health and tackle inequality.
Dr Walsh and Prof McCartney outlined exactly what has changed in relation to health inequalities over the period, and importantly what has driven those changes. On the journey to understanding where we are now and how we got here, they looked back at what the trends showed 20 years ago when Scotland’s health divergence from Western Europe (and Glasgow’s divergence from other UK cities) was becoming clearer, and discussed the detailed, comparative, UK and international research that followed. Bringing the talk to the present, they outlined the most recent, deeply
concerning, trends which have seen a new form of inequality emerge, and which urgently require concerted action to prevent these worsening further.
The seminar was Chaired by award-winning journalist, Dani Garavelli, who was joined by a small panel of respondents.
Hello and welcome to the latest seminar from the Glasgow Center for population Health supporting new approaches to improve health and Tackle inequality at this chaired presentation and discussion we explore Health inequalities and ask what’s changed and what now this event was chaired by journalist Danny garavelli presentations
Were made by Dr David Walsh public health program manager at gcph Professor Jerry McCartney professor of well-being economy at the University of Glasgow and panel members included Donna mil director of Public Health and health policy NHS Lothian and Dave moxom Deputy General Secretary of the stuc this seminar was recorded in front
Of a live audience in Glasgow as part of the gcph seminar series on the 23rd of November 2023 welcome everyone to this Glasgow Center for population health seminar in which D Dr David Walsh and Professor Jerry McCartney will explore Scotland’s deepening Health inequalities highlight the political drivers and look at
Policies which could help reverse the trend my name is Danny garavelli and I’m a freelance journalist who specializes and social justice issues I’m delighted to have been asked to cheer the event to be honest I say no to almost anything that requires me to stand up in front of
People but I said yes to this because Health inequalities and the low life and healthy life expect IES of our most deprived populations is something I feel deeply invested in last year the work of the Glasgow Center for population Health formed the basis of a chapter I wrote
For the Joseph rree Foundation back book broke about deepening poverty across the UK so I know how crucial a role the gcph has played in analyzing and exposing the problem and I’m as Keen as everyone else to hear more about the research and the possible ways forward before I go any further there
Are as always a few brief housekeeping points points to cover there’s no planned fire alarm if the alarm does sound the staff of the TIC will direct people to the nearest fire exits and must points the toilets are located on level one which is this floor H could
You please make sure your mobile phones are switched off or on silent and if you’re tweeting could you please use # gcph sm20 that’s gcph all caps same with a cap s at 20 finally the seminar is been recorded and will be available without audience questions on the gcph website shortly
After the event the link will be emailed to you and it’s been published and please feel free to circulate it to all your colleagues so back to the seminar itself first of all this afternoon we’ll hear from Dr David Walsh and Professor Jerry McCartney David is a public health
Program manager at the cph he’s responsible for leading a number of different research project programs within the center recently this has included a large body of work aimed at understanding Scotland’s and glasgow’s excess mortality studies of de-industrialization and health across European regions and other collaborative Research into the nature and causes of
And solutions to health inequalities all of which he’s about to talk about um Jerry graduated from medicine at the University of Glasgow and did his GP vocational training in Paisley while working as a junior doctor he completed an honors degree in economics and development at the University of London
After this he entered the Public Health Training scheme based initially at NHS Argy and Clyde and then at NHS greater Glasgow and Clyde during this time he worked on the 2007 eoli outbreak in Paisley performed needs assessments for communities in the East End of Glasgow
And did his MD at the MRC social and Public Health Sciences unit on the impact of the Commonwealth Games he also worked at the GP at the gcph where he produced the first synthesis of the causes of excess mortality in Scotland and Glasgow after their presentations
I’ll ask a couple of questions and then invite a response from our two panelists Dave moxom and Donna mil who I’ll introduce properly later we’ll also have some time at the end for questions from the audience so now if I could just invite David to come
Up okay thanks Danny can ibody hear me um I also tried to say no to speaking but I work for the organization so they wouldn’t let me um so this is the 20th seminar series which is a bit scary cuz I remember being at the first one which
Was 20 years ago and obviously in that time there’s been a whole series a whole run of esteemed influential and actually inspiring speakers and it’s terribly sad that that comes to an end today um there’s a couple other things I’ll just say quickly so Jerry and I are doing a
Kind of tag team thing it’s a kind of presentational version of bad cop good cop in the sense that I’m going to kind of do a lot of bad news by describing what’s been going on and then Jerry’s is going to give you a more kind of
Optimistic slant on how we respond to that and I’m just saying that because as I take you through the slides and you feel a sense of increasing Relentless misery and doom just remember that some good news is around the corner or sitting over there H and also I was
Asked to include quite a lot of stuff so there is quite a lot of stuff so my solution is always H to get through this in a manageable time is just to present it very quickly so just try and keep up if you can so we’re going to ask three
Questions the first is What’s happen to health inequalities over the last 20 years and I suppose as part of that is also what have we learned over those 20 years the second question is then you know why has that happened and then as I said Jer will be talking about what do
We do about it I’m going to kind of give you the answer before I go into all the detail so a little bit like the news before Sports scene or match of the day if if you don’t want to know the result Look Away now but in essence they’re not
Kind of happy answers um I did have a more profane answer but I was asked to tone it down um and the the answer to H why that’s the case is because of of politics because of political decision making and what I’m going to try and do
Is frame what I’m talking around um about around four examples of that okay and I’m hoping this will make some kind of sense I don’t need to worry about the third question because Jerry’s going to deal with that so um years ago when presenting to different groups and
Especially if it was groups or students that were from different countries I used to always kick off these Talks by saying asking the question you know what do you think of if you think of Health in Scotland um I stopped doing it because there’s only so many discussions
About the deep fried marsbar that you can have in one Lifetime and so instead I kind of kick off these Talks by saying well if you work in public health one of the things you think of is maybe headlines like this the sick man of Europe This is a frequently used
Headline in the Scottish media as you can see um and one of the interesting things about it I think is that if unlike a lot of the stuff you read in um the Scottish media especially open inverted Comm newspapers like the one in the middle is that it is as you know
True in the sense that if you look at some kind of summary measure of population Health like life expectancy as everybody in this room knows Scotland likes behind all the main kind of Western European countries and that’s true for men and for women what a number
Of people in this room will know but maybe some don’t is that part of the explanation for this lies with a much slower rate of improvement over time so this next chart and if you’ve seen this before this is updated H this next chart shows long-term trends in life
Expectancy M and life expectancy for all the main Western European countries and this goes all the way back wrong thing to the middle of the 19th century more or less to the present day just before Co hit and every red line is obviously one of the main Western European
Countries and if we just highlight the trend for Scotland there are two important things to note first as the slide said a second to go Scotland has not always been in this position of having lower life expectancy in the other countries and from the middle of
The 19th to about the middle of the 20th century we’re kind of in the middle of the pack of all these countries but then what happened over the next six decades or so is that although things generally continued to improve they improved more slowly meaning that by the end of the
Period we are in this position of having the lowest life expectancy in Western Europe now there’s two other quick things to say the first is there’s an obviously really weird change in the trend in the most recent decades and I’m going to pick up on that in the second
Half of my contribution and the other point to note is that that General Divergence of Scotland from the other Western European countries has been particularly acute since around the start of the 1980s or to be more politically accurate since about 1979 and I’m going to pick up on that as well
So the first kind of political framing if you like if of trying to understand these Trends is the fact that life expectancy in Scotland is comparatively low because of the impact of inequalities Scotland has lower life expectancy than elsewhere in Western Europe because we have the widest Health
Inequalities in Western Europe so the Gap in health terms between rich and poor is much wider here and if you think about it that therefore pulls down the overall average and I can throw lots of stats at you to show that that’s the case this is a study from 10 years ago
Don’t worry about the detail it’s just showing that that Gap in health terms between rich and poor is indeed much wider here than elsewhere this is a different measure called lifespan variation H for the sake of audience sanity I won’t try and Define it but it’s basically a kind of proxy for
Inequalities in life expectancy how much life expectancy varies across the population and as you can see Scotland stands out from these same Western European countries that we’re looking at and the really important point is that those same Health inequalities have widened consistently and considerably over that period in which Scotland has
Fallen behind all these countries so again if we go back to this measure of inequalities in life expectancy for all these same European countries the early period doesn’t really matter so much but I’ll just explain it so you understand the chart back in the middle of the 19th
Century obviously lots and lots of people people died very young so you had a huge gap across Society in life expectancy and then as living H circumstances improved Health improved that dropped dramatically and consisteny consist consistently across all countries but by the time we get to 1979
The UK as a whole but much more this Blue Line Scotland bucks the trend in terms of increasing Health inequalities over the periods both in a um absolute sense and obviously also relative to the other um countries and that’s really important because that’s what drives that trend of Scotland falling away from
The the rest of Europe as the overall aage is consistently pulled down why is that happened well it’s happened obviously because of the profound link between socioeconomic circumstances and health between socioeconomic inequalities and health inequalities and over that period Society has become a profoundly different place a profoundly more
Unequal Place Scottish Society but also the UK society as a whole whole and again I can throw lots of stats at you to back that up I can show you different Trends in socioeconomic inequalities this is a a kind of um subp part of that in the sense of looking at income
Inequality not around Health but just generally in society the gap between rich and poor and back in the 1960s this measure of inequality in Britain was jumping about a lot but it was low and it and it was it was going down effectively and then from 1979 Society just changed completely and
Become a much much more unequal place and it’s maintained or or worsened that ever since to the point where across all these countries Britain as a whole is the most unequal society and clearly at the risk of patronizing the audience that has been caused by political and particularly
Economic decisions that have that have driven all that so it was particular governments um that drove that initial increase but that’s been followed by other governments which have maintained or indeed worsened that possession I always forget about her I actually did have some amusing uh pictures of some of these um Prime
Ministers but I was advised to take them out I don’t know why I think maybe it’s the one with Cameron with the pig that was proven a bit too offensive however in understanding inequalities we also have to understand that in Scotland and particularly parts of Scotland there’s also a bit more to
Than that so there are other influences on top of those big UK wide macro effect effects which also further widen inequalities but those influences are all still very very political and so this is the second of the kind of political framings if you like that I want to talk about in terms of
Understanding different Regional Trends so going back to this chart H this is when the seminar series and gcph itself kicked off and at that point as we were working with gcph it was clear that that Divergence was becoming quite acute and we were trying to understand apart from
These kind of UK Trends you know what else was driving that country comparisons can be quite tricky though because obviously especially in an unequal country you have people living in quite different circumstances and in Scotland’s case it was really important to understand the particular de-industrialized nature of society
Which also drives different kind of Health outcomes so we were looking at this in terms of not country comparisons but rather trying to understand differences across other po industrial parts of Europe to give us a bit more of an Insight so to introduce this and I won’t go into detail but to introduce
This this is looking at inequalities in life expectancy across the 32 local Authority areas of Scotland as in any High income country we’re not an exception in this case the areas with the worst Health are those which were previously very industrial but which have since suffered profoundly from the effects of de-industrialization
The loss of so much industrial employment over the latter half of the 20th century um allar one of these dunde is obviously located in the West Central Scotland conurbation where we are today and in this study which is now a good number of years ago we were comparing
Health and health inequalities in this area with lots of other parts of Europe which had also experienced broadly similar levels of de-industrialization and the thinking here was to try and come up with more meaningful light for light comparisons rather than just those kind of harder country comparisons all that said um the
Analysis basically showed very very similar results to the country comparisons in the sense that at that time although life expectancy was again improving in the Scottish area it was doing so more slowly or it was dragging behind all the Western uh Western European post industrial areas and had
Actually been overtaken by the Eastern European industrial areas so again we were kind of bought of the of the Heap and in trying to unpick the reasons for that we did all the usual kind of quantitive analysis in terms of data collecting and number crunching and tree
Killing because we killed lots and lots of trees and Reporting all this which was probably unnecessary but actually some some of the main insights came from more kind of qualitative work looking at different kind of policies but in combination the totality of all the work just showed that the reasons for differences in
Health across all these broadly similar places was just all a bit different politics it was all about bit different political decision making and the extent to which they protected or did not protect health so from the number crunching we showed the income inequalities was again higher in the
Scottish and the other UK areas and again that’s important because it drives wider Health inequality pulls down the overall average again but more broadly there was just lots of evidence of better political decision making in these different parts of Europe compared to the UK and particularly compared to
The Scottish area that we were interested in I’m not going to go into detail but just very very quick examples in the French area we looked at which was an ex mining area in the north of the country there was good evidence that they had seen the threat of deindustrialization much earlier had
Responded much quicker and diversified their economy into into different techn Technologies meaning that they protected employment therefore protected wages therefore protected against poor health in the Polish area they just had better State investment H and they also mitigated against the effects of de-industrialization by increasing levels of Social Security to protect the
Income and therefore the health of the poorest and the most vulnerable during that transition very similar things happened in the Czech area we looked at where they also managed to retain a lot more industry and therefore protect employment protect wages protect the poor health and in the German area there
Was again evidence of better investment better planning etc etc so it wasn’t that all these different places did the same thing to be better than the Scottish place but there was an underlying overall theme that it was all about better better politics however on top of all that and
Again in understanding the scale of inequalities where we live from the national to the regional to the city level in glasgow’s case where we are today there are are other City level influences again on top of those other factors that you have to understand to understand the scale of
Inequalities but yet again we’ve shown in the stuff that we’ve done with gcph over the years that all that is also political so this is the the third of the kind of political framings if you like and this is about excess levels of deaths why mortality rates are higher
Than you may expect them to be in Glasgow this is what the media refers to as a a Glasgow effect what we refer to is X as mortality if you take only one thing from the seminar other than the amount of information I’m going to throw
At you at a rapid Pace it’s not to use that term because it’s quite a meaningless pointless term and I’ll come back to it just in a few seconds to introduce this part of the talk just go back to this slide of life expectancy across these 32 local Authority areas
And you don’t need me to tell you that the area with the lowest life expectancy is obviously where we are today but a really important point about that away from talk of a Glasgow effect or anything else is that the main cause of this is just poverty poverty is the main
Driver of poor health in any society it doesn’t matter if it’s Glasgow it doesn’t matter if it’s anywhere else and just to hammer home that point if we put that slide up in the top and just label it life expectancy and then pull in some data for these same areas which are
Basically data on poverty or deprivation you see that one is basically a mirror image of the other whenever you have high levels of poverty you will have worse health and in this case lower life expectancy and just to labor the point and move Beyond Scotland if you if you
Plot a measure of poverty along one axis and and life expectance in the other and you throw in the main UK towns and cities you see the tragic truth of the matter is that the greater the level of poverty in society the younger and average people die but the issue for
Glasgow is it’s always been a bit of an outlier and we spent quite a lot of time working with gcph in terms of understanding why it was so different from other broadly similar cities like Liverpool and Manchester and the answer you won’t be surprised to know but which we published
In the world longest report in 2016 was again it was just all political in this case it was a bit a whole series of historical political factors that had placed Glasgow at a much greater disadvantage to these other broadly similar places this in itself is about a 45 minute PowerPoint presentation so I’m
Not going to go into the detail of it but in essence there was a whole set of historical factors that thearch showed which had placed this disadvantage on Glasgow it related to lots of things like the fact that living conditions were worse in Glasgow historically anyway and that’s relevant in terms of
Understanding adult Health then but also adult Health today in part consequence of those worse living conditions there was evidence that um changes made by local government in the post-war decades had a much more detrimental effect on the people of of Glasgow in comparison to other cities like Liverpool and
Manchester this related to lots of things like the sheer scale of Slum um Demolition and H Demolition and slum clearance and and that’s important in the sense of of how it broke up existing communities it related to issues like building really really really poor quality housing this kind of housing was
Done across Britain but the evidence showed it was done on a much larger scale in Glasgow housing and affecting a lot more people in absolute and proportionate terms it related to building a lot more multi-story Flats relevant because of the evidence in the research literature linking this type of
Highrise living to poor mental health and there are clear evidence links between poor mental health and poor physical health and we just built a lot more of them and fundamentally it was also just about investing less money in key points in time and actually repairing and maintaining and looking
After these places where people lived so to describe this more simply looking across these three cities at different points of time although they all all had similar levels of income based poverty people in Glasgow are just living in worse conditions which obviously is has hugely important knock on effects in
Terms of health on top of all that there was lots of other things going on there was evidence about actions by the Scottish office which also had detrimental effects in terms of economic investment being moved out the city and there being a socially selective movement of people as well which had an
Impact on the composition of the remaining population I don’t have time to go into that today and by the time we got to the 1980s there was also evidence evidence that at that time a period of de-industrialization of widening inequality of increasing poverty that there were differences in how local
Government responded to those major major challenges of the time and without get into detail in essence there was a lot less done in Glasgow than the other places to actually looking after the poorest populations so it’s a very complicated story there’s lots of different historical nuances but it can
Be summarized I think effectively as it was all about politics and maybe a subheading is what that means is there’s no such thing as a Glasgow effect in the sense of being something different about people in glasgo it’s just another example of a political effect on health
Of which all the things I’m talking about today are are further examples of that as a quick aside and when we published that report in 2016 I spoke to lots of journalists and not Dany but lots of journalists at the time and tried to explain why this term glasow
Effect didn’t really mean anything it was actually quite an unhelpful thing and and asked them not to use it in the coverage of all their reporting of it and it was it was terrific how they responded by by not using it apart from in every single headline that there was
However that’s journalist for you no offense okay however Jerry and I are doing a lot of writing at the moment and he slags me off for using particular words too frequently one of them is however but however H to bring this up to date um all of that stuff all that kind of
Historical stuff that we kind of Unearthed during during those those basically the last 20 years I think is arguably overshadowed by what’s been happening much more recently and the impact of political decisions on health inequalities more recently is arguably worse than what we’ve seen in that longer period that we’ve been talking
About and this is referring to what I showed you earlier as this kind of weird change in the life expectancy Trend in the most recent period this has been referred to as a stalling of improvement of life expectancy I think language is really important here because I don’t
Really think a lot of people quite understand what’s been going on but indeed the background to all lies with headlines that were appearing prior to the pandemic about that very thing I sto of improvement in life expectancy both in Scotland but also in the UK and as I say I’m pretty clear that
People reading that maybe didn’t know what it meant and even if they read the detail of the Articles which was saying that life expectancy was now no longer going up quite as fast as it was before probably thought well does that really matter is it a big deal but if you were
Working in public health this was ringing all sorts of alarm bells for the very simple reason that in a wealthy Society be that Scotland be it the UK it just shouldn’t happen life expectancy should still be wiing up and conversely mortality rates I’m going to show you
Which are based on exactly the same data should still be coming down because the only time that’s not happened going back over over a hundred years as you can see from that last slide have been times of profound societal crisis times of War times of pandemic so this caused lots of
People including ourselves to try and dig into what was going going on and dig into the data to see what was going on and what Amer from that I think is is pretty horrendous so I’m going to start deliberately with England because an important part of the story is that it’s
Not just about Scotland it’s a kind of UK wide issue and I’m going to show you mortality rates for females of all ages but it’s the same picture for males and this is the long-term Improvement going back decades and decades so basically people living longer this goes back to
The 1980s but you could track it back decades and decades before that and in the early 20110 you get this so-called stalling of improvement this leveling off this kind of slowdown what’s really important is that this isn’t about those living in the least deprived areas uh there there’s a slight change in the
Trend but importantly mortality rates are still coming down but it’s very much for those living in the most deprived areas who are barely believably barely believably mortality rates stop coming down and actually start to go up at the risk of laboring the point in a country as rich as
England this just shouldn’t happen at all and this isn’t the you know the 1% or the 2% most deprived populations those on the on the periphery this is a fifth of the population of England for goodness sake the picture in Scotland on slightly different scale because
Mortality rates are a we bit higher to start with is exactly the same increasing death rates among the 20% most deprived areas in in this country if you dig into the data you see really sharp increases in female premature mortality rat among those living in the
Most deprived areas if you look at these exact same data for this city Glasgow you see a dramatic reversal of previously sharply falling mortality rates among those living in the poorer areas of the city all these starts to us up to co by the way but I’m going to
Update this one in a second just to show you the impact of adding in the two peak Co years if you go to edenburgh Edinburgh is a fabulously wealthy City so why have we got increasing death rates among men of all ages among those living in the 20% most deprived areas of
That City and if you look at male premature mortality there’s just dramatic things going on for example in dunde and as most of you will be aware all of these changes have coincided with the UK government’s austerity agenda which sought to cut frankly astonishing amounts of money from public spending
Including vital public services that everybody relies on but included in that H and more pentious is cuts of tens and tens of billions of pounds from Social Security Social Security in a civilized society is a safety net for people living in difficult circumstances if you take that safety net away what happens
Well what these data suggest are that people die and they die in increasing numbers and that now then becomes quite emotive language and so we have to be very careful Public Health in terms of what we are seeing is actually supported by the evidence is it evidence-based but
The answer to this question now is is just a huge yes it’s yes to all the international evidence that there exist around the impact of austerity it’s yes to all the UK evidence it’s yes to all the Scottish evidence if you don’t believe there’s lots of evidence there’s
Lots of evidence H and in a report we published last year led by Jerry H we did a critical assessment of all that evidence and it showed very clearly that the main drivers of these frankly appalling tra have indeed been UK government austerity measures which have impacted
Particularly on the poorest and the most vulnerable in our society as a quick aside H in a departure from our usual activities of writing reports like this that frankly nobody reads H we also produced a three minute animation with a a great company called media corop which is basically
The same evidence but a much more accessible format and I would encourage all of you to have a look and share it if you can I said I’d update one of these Trends and there’s a particular reason I want to do this so this is to
Include the the two peak Co years and this is the one I showed a minute ago for glaso and premature female mortality the one with this dramatic reversal of previously sharply falling mortality rates so it’s no surprise that if we add in the two peak Co years that these
Trends basically become worse but the point of showing this is actually just to pause for a second and kind of take a step back because what this is showing is that in Glasgow a city renowned for poor health and and high mortality rates if you go back over a decade what we had
Was kind of a bit of a success story in the sense for this particular population mortality rates were coming down but they were coming down more sharply in the most deprived areas so that’s a picture of narrowing inequalities if you like what we’re all trying to seek to
See and and to achieve and then you fast forward through over a decade of austerity and what we have now is death rates are higher in the most deprived areas than they were 20 years ago this is totally unprecedented I don’t think enough people are aware of it and it’s
It’s also just frankly horrible that impact of austerity I think is quite hard to overstate we’ve been doing a lot of work in this area but if you just think of a few things like food banks food banks are everywhere they’re in the news they’re they feature you see them every week at
The supermarket Etc prior to 2010 they didn’t really exist there’s been analysis done by people at headit W University just showing they didn’t really exist prior to 20110 now they’re everywhere child poverty rates which were coming down prior to austerity across the UK are now you know all over
The place I’ve shown you mortality rates if you look at measures like healthy life expectancy this is a how long people live in good health rather than just how long they live that should be going up it’s going down and in the poorest areas of Scotland people are
Only living in good health into their 40s when does a number become a scandal if you look at mental health trends for sections of the population they are going completely the wrong direction as well over the same period you look at maternal outcomes there are is decent evidence of the impact of
Economic stressors translated poverty on things like premature birth rates on low birth h both low birth weight babies we’ve been know to work around this as well and among the poorest areas we’re seeing a big increase in that as well when I said things weren’t good I wasn’t joking and this originally said
When I said things had gone to I wasn’t joking but that’s maybe more a more appropriate reflection so what do we do well uh the first thing I’m going to do is shut up in a minute and hand over to Jerry but because we’ve been writing a lot about this and doing quite
A lot and lots of talks and presentations I do kind of think about this quite a lot myself in terms of what we should do and my first reaction is always this one was just to kind of weep and then possibly weep some more in
Terms of what’s going on but I also do think very um sincerely that that there’s a responsibility to shout about this because I see I don’t think enough people know about what’s going on and the impact of the last 13 years years on inequalities and I think people are either
Unaware or maybe don’t care I think it’s more the former rather than the latter but I also think there are sections in society where maybe the latter applies so I’ll just say one last thing before I hand over to Jerry um obviously at the moment the co inquiry is going on um and
You don’t need me to tell you about the impact of covid on society aside from the whole kind of Economic and societal impacts on a more profound level I said I it’s very surprised there’s anybody in this audience who doesn’t either know someone or know of someone um who died
From Co during that kind of peakco period and what I’m about to say doesn’t take anything away from that but early on in in the in the pandemic Jerry LED some work which was basically comparing the at that point projected number of deaths from covid with the numbers of
Deaths we get from inequalities in the UK generally and if you look at the number of people who have died from covid that’s effectively the number of people who di from inequalities in the UK every year or two every year or two but we don’t have independent inquiries and we
Don’t have astonishing government responses to that situation we published another paper last year which showed that more people had died from austerity than had died from covid and we made a big effort to try and get that message out and we’ve got a great comms team
That were doing all sorts of things to try and get the message out and it was picked up in some quarters uh the guardian uh ran with it and of course the guardian retweeted it to that Guardian bubble of what does soel braan call them Guardian reading to F eating W
Karati orever she called them and so people in that kind of section of society saw it but we also had lots of interviews elsewhere and I did an interview with with the BBC and I did an OK interview and they ran with it at halfast 6 in the morning um but by
Halfast 7 that story had been replaced by the story of a new College course on keeping chickens so to an extent we’re operating in a parallel universe and that’s kind of why I think we have to weep before we shout I’m going to stop there and let
Jerry tell you something a bit more constructive and optimistic [Applause] thanks can you hear me okay yeah so thank you David um there’s only two things worse um than giving a presentation any time first is following David because he’s such a good presenter the second is having to provide good news are you
Just getting Echo and get Echo would I just bear with me so the third thing that makes it even more difficult is having to deal with an echo so I’ll switch this off hopefully this works okay so hopefully we can do it like this so um
Yeah I I’m to give you some some good news about how we might respond to the challenge so be kind to me here because it’s quite difficult to give good news in the context that David’s just um talked about so how might we respond to this challenge so the good news is that
We’re not starting with a blank sheet of paper there’s a very very long history of what we need to do to improve the health of populations and that goes all the way back to virtuals report on tyus in Upper cesia one of the the European areas that David compared West Central
Glasgow to and in that report actually they were talking about housing conditions economic conditions unemployment poverty even then in the 1840s we knew about what we needed to do to improve the health of populations and to reduce inequalities in health so we’ve got a long history here it goes
All the way through angle’s report on the conditions of the working class in England and in Manchester in particular more recently the Black report in 1980 the health divide by market Whitehead in 1987 Sally McIntyre’s brilliant report in 2007 updating all evidence around what works to reduce inequalities in
Health the who’s work led by Michael Marmet um first of all on a global level and then in a UK level about how to reduce inequalities again summarizing the evidence a great report I’m biased because I was one of the authors on this but a great report by NHS Health
Scotland in 2013 which again updated this evidence and there was also a series of reports done off the back of that for different groups like what can a a non-exact director of an NHS board do to implement things around Health inequalities and then there’s the reports that David already talked about
Which again had long lists of recommendations all informed by the evidence about what we needed to do so we’re not starting from a blank sheet of paper to summarize these reports are consistent all the way back to 1847 in Virtual so what’s changed is we’ve got a gradual
Increase in the depth and the quality of the evidence is triangulated across different data sets different teams different methods and it’s all pointing the same way the fundamental causes of inequalities in health are inequalities in income wealth and power and addressing those fundamental causes will make things better again and we know
That because that’s what happened in the first half of the 20th century in the UK when inequalities and income wealth and power reduced and inequalities in health also reduced some of us have argued that power is actually quite a good overarching framework here because it also incorporates economic power as a
You know very tangible way in which power is operating in society but it also includes more recent sort of evidence base around racism and discrimination of different forms and various um people in the room actually had contributed to a paper that describes how power is a good framing for operationalizing different actions
To reduce inequalities and health at different levels indeed shardon F who I think is coming to speak at a future seminar series event has operationalized very similarly in the Australian context and I would put that M to come and see her speak on that beyond that we know that action on
The fun the The Wider environment so whether that’s about employment conditions housing education um they all matter for health it’s not as effective as dealing with the fundamentals but it still matters and it’s still very important and we also know how important it is to deal with people who have much
Greater needs so sort of inclusion Health groups people who are homeless um people who have multiple health conditions that impact on them and providing bespoke services that meet those needs will also make a difference a lot of the reports that described really from Sally McIntyre and
Mara onwards have made a lot of um effort to look at the the evidence around what kinds of interventions work and especially the kinds of interventions that public health people have a bit more influence on because much as we might want to reduce poverty and much as we might want to reduce
Income inequalities often that seems a we bit out of of our grasp a we bit out of our agency but sometimes we have managed to introduce or be part of a system that introduces regulation legislation and specific taxations and we do know that they can be very highly effective at reducing inequalities in
Health but we must remember as summarized in the health inequalities policy review published by NHS Health Scotland that these kinds of actions where where they are addressing wider environmental causes or individual experiences will not solve this problem we need to deal with the fundamental causes such as lack of power and money
If we are to reduce inequalities in health I want to spend just a slide or two though talking about how we can sometimes get distracted in public health because I think it’s as important to describe what doesn’t work and what we shouldn’t invest money and time in as
It is to discuss what we should do there was a report published um earlier this year by the health Foundation which I I’m very very critical of and called leave no one behind and it described something uh of an implementation Gap as being the key problem in Scotland for why we have
Higher Health inequalities I don’t think we have an implementation Gap problem in Scotland indeed You could argue that these blocks here implemented the austerity program and the welfare reforms and averted commas that very clearly was implemented exceptionally well and led to the stalling in life expectancy and the
Worsening in life expectancy trends for the poorest groups so arguably we don’t have an implementation Gap we’ve got an implementation problem it’s just the wrong policies have been implemented but we’ve also had a series of programs in Scotland that were also about reducing inequalities in health
Such as the keep well program and we know now with hindsight that keep H didn’t reduce inequalities in health outcomes and it took us quite a long time to come to that conclusion and quite a lot of money was invested in that program we do have a really big deep
Evidence base about the kinds of things that work and do not work so for example here’s a Cochran review and for those that are not familiar with the Cochran Library they spend a huge amount of research time consolidating reviewing quality appraising and then analyzing the evidence for interventions across
All areas of healthcare whether it’s medicines and surgery um or whether it’s public health interventions and just for one example here there’s a huge systematic review and meta analysis here of whether opportunistic screening in Primary Care around cardiovascular disease improves health and reduces inequalities and the answer is a really
Clear no and yet that’s still part of the policy conversation in Scotland and yet we still spend time we still spend money there still opportunity costs about interventions that we know don’t work there’s also been a bit of a theme in Scotland about using Improvement signs inappropriately so you’ll see lots
Of reports about using Improvement signs to try assess whether an intervention is effective or not we wrote up in the paper here that that’s a really bad way of assessing whether something’s effective or not it’s a really good way of seeing if something that we know already Works has been implemented fully
But it’s a really bad way about assessing Effectiveness so we need to use the tools we’ve got effectively so back to where I think we do have some agency and we do have some influence in the public health system and I think it’s around this idea of the commercial determinance of health so
That can be any sort of industrial kind of in process whether that’s the food industry the alcohol industry the tobacco industry gambling things like that that has an impact on health and I want to tell a bit of a long story um about how we’ve been effective in this
Kind of Arena and if we think about the smoking ban there was about a 15 to 20 year cycle of us getting that in place and public health people people like you have been instrumental in making that happen and that is a really effective intervention that had an impact in
Reducing in qualities and smoking related outcomes including mortality but it took 15 or 20 years to get the evidence together to disseminate that evidence to produce that evidence in briefings and formats that different users could use whether that’s advocacy groups like ash Scotland or whether that
Was politicians or the media we had to resist the merchants of doubt the people who opposed that the the people who were making profits out of those kinds of Industries in this case the tobacco industry and be aware of all of the legal challenges all of the um
Misinformation all of the doubt that was created by the people that were set to profit from it and then of course in the case of the smoking ban we had the the Irish example where it was implemented in the first minister at the time and Scotland went across and was really
Impressed and thought actually maybe we can implement the smoking band in a Scottish context and then we implemented and we evaluated it and we found out actually this had a massive impact on a whole range of Health outcomes so it takes time it takes persistence and
Resilience but we all have a part to play some of you might have played a part in different parts of that cycle a similar 15 to 20 year cycle is just kind of coming to an end around minimum unit pricing for alcohol but we could talk
About this kind of 15 to 25 20 sorry 15 to 20 year cycle for lots of these commercial determinants of health and arguably we’re just a little bit earlier on that process for things like poverty reduction and austerity we’re still reviewing the evidence we’re advocating it disseminating it or resisting the
Merchants of Doubt but we’re just trying to get those politicians to get engaged in it and to implement that so that we can then evaluate those impacts and arguably in Scotland we’ve got some attempts in that way like the Scottish CH payment which is making a bit of a
Difference to mitigate against some of the austerity policies coming from the UK government so I think we need patience and persistence in tackling power as seen in the commercial dets of Health but I think there’s lots of scope for us to use more forms of legislation regulation and Taxation and we’ve got
Lots of evidence about the kinds of things that we works so it’s always astounded to me that we don’t use that evidence particularly well for example there’s a really good systematic review meta analysis that shows in the context of the USA of all places that bringing off licenses for alcohol into public
Ownership is a really effective way at reducing alcohol harms and alcohol related deaths and we’ve known this for 20 years but we’re not really discussing that as a possible option in Scotland why not well it cuts across a lot of commercial interests and a lot of power
But if we’re really serious about this lots of other countries do it Iceland does it lots of the Nordic countries do it why are we not introducing these kinds of interventions which are pretty much cost free that could have an impact on health and health inequalities we also need to address the
Obvious gaps in the commercial determinants like foods like landlords there are also new commercial determent of Health coming on all the time so gambling new forms of gambling like online gambling in game gambling vaping the digital media again there’s a lot of there’s a huge lack of regulation
In there and they’re all having Health mental health impacts but we the the sort of common theme through all of this is that we do need to address the power differentials within that and the commercial interests and that will be challenging we will end up in court I’m sure trying to persuade
People that the evidence is there that these things work but Public Health as a community has a role about providing evidence making that advocacy and giving politicians a bit of steal for acting because it can be difficult to make those kind of political decisions where they’re not always popular initially I’m
Not sure of many people would want to go back to Smoke Filled pubs I remember vividly coming back when my student days from going clubbing and my clothes absolutely minging of tobacco smoke nobody really wants to go back to that now I think we’ve also got scope to sharpen our understanding and
Recommendations when we are string into ideas about the economy and David’s talked a lot today about about polit politics and the economy and how we know that is fundamentally important to driving the trends in health inequalities we’ve done some work recently to understand and address um what we understand about economic
Relationships between social groups so quite often in the past we might have said we just need to reduce poverty we need to in include a new benefit we need to um perhaps change taxes and all of those things are true and we should do them but we need to also understand how
Money flows in society how flows through rental incomes for example from tenants towards landlords how profiteering a monopoly capture means that some people become very very rich and we don’t need to look too far to find billionaires in this world now who are making excessive
Profits from from many of us and all of these other um economic mechanisms too and the way to address these underlying economic relationships is about thinking about economic democracy and plural ownership of different parts of the economy there are colleagues within Public Health Scotland who are doing a
Review about what works to understand that and what the kind of Health impacts might be around that that’s a really live topic now but it’s also being implemented in different parts of the UK usually under the banner of community wealth building this is a study by a team at the University of Liverpool
Looking at the the city of Preston in Northwest England and Preston was the earliest adopter of the community wealth building approach and it involves a range of different things around using the procurement and Supply chains of the public sector and to try and make a difference to economic outcomes and
Reduce economic inequalities but it’s also about changing the ownership structure within local areas and trying to introduce more cooperatives workers cooperatives social Enterprises and more public ownership as a means of trying to stop that wealth leakage towards the very very rich and what this initial study finds is that mental health
Outcomes and self-rated health get a lot better when you EMP imp Community wealth building it’s a really robust study we also have opportunities in Scotland to get involved in conversations and make a difference around basic income around the minimum income guarantee I’ve been involved in policy conversations around that we’ve
Been able to use Public Health evidence in those discussions or live discussions as everybody knows around child poverty but we’ve also got an opportunity I think to study up and think about power inequalities in society and there’s a big literature out there I’m now sitting in a sociology Department rather than a
Rather than a public health department and I’ve learned a lot from my colleagues in those kinds of departments about how to do that kind of work how to understand the sort of Genesis and maintenance and replication of inequalities through power networks in society and I think that’s really
Important not least today when when this chap is made a decision about reducing employment in the the fourth Valley we’ve also got opportunities I think to try and get co- benefits because we know we need to make a transition really quickly if we’re to to avoid the worst excesses of climate
Change and biodiversity loss and we do know as well that it’s possible to get spin-offs so we can get health outcomes and Equity outcomes as well as sustainability outcomes with the right kinds of interventions whether that’s around moving people into public transport and active travel with our transport policies whether that’s about
Retrofitting our housing so that we can reduce our carbon improve our health and reduce inequalities so there’s an opportunity to get involved in those kinds of conversations I think so that we achieve the so-called just transition that improves Health as well in Scotland we’ve got this framing
Of a well-being economy and that’s a really useful framing for this kind of New Economic design but it’s contested and it could be um lifted and and misused by people who don’t share these kinds of um aims and so again within Public Health I think we’ve got a real
Opportunity to infest the public well-being economy discussion with evidence with data and with advocacy for health outcomes we’re not alone in thinking like this so so the who Council on the economics of Health for all published this report earlier this year and that commission is an all female panel and it’s come out
With really really clear recommendations about the need for a different kind of economy so they asked what would it take to create economies that serve these objectives I.E Health Equity and sustainability objectives rather than profit for a few how can we create metrics or outcome measures that reflect
What is ultimately of value and in doing so they’re challenging International institutions to think differently about what the purpose of an economy should actually be we’ve got good examples in Glasgow this is Green City H Foods I had the privilege to go and visit them last year
And do a podcast with them about how they work Green City is now 40 years old it employs almost 60 people it’s a genuine workers Coop where everybody has a say in how the um the workers CT runs everybody gets exactly the same pay it is the most fun workplace I have ever
Experienced in my life every morning when you go into their warehouse there is a debate about whether it’s going to be bagpipe music or Swedish House music that’s going to be playing in the background there’s a gorgeous area of the warehouse which has got all their spices but more importantly they have
Been making a difference across the supply chains of Scotland for 40 years now they Supply ethical Foods they Supply fair trade Foods they Supply vegan foods and they are genu ating Supply chains that meet the kinds of objectives I were talking about so they’re achieving Equity through the workplace practices they’re achieving
Sustainability by moving people away from high carbon food stuffs and they’re um achieving Health outcomes through the best practice around workplace and around income and Employment Practices so we have good examples we’ve got places we can point to and learn from and these are good stories good news
Stories that David asked me to talk about I’m going to finish just with a slide about what a population Health strategy might look like because the Scottish government have started a conversation about what that might look like as a means of coalescing these kinds of ideas and and in response to
The kinds of challenges that David laid out and I think fundamentally as David said we need to recognize that inequalities and power income and wealth are the central Challenge and in particular the role of UK economic policy in driving the health Trends and I think we need to recognize that but
Within a Scottish context it can be quite difficult to fully address that I think we need to think about our national performance framework and the national outcomes so what are we trying to achieve with policy across Scotland what actually delivers what those outcomes so if we were to say that
Health and health in equality and ecological sustainability were the outcomes were interested in would we then still have the same policies in place because at the moment GDP for example is up there at the top and it says well we need to have an economy that delivers faster growth that’s fine
If faster growth will achieve these outcomes but I’m not awfully conv vinced that that would necessarily be the case what would an economy look like if it was actually reorientated and designed to achieve Health Equity and sustainability I.E the genuine well-being economy and I think we should use evidence Effectiveness evidence to guide
Policy decisions we know a lot more now about what works there’s an increasing number of systematic reviews being done of the evidence around economic policy for example discounting things like the laugher curve which suggests that higher taxes actually reduced tax take we know that that’s not true from these kinds of
Reviews now we also need to use the capital Investments the amount of oneoff monies that we have to invest more sensibly for example we’ve got a massive Gap about getting housing retrofit so that we don’t have excessive energy costs across particularly our social housing why are we not using the capital
Monies that we have to invest in these kind of things that would have this one11 kind of outcome but more within the powers of people in the health department the Scottish government maybe we need to develop and Implement an Evidence informed legislative program across those commercial determents of Health
Both the old ones like tobacco because there’s more to be done on that but also the new ones like gambling like digital media so and so on and use the existing powers that we have around the public health act to um create the kinds of legislation that would improve health and reduce
Inequalities we need to deepen and broaden what our ambition is around Community wealth building for example we do an awful lot of research into Pharmaceuticals across UK and Scottish universities but that wealth is extracted by big pharmaceutical companies why don’t we have a an NHS board that deals with trials in
Pharmaceuticals we could retain that wealth within the NHS maybe we need to think more ambitiously around that I do think it’s really important that we disinvest I stop things that we know don’t work money is really tight people’s time is really tight we can’t afford to keep doing things that we know
Don’t work that can be one of the most difficult things for people like us to do but I think that’s one of the challenges that we need to engage in and then lastly I think we need to take Equitable Health Care seriously we don’t often in public health we spend a lot of
Time saying you know it’s a social determinance of Health it’s a commercial determents of Health it’s the economy and it is all of that but healthcare does also matter and we do need to think more seriously I think about how we make sure that is um Equitable towards
People’s needs and that includes a f Fus on inclusion Health includes the discussion around funding allocations and proportionate universalism providing according to need thank you very much to the gcph for the invitation to speak thank you to the huge number of people who have co-authored on all the the range of
Underlying Publications credit to whoever test tickle 89ers for the the the um the picture of St that I I knck there and also to cat Smith for the idea of using murals on my slides uh and thank you for not heckling I don’t don’t think I served one single Heckle so I’ll
Hand back over to Danny and I think we’re going to have a panel discussion now thank you so much to you both um I think even if you know I think you know an awful lot about Hyster hearing it h the impact outlined the impact on health
INE equality outlined and so starkly is pretty shocking and it’s there’s been a lot of food for thought there for me as a journalist as well and what I can personally do to change the headlines and and and change the narrative a little bit um I wonder would it be okay
Would you come up and join me thank you so so we’re very lucky to have um with us also Dave moxom and and Donna mil um Donna is director of Public Health and health policy at NHS loan and prior to joining NHS loan she was director of
Public Health and F she’s worked in children and young People’s Health in education within local authorities the voluntary sector Scottish government and the NHS and Dave moxom is Deputy General Secretary of the STD with lead responsibility for a wide range of policy areas including cost of living crisis just transition and transport
He’s represented the sduc on a wide range of bodies including the just transition commission and currently the Scottish government tax Advisory Group and fair work implementation group so thank you both very much for joining us I wonder if just if I before I come to
Them I could just ask um I mean one of the things I was thinking of while I was listening to you both was you know those the the it’s it’s very positive to hear that there are ways forward but in the climate we’re in just now the political
Climate I mean these require political will and we know that even politicians who are ideologically inclined towards tackling poverty and who talk a good game on progressive taxation tend to run scared when elections are coming up I wonder if you know is there anything that can be done to kind of encourage
Them to be braver what can we do H yeah um so I suppose in public health the main thing is about the evidence so so it’s not I mean I was speaking at a different thing last week and I had that on my slide saying we to shout about it
And that was kind of questionable there’s not much point just just shouting so it’s not just shouting but it’s actually saying as Jerry was pointing to that there’s there there’s just so much evidence around this now and it’s about trying to way people to understand the evidence
Um you know in terms of the whole kind of is there any money in the system people in because we talk about you know everything that’s going on cost of living Etc it’s kind of easy to forget that we are in a massively massively wealthy Society Scotland is
Massively Rich the UK is massively rich just obviously as we all know it’s all massively unequally distributed so it’s about trying to point to these facts and to the evidence of what’s going on to try and make people of a particular political persuasion especially if if especially at Westminster level there’s
Going to be a change in government to try and understand what’s going going on and try and understand that I think it’s their moral OB obligation to do something about it and do you think if people were more aware like you talked about if they were more engaged do you
Think people are more inclined to back higher taxation than politicians sometimes fear well there are public attitude surveys around this kind of thing and generally they do show a little bit more appetite than um than politicians sometimes portray but there’s also a kind of did I say a commercial deter of
Healthy which is the media so um we’re all I mean traditionally we would have got the media from you know newspapers and there’s obviously very skewed ownership structure around that and has become even more skewed over time in fact from what I gather now and I’m no
Expert on this we all see our news very differently because most of us now get our news from digital media and you know your Facebook feed or your Instagram feed or whatever will very different because it feeds you and pushes more and more of the same kind of stuff towards
You and that’s kind of what was getting to a degree around you know we need to think about digital media as a commercial determin of Health but also as a kind of commercial determinant of democracy and how that frames Democratic decision making because a key component
Of democracy I guess is having access to the truth and having access to the evidence is totally legitimate and important to people have different views and different values and different perspectives on that but there are some things that are just true and it’s you wouldn’t necessarily know that from from
The media that we have at the moment yeah it’s a better communication really it’s just it’s also about again it overlaps with the answer about evidence so there’s been a lot of stuff done cat Smith is in the audience they they’ve done she’s done a lot of work around
Where you speak to people you speak to panels of people do you think do you think you would be happy with these particular policies and they may have a particular view but then you shown the evidence of you know how that could be used to make Society better and you know
People do listen to the evidence and then change their views so I think it does come down an understanding of what’s going on and making people aware of what’s going on to a much greater degree so like you said sh about it Donna could I ask you I mean um
Obviously everything that Jerry and David said has been indictment of austerity policies in your many roles in health and education um you know what have you seen in the last decade how has it played out for you and um and what’s your response to what they’ve what they’ve been
Saying thanks Danny so um I’ve been frantically scribbling sure of course is that any better no I’m one of those gentle edenburg girls I think you know we don’t we don’t shout David we tend to get a bunch of folk in a room give them a cup of tea and then
Try and convince them that really really you do want to think the way we do and um the evidence we have in front of you is compelling and maybe you should take a we bit of action about it um so I’m just kicking off with that I when I saw
The slides earlier I was thinking I was thinking it maybe it’s a subtle message but it really wasn’t and in terms of the political stuff and Danny you’ve asked a question about what we’ve seen in the last 10 years and I I think things have just got harder in the last 10 years
They’ve got harder for everybody um not for everybody sorry but for those who um are struggling just to get by who don’t have enough money to live on who don’t have decent housing who are struggling to get good work and then those of us in the public sector who are trying to
Support them and to change policy and to improve people’s lives we’ve seen reductions in public service infrastructure and investment so you’ve got those two things together and I think that just makes it really really difficult I am though I did say to Jerry earlier on I am a glass hat fuel person
So I’m quite Keen to come on to the what to do B too so I mean what initiatives have you seen that do work I mean I’m thinking of things like the deep end you know grouping together the deep end surgeries community links practitioners what have been the things that you’ve
Seen that have have worked pretty well uh so I have some I guess I have some personal favorites that I’ve seen in other parts of the country and I’ve not always managed to get them delivered up here but and I don’t know if some of my colleagues around the room would agree
But I do think some things have shifted in the last three to five years in terms of how we think about things um both of you spoke I think about Community wealth building spoken about well-being economies we’re talking about anchors work I think some of that is capturing
An imagination and it’s also a bit more Tang ible than some of the public health stuff that we’ve talked about in the past so Danny I’ve seen examples whereby um Health trusts in England have tried to recruit and give people apprenticeships the young people coming forward have not been able to take the
Apprenticeship because they couldn’t afford their accommodation the trust has gone a step further and given them accommodation refurbished Hospital buildings and given them accommodation so they get a job they get a house and as a young adult that makes a huge difference and I don’t think we have
Made enough of that here in Scotland I’m hoping we will as part of our Anchor’s work so where there are positive developments you’re always fighting against the financial constraints so aren’t you even when those initiatives are brought in and and you’re saying we haven’t made enough of them here in
Scotland but even where they are brought in the next thing you hear is oh they’re going to be cut and and yeah so um is it hard to keep optimistic yes I don’t know never get up in the morning and think I don’t want to go to
My work so I must be naturally optimistic um I think we have a fantastic Public Health Community in Scotland I think we have focused on evidence we’ve got amazing data and we should be able for the size of this country to get our key folk in a room
And convince them of some of the things that we want to see happen so as I said Danny my glasses always half full um I I do think our government colleagues have a really tricky job job and trying to get these things into policy and then as Jerry highlighted so beautifully in the
Slides about smoking and minimum unit pricing we’re in it for the long game aren’t we in public health and it’s how do we get our allies who else do we need to speak to to to come with us on that longer term Journey because that’s what we
Need yeah and and and Dave I mean sometimes when I think about um Health inequalities and poverty maybe I think more about people who are unemployed employed and who are on Universal Credit and and facing all of that um but you’re seeing obviously employment precarity zero hours contracts people in low paid
Employment um you know how does that you know tally with what um David and Jerry have been seeing I was um um relatively pleased I suppose to find that Jerry’s Solutions slid the policy stuff um both in terms of kind of um direct interventions um smoking ban and others
But also some of the wider positions on everything from retrofitting to um to others do correlate with sduc policy it’s nice to come to a position from a different starting point I guess which is you know um how are our workers and their families fairing um in the jobs
Market but also out with the jobs Market we consider our mission to represent people in work um and out of work um and we have certainly been in uh influenced I think by the um by the inequality dialogue over the last um 20 years so you will see trade unions more than they
Used to what we call bottom protecting our wage claims so if you see most of the wage claims and we’ve been quite successful over the last a couple of years for a change you’ll see offers which are about ,000 or three or 4% whichever is higher so we have been
Trying to look um I think quite carefully at how within the workplace we do that and one of the problems that we face and we’re trying to address too is of course very often the people in the worst jobs are the ones who are least
Likely to be in a trade Union so we’ve been trying very hard recently to uh to find out ways in which we can collectivize Hospitality workers um we’ve been doing a lot of work recently um around the national care service and how we can lift Trade union membership
And obviously pay um in that in that sector too so we do see it as fundamental the workplace and work related issues as fundamental to this but we we don’t think that’s enough um and we do think that we’ve got a a role in wider public policy including Health
Policy which I’m happy to talk about till the cows come home but I’ll shut up just for a second I suppose I mean you’re talking about there some of the well Donna was talking about some of the things the initiatives you can bring in but we were also talking about how it
Has to be systemic and wider and um I wonder how you feel things like the Scottish child payment um and have made a difference in something like Universal basic income might make a difference you know are these and How likely is that to ever be a a realistic proposition yeah
Um two two different halves quite quickly answer to that yeah the Scottish child payment you know credit where credit is due the evidence says that it’s positive um we’ve been working with civil society organizations poet Alliance Tri poty action and others um to make sure that that’s the case no
Criticism I think everyone understand understands that it’s still quite at the symptom level that we’re dealing with that in terms of fundamental inequalities and poverty but you know you got to you’ve got to do what you can to deal with the symptoms and that’s certainly been positive you know we we
Don’t have I say we don’t have an issue with minimum income guarantees I think we’re a long way from winning the political argument it comes a bit about back to that discussion about Taxation and The Wider contribution that’s expected from society in order to Prov to provide everyone with that with that
Basic income I think you there’s a lot we can do and a lot we need to do um to win that argument and there’s an awful lot that we need to do over the next three or four years to change our whole tax base so that we’re taxing wealth a
Lot more um and income uh a lot less and we’re going to need to get rid of that horrible council tax as soon as we possibly can just to Chuck something in there so um the one of the themes of of this whole seminar series is it’s 20 years uh
Since the first one and 20 years ago there was all sorts of analysis done around child poverty and they used to there’s been books published as well and they would list like the top 10 worst places in the UK for child poverty in 20 years ago seven or eight out of 10 would
All be in Scotland and most of them are in Glasgow and now they’re not now they’re mainly in the northwest of England and it’s not that things are fantastically great here it’s just that they’ve got a lot worse than England and so this is about sort of mitigation um
And so things like Scottish child payment help enormously it’s clearly not enough everybody knows it’s not enough but it helps enormously and the trends South of the Border are way way worse I mean that’s interesting because sometimes you feel like there’s a negative narrative there that you know successive governments have have
Promised to tackle child poverty and nothing’s happened and and and yes it is only mitigation but I mean that’s something isn’t it yeah and I can’t really ignore the fact that we’re sitting here um the day after the Autumn statement and um I guess I’d like to ask
Everybody whether um there was any bright light at all out of it even increasing the national living wage and um and whether well whether it flies in the face of of some of the things you’ve been saying but obviously again we’ll be looking towards another government and what you would hope from
That uh yeah I still insist on calling get the national minimum wage not the national living wage um uh and it still falls short it was I guess in inflation terms it was roughly speaking what was needed if we take into account the inflation rate RPI rate on on the things
That poorest people buy most food food stuffs um and others uh the National Insurance cut will be of some assistance to to to lower paid workers but you know taken together it’s a it’s a horrible horrible budget um we’re talking well probably the next Chancellor of the next
Political party is likely to inherit um a a planed austerity program the likes of which um we’ve never seen so it’s an absolutely um uh it’s an absolutely dire State of Affairs um and one which you know I think the Scottish government can mitigate to some extent and it’s got its
Budget coming up and I wouldn’t want to be um uh Shona Robertson delivering the Scottish budget but we do think that there’s some things that Scottish government can still do um uh in terms of mitigation in terms of um uh um changes to the tax base which can
Mitigate what frankly is a pretty awful situation down south yeah I’m a kind of glass half empty kind of guy you may have noticed um but I there was there was an interesting thing on the radio yesterday which I went to check it was actually true because they were talking about the
Increase in the minimum wage you know they call it uh the the living wage and somebody was just saying but actually in Scotland 92% of employees are actually on the real living wage and I thought that can’t be right and I went to check and it does appear to be right according
To WS figures and I thought that was quite encouraging given the the big kind of drive from the Scottish government to get people signed up as real living wage employers and all the rest of it but generally speaking Yeah it’s not a happy thing and I think it would just point to
Jerry’s um slide around all the recommendations we we spent quite a lot of time in various reports H talking to people in like oxf and child poverty Action Group and coming up with sets of recommendations that have to be done at the political level and
And that that’s what we need to do not what was done yesterday effectively Donna I’m not sure I’m that hopeful actually after yesterday um I guess one of the things Danny that really disappointed me was um yes we saw the increase in around the living wage
And we saw that change and come in at age 21 I think instead of Age 2 3 what a missed opportunity to bring that lower that one of the fundamental inequalities that we see at the moment is just the way in which our younger folk are
Treated and we expect them to you know take on the jobs that we have at the moment to care for all of us in the future and we won’t even give them a decent pay for the job that they’re doing um so I was a we bit disappointed
I was kind of hopeful that one might have been picked up and then we slack them off top all left you’re in the Press in the med did you want something positive sorry was that was that okay so well it could have been worse it could have been worse so there
Was there was a fear that benefits weren’t going to be upgrated at all so you know I I was very worried that that might happen and that didn’t happen um but you know in the glass half empty side um not withstanding what David said the inflation rates that are felt by the
Poorest groups are much higher than RPI so we did a study looking at modeling or estimating how much the higher inflation that we’ve seen over the last couple of years was likely to impact on mortality rates and we estimated that inflation in 2022 would would increase mortality
Rates by 6% across the board but it was 8% in the poorest 20% and it was two or 3% in the in the richest group and that’s because a much higher proportion of people’s income in the poorest groups are spent on the things that were Rising quickly whether that’s gas or or food
And so actually the real inflation rate for most people who are on benefits is much higher than RPI and so they will see living standards drop further in the coming year not withstanding the other conditions that we’re also putting people’s benefits which will again be more likely to see people sanctioned and
Made destitute so it’s difficult to be too optimistic but I guess it could have been worse can always be worse do you see any signs that a labor government would be a a a great Improvement then you know are you are there any are there are there any policies that you can
Highlight it might like be a little light in the dark um yes okay let’s be positive so the labor party at UK level do still seem to be committed to new forms of public ownership around transport for example and that would reduce some of the rent seeking
Behaviors that we see from big companies like ariva Miguel yadada and um that could then you know improve employment conditions and reduce costs for the purus group so yes that might help a little bit was Jerry being optimistic and I’m going to ruin it so um I think one of the most
Dispiriting things I saw was the the discussion around the two child cap the two child benefit cap is sort of seen as quite kind of emblematic of austerity in terms of all the policies the the impact it had in in Driving Child poverty rates the there’s loads and loads of evidence
Around all this and so again it comes back to that word evidence so are people in the high levels of labor party just completely aware unaware of all that evidence I kind of assume so for them to say openly that they’re not going to do anything about that and that’s only one
There was there was in the first Parliament and from 2010 there were 150 different social security cuts made h i mean there’s astonishing thing was going on but there are certain ones which kind of really kind of echo um and really kind of relate to people and and the two
Child cap is one of them um and so it’s just quite kind of astonishing that that they they’re basically saying they’re not going to change anything but again I think that’s then becomes incumbent in all of us to and kind of making them change their mind and try and understand
As I said before the evidence of what’s been going on could you want to yeah I I’m I’m slightly pessimistic I mean there’s three things I guess that a UK labor government had broadly committed to although there’s been quite a lot of tempering of commitments is
Probably the kindest way to say it over the last um uh number of years I mean one was reform of care um and obviously that would reflect in Scotland in in in funding for a national Care Service you know some sometimes it’s these double win things because it’s better wages for
People who um who provide that vital service but it’s also about family community um cohesion and obviously about health um itself so that’s one thing we’ll be saying you were committed to that um the second I think is around um transport I think that you know the
Um the need for a publicly owned transport system including a bus system is abs absolutely vital and again it’s a kind of double plus Goods because it can be a job provider it can um uh uh assist with emissions um uh and um the third I guess is around energy and in particular
Retrofit in which um Jerry mentioned on the board there I mean a government Le municipally delivered retrofitting program is probably arguably the most transformational thing that we could do now people can argue about other priorities but you are providing decent jobs very often for the young people who
Are being left behind just now you’re dealing with or at least addressing fuel poverty and you’re addressing climate change all at the same time and one would hope that it would be very very difficult for a labor government not to not to hear those voices and and
Obviously there would then be knock on effects for the Scottish government depending on the the form of funding in terms of uh Bonet consequentials so you know let’s keep our eye on the prize although I’m not been filled with hope over the last year given some of the pronouncements that we’ve
Had thank you so [Applause] much