How does health connect with the independence debate? On the face of it, not a lot. After all, health spending has been devolved since 1999.
And yet when it comes to general confidence about an independent future, voters are not just assessing the plans of Alex Salmond. Consciously or unconsciously, they are also assessing the capacity of their fellow Scots. Are we mentally, physically and emotionally equipped for “going it alone?” Anyone on holiday with fellow Scots this summer will have seen first-hand what statistics can only assert. A fair chunk of us are smoking, eating and drinking ourselves into early graves – and that knowledge creates a deep-seated, little-discussed sense of foreboding. The poor physical condition of the average Scot is the elephant in the room of the constitutional debate. Why are Scots sicker and dying earlier than our British and European neighbours? Is it “just” the working-class West of Scotland? And can the rest “just” ignore a third of Scots?
We really hardly dare ask. Is there something inherently weaker, poorer and sicker about the Scottish way of life, climate or physique? Why does a nation exporting high-value foodstuffs cling to a starch, salt, fat and sugar-laden diet guaranteed to create health problems?
Why, with fabulous nature, do we spend so much time inactive and inside – unable to adopt the Norwegian adage: “There is no bad weather, only unsuitable clothing.”? Never mind the Scottish Parliament building debacle, the trams or the banking collapse, a general lack of wellbeing saps health budgets, public confidence, human vitality and political optimism.
The Glasgow Centre for Population Health has tried to unravel the “Glasgow Effect.” It’s found that current deprivation profiles of Glasgow, Liverpool and Manchester are almost identical. Despite this, premature deaths in Glasgow 2003–2007 were 30 per cent higher across virtually the whole population. Surprisingly perhaps, deaths from the “Scottish classics” – lung cancer and heart disease – were fairly similar in all three cities. Deaths through drug and alcohol misuse, suicide and violence were far higher in Glasgow.
Chief Medical Officer Sir Harry Burns is no politician but in a keynote speech last week he cut to the heart of this dilemma. “Sixty per cent of the excess premature mortality in Glasgow [compared to Liverpool and Manchester] is due to drugs, alcohol, suicide and violence. We are not going to fix that by reducing the saturated fat content in the diet. The treatment is psychological and social and returning control of their lives to individuals who have been alienated from society.”
Harry Burns is right – and that last sentence is massively important. It should change the face of Scottish society. Glaswegians’ life-shortening behaviour is almost certainly caused by despair over the statistically certain prospect of a passive, unfulfilling life and the cumulative effects of chronic disempowerment over centuries – factors which have not been fully recognised nor remedied by any recent government.
Despite our conceit of ourselves as a more down-to-earth, equal, fairer and community-oriented society than our southern neighbours, Scots inhabit a country whose structures make such egalitarian ambitions impossible to achieve. We have the largest council units in Europe with the weakest community tier of government in Europe (the average community council budget is £400). A thousand people own 60 per cent of our land, health and educational outcomes are rigidly determined by income and we have a legacy of housing as little more than a billet for the poorest Scots. Postwar Scotland offered its people council housing where space, indoor toilets and security of tenure also meant endless waits for repairs, few social amenities and no control over door knockers, let alone local life.
Other countries did much more. After the war, the Norwegian Housing Bank offered grants for self-build, since Norwegians were presumed to have the capacity to pool skills and build their own homes. Urban Norwegians were offered flats as co-owners within small housing co-operatives since it was presumed capable people would want a say in shaping their lives.
Also, what those different presumptions mean is tangible in Denmark where urban housing co-ops are the norm. Small two-person lifts have been retro-fitted on to the back of tenement closes so older residents can access any floor. Small district heating systems – fed by solar panels – keep fuel bills low. Restrictions on sale create a cap on house price inflation. Back courts have vegetable plots and play areas with swings and seats. All funded, designed and controlled by co-op residents. This kind of involvement, connection and genuinely local control over the truly local domain creates empowerment – the first prerequisite for good public health.
And yet empowerment is missing at every level for most Scots. By contrast we inhabit a “stand there till we fix you” society with top-down control by distant professionals. Those who have struggled against the odds in voluntary groups and development trusts are nothing short of heroic given the paternalistic direction of British and Scottish Government social policy to date. The community of Gowkthrapple in North Lanarkshire, for example has set up barbecues, cooking classes, computing courses and a shop supplying low-cost fruit and vegetables. The papers report that recorded crime has halved in a year.
Similar examples are legion. And yet such community projects are still pilots and one-offs dependent on the approval of larger, remote authorities for funding, permission and longevity. So it’s been for decades. The proof of the pudding is in the eating. If the Scottish Government presumed human capacity exists within every Scottish community, then structures would change to devolve control, jobs, power and democratic clout to that delivery level – as is normal in every European democracy. Instead in Scotland, we are still heading in the other direction. Services are still being centralised.
Big is still beautiful. Community is still an afterthought. The authorities clearly don’t have faith in the power of the people. We get it. The last decade could have been spent repairing the health, social and democratic damage created by centuries of structural inequality and cap-doffing feudalism. It hasn’t happened and that has political consequences. Passive, “done-to” people demand constant reassurance and fear new challenges. Active citizens running local communities are more upbeat about the prospect of more control.
Independent-mindedness is the vital quality missing in Scotland today. With a herculean transformation of outlook in the SNP, it could still be otherwise.