English title: Health and its determinants in Scotland and other parts of post-industrial Europe: the ‘Aftershock of Deindustrialisation’ study - phase two
Author(s): Martin Taulbut - David Walsh - Sophie Parcell - Anja Hartmann - Gilles Poirier - Phil Hanlon - Dana Strniskova -
Type: Report, working paper
This is the second stage of a research project which compares health and its determinants in West Central Scotland with a number of other post-industrial European regions. The first stage was published in 2008 by the Glasgow Centre for Population Health and NHS Health Scotland in a report entitled ‘The Aftershock of Deindustrialisation – trends in mortality in Scotland and other parts of post-industrial Europe’. Post-industrial decline is often blamed for Scotland’s – and particularly West Central Scotland’s (WCS) – enduring poor health status. The first stage of research, therefore, sought to: (a) identify other regions in Europe which had experienced comparable levels of deindustrialisation; and (b) collect and analyse long-term trends in mortality for all the identified regions. The results showed that mortality was generally lower in the other regions compared to WCS, and was improving faster. The aim of this second stage was to investigate the reasons why this was the case. Specifically, it sought to determine: • whether WCS’s relatively poorer health could be explained purely in terms of socio-economic factors (poverty, deprivation etc.). • whether comparisons of other key health determinant data could identify important differences between WCS and other regions. In addition, it drew on emerging results from accompanying research analysing the historical, economic and political context in key regions. This report presents analyses of a range of data across twelve post-industrial regions in Europe (four in the UK, four in western mainland Europe, and four in eastern mainland Europe). These analyses are underpinned by illustrative examples from more in-depth comparisons between WCS and four particular regions within: Germany; France; Poland; and the Czech Republic. These case studies are published separately as four accompanying reports. The principal findings of all these analyses are that: • The vast majority of the post-industrial regions share important characteristics: deindustrialisation causes economic and social upheaval, and impacts on population health. • The particular poor health status of WCS compared to the other regions cannot be explained in terms of current measures of poverty and deprivation: socio-economic conditions within WCS are similar to, or better than, many regions which have superior health profiles. • Time series data do not provide convincing evidence that historical poverty is responsible for current poor health outcomes in WCS. • Compared to other post-industrial regions in mainland Europe, income inequalities in WCS (and in the other UK regions) are greater. • Health inequalities also appear to be wider in WCS. • WCS also stands out in terms of a number of social factors: for example, proportionally higher numbers of its population live alone or as lone parents. • Differences are also apparent in relation to aspects of child and maternal health: for example, there are relatively higher rates of teenage pregnancy and motherhood, and higher numbers of low birth-weight babies in WCS. • Some of these distinguishing features – e.g. higher income inequalities, more lone parent households, more teenage mothers – are true also of the other UK post-industrial regions. These regions also share a recent economic history different to that experienced elsewhere in Europe. • Of all the other deindustrialised regions in Europe, Merseyside appears the most similar to WCS: it shares almost all the adverse social and economic characteristics listed above. However, what distinguishes WCS from Merseyside is a poorer health profile. What emerges from these observations is a picture that is only partially coming into focus. Poorer health in WCS can be attributed to three layers of causation. First, it is a deindustrialised region. This is a fundamental driver of poor health which WCS shares with all other regions that were part of this analysis. Second, by virtue of being part of the UK, WCS has experienced a set of economic policies and social trends which overlap with continental Europe but are, nonetheless, different in important ways. Chief amongst these are the more ‘neo-liberal’ economic policies pursued by the UK, higher levels of economic inequality and higher proportions of potentially vulnerable households. The third level has to do with unexplained factors which cause WCS to experience worse health outcomes than similar regions within the UK: in particular, WCS has worse health outcomes than regions like Merseyside which have remarkably similar histories and socio-economic profiles. That is why the picture is only partially in focus. The investigation is continuing with a programme of research focussing on the post-industrial cities of Glasgow, Liverpool and Manchester. Initial results are expected in early 2012.
Institution: Glasgow Centre for Population Health
Number of pages: 261