school by socio-economic characteristics of their parents or the area in which they live, it’s a gradient,” he told MSPs. Te UK nations, Marmot pointed out, perform badly against other OECD countries in tackling this gradient using tax and welfare. He recounted an encounter with an economist at the UK Treasury,
showing a graph of the gradient of inequalities in the UK. “He said, ‘Oh, don’t come to me with that Scandinavian nonsense
– we’re Anglo-Saxons here,’ adding, ‘We focus on the worst off. Tat’s the default position of British social policy, and this Scandinavian nonsense is not for us.’” Marmot said he was careful not to make political points, but to point out the political choice being made. “If the Chancellor says he is happy with that choice, that is absolutely fine. However, I feel a responsibility to say, ‘Tat will damage our children.’” As a doctor himself, Marmot said he adopts the thinking of 19th century German public health pioneer Rudolf Virchow, who said doc- tors were “the natural attorneys of the poor,” but his ‘proportionate universalism’ advocates universal services with spending proportionate to need.
Te NHS in Scotland operates such a model. Kirsty is born into a community which is likely to have several robust local initiatives, but her progress will depend on how Caley relates to them. If she is lucky enough to live in Inverclyde, Govan, Edinburgh,
Tayside or Grampian, she may have access to one of the Scottish Government’s new primary care test sites, which integrate local services and allow GPs to signpost to necessary support from the third sector, housing associations or elsewhere. Te latest such hub, in Lanarkshire, launched in March. Family nurse partnership, which gives quality one-to-one support
by family nurses to vulnerable families, operates in ten of Scotland’s health boards. However, at 24, Caley does not qualify for this support. Te Scottish
Government says it aims to expand the programme to support 20-24 year old mothers, but it will be too late for Caley. Dr Mullin says women at the Govan SHIP (Social & Health Inte- grated Partnership) project tend to attend their antenatal appointments. “Good antenatal care is really important, and we have the infra-
structure for that here. We would only get agitated by that part of the pregnancy if they weren't attending their antenatal appointments, not turning up, which is actually highly unusual,” she says.
Voices John Carnochan OBE QPM, Retired director of the Scottish Violence Reduction Unit Kirsty needs prevention
▏ Imagine if in Scotland we could reduce our inequalities in health and wellbeing, what would that Scotland look like? It would be a country where fewer people smoked, fewer people used heroin, there would be less binge drinking, less vio- lence and there would be fewer people in our prisons. All good. This also means that there would be less demand on public ser- vices, and the Christie Commission report in 2011 spoke of the need for public service organisations to prioritise preventative measures to reduce demand and lessen inequalities, so that's good too. I was a police officer for almost 39 years
and most of that time I was working as a detective investigating serious crime. I learned that the most effective way to solve a murder was to follow the evidence, step by step, to understand what we know and respond using that knowledge to the next step and achieve our purpose, solve the murder. In Scotland we have an excel- lent and enviable detection rate for murder.
22
www.holyrood.com 23 May 2016
That same evidence-led methodology applies equally to prevention; understand what we know and respond using that knowledge to achieve our purpose. Our purpose today is to ensure a better future for baby Kirsty. We know that adverse childhood expe- riences or ACEs, have a significant and lasting negative impact on our life course. ACEs include being the victim of physical abuse, sexual abuse, domestic violence, parental separation, emotional neglect and emotional abuse or living with an alco- holic or drug abuser or having a parent in prison. A child who is the victim of any of these
ACEs will be significantly disadvantaged throughout their life. A recent ACE study in Wales concluded that a child experiencing four or more ACEs compared to a child experiencing none was: • 2 x more likely to binge drink • 3 x more likely to be a current smoker
• 5 x more likely to have sex under 16 years
• 7 x times more likely to be involved in recent violence
• 11 x times more likely to have used heroin or crack cocaine
• 11 x more likely to have been incarcerated.
We must consider all our public policy within the context of prevention and develop our strategic planning through the lens of adverse childhood experiences and if we do this, we won’t have to imagine a Scotland that is less unequal, it will be a reality. I realise there is a fine line between
vision and hallucination, but this is a vision founded on evidence. It can be made real,. Follow the evidence, Kirsty deserves it. ⌞
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48
