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Institute of Health and Wellbeing Early Career Researchers' Blog

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  • Aug 14 / 2015
  • 0
Academia, PhD Experience, Ruth Agbakoba

…it’s nice to see you, to see you nice! How to get the best out of a world congress

Photo by Korean Culture and Information Service © 2010. UNESCO WCAE. From Wikimedia Commons.

Photo by Korean Culture and Information Service © 2010. UNESCO WCAE. From Wikimedia Commons.

By Ruth Agbakoba

You may be thinking that this week’s blog post is a tribute to Sir Bruce Forsyth or a reminder of the classic TV show ‘play your cards right’! I know!! L “Come on down” Unfortunately and I’m sorry to disappoint you but it is not entirely. Hopefully I have succeeded in getting your attention though! In my previous post I talked about my ‘five top tips for writing a conference paper’. Now your paper has been accepted (congratulations!) and you are due to attend this amazing conference! What do you do next? Well the purpose of this post is to really highlight and capture how best to participate and gain the most value from a research conference in particular a World Congress. Continue Reading

  • Jul 29 / 2015
  • 0
PhD Experience

Lions and tigers and theses! Oh my!

By Olivia Kirtley:

Blog posts and advice columns about writing your thesis abound and the vast majority speak about it with great reverence; it isn’t just a thesis, it’s “The Thesis”, “The Big Book”, the Goliath to your David, the magnum opus of the last 3 or 4 years of your life. The thesis as a portrait of academic Herculean struggle can strike fear into the hearts of many PhD students. It feels like an unknown, a dark forest with lions and tigers and bears, but perhaps writing your thesis isn’t as scary as it first sounds?

Oil can!

Just like the Tin Man, if your writing is going to go smoothly, your writing skills will need regular oiling, which means…more writing! From the very start of your PhD, if you do a systematic review, try and write it up for publication. If you have data, write it up for publication. If someone “scoops” you and publishes that dream study that you have carefully planned in your head for months or years, why not blog about it or write a commentary on it? Reports, book reviews, blog posts, articles for the university magazine; all of these things will keep your writing skills from becoming squeaky. I was very lucky that I had the chance to do quite a bit of writing before starting on my thesis and I definitely feel this made it a lot less terrifying. Having received feedback on my writing from my supervisors and peer-reviewers meant I was aware of areas where I could strengthen my arguments or stylistic holes I may fall into. Obviously, you can write things without showing anyone, but opportunities to get feedback on your work are truly invaluable. Take some lion courage and let other people look at your work. Your future self will thank you.

If only I had a brain! But don’t forget to have a heart.

There is something about the prospect of writing a thesis that can make one feel completely overwhelmed. Maybe it is the idea of writing so much, the amount of time it will take, having to weave together all of your work into one story, or indeed, all of the above. How will you accomplish this? If only you had a brain. But you do! You designed your studies (or at least had some input into them, if it was a pre-organised grant), you have worked with your data, you have read all the papers. You are the expert! Own your research (warts and all) and tell its story.

But also don’t forget to have a heart. Why did you do this research? What does it mean to you? What could it mean for other people? By the time you get to the stage of writing your thesis, it is easy to feel tired and jaded, but take some time to remind yourself why you love your research. Not only will this enthusiasm shine through in your thesis, making it much easier to write and also for others to read, it is this love for what you do that will see you through the long nights and working weekends of your final year. Thinking about the hundreds of people who have shared some of their most private and painful experiences of suicide and self-harm with me, is the strongest possible motivation; my thesis is made up of their stories and I have to tell them with my data. Maybe the contents of your petri dish will cure cancer? Maybe your research could change policy and help millions? Always have a heart and always put that in your research.

A hippopotamus? I’d thrash him from top to bottomus!

When your thesis is finished and in its nice shiny binding, it is a big book. But, before that point, it is a much smaller beast. Your thesis is made up of chapters, and these are made up of sections, containing sub-sections and sub-sub-sections; small chunks of writing that when all fitted together, will form the complete picture of your work. When I first began to write my thesis, I would set up a blank word file for each chapter and write in the major headings, e.g. abstract, introduction, methods, results, discussion and conclusions. Then I would go back through again and add in sub-headings for each of these sections. In the introduction of a chapter, for example, I may have sub-headings for self-harm, self-harm and physical pain, self-harm and emotional pain, the relationship between emotional and physical pain, etc. These sub-headings could change and I often found myself adding more in as I wrote. Sometimes I would sit down to write one sub-section and then realise that actually I got through it more quickly than I thought I would, so I went ahead and started on another sub-section. Your thesis ends up as a hippopotamus, but that’s not what you sit down to write. A little bit at a time, persistently plugging away writing small sub-section after small sub-section will eventually turn into a finished thesis.

Writing your thesis will be hard, but it doesn’t have to be terrifying. As long as you keep putting one red slipper in front of the other, you’ll be in Emerald City before you know it.

  • Jul 16 / 2015
  • 1
Academia

On sharpening knives, stigma and mental health

By Tiago C. Zortea:

Ten years ago, in the second year of my undergraduate course in Psychology, I came across a short book chapter that caused me to rethink many of the ways in which I understood mental health: The actress, the priest, and the psychoanalyst: The knife sharpeners, written by the Brazilian Professor of Social Psychology Luis Antonio Baptista [1]. Baptista uses the examples of an actress, a priest and a psychoanalyst to explore how ‘public opinion makers’ can indirectly contribute to intolerance and violence against those who they do not consider ‘standard’, ‘holy’ or ‘normal’ respectively. According to the author’s metaphor, they are not directly involved in these people’s death, but they ‘sharpen the knives of the crimes’.

Since then, I have asked myself many times whether I am a ‘knife sharpener’. Do the things I do and say, in some sense, contribute to excluding people from society? Am I categorising people into personality profiles or groups of symptoms that mean they identify themselves as being either ‘normal’ or ‘pathological’? What kind of approach do I take towards mental health and what are the consequences of this approach in people’s lives? The more I study, the more concerns I have about the implications of my words on people, especially on the general public. Diagnosis criteria can be easily misunderstood, particularly when the topic is mental health. It is critically important to be careful when talking about psychiatric diagnosis in a public forum (e.g., on television, at public engagement events). It is from misunderstandings and insensitive perspectives on mental health that popular and stigmatising notions of ‘normal’ and ‘pathological’ are born. In 2014, Professor Peter Kinderman, President-Elect of the British Psychological Society published a fantastic book entitled “A prescription for psychiatry: Why we need a whole new approach to mental health and wellbeing” [2]. Among several issues regarding mental health, Kinderman alerts us to how problematic certain labelling practices can be and suggests we should stop dealing with “people’s distress as merely the symptom of diagnosable illness and instead develop a more appropriate system for describing and defining people’s emotional problems” (p. 48).

Baptista [1] examines how stigma can be reinforced not only by specialists but also celebrities and certain conservative religious institutions. It is important to remember that until the 1970s, homosexuality was listed as a mental disorder in the DSM (Diagnostic and Statistical Manual of Mental Disorders) classification [3], and several religious institutes based their arguments on DSM to state how each gender should behave and to to justify their position that same sex relationships were abnormal and unnatural.

On the 17th of April 2015, BBC Panorama showed a documentary entitled “A Suicide in the Family” [4] and one of the interviewees, Matt – a young man who tried to end his own life – said: “I’ve always been a quite expressive person, if you like… I’ve been sort of, quite effeminate maybe? It did not really fit in with my group of friends, sort of things. I always felt like an outsider looking in. That was obviously difficult because when you’re growing up, nobody likes to be an outcast, do they?”. Notice which topic Matt chose to bring up to the conversation where the main theme was suicide. He could have mentioned numerous issues such as unemployment or family problems, but he chose to describe something that he had experienced since he was a child: feeling rejected for being an expressive person. ‘Effeminate’ was the label. Matt grew up learning that in order to be a man he was required to fulfil a list of behaviours and modes. For those who couldn’t respond to the requirements, something was wrong, strange, unnatural or abnormal. Fortunately, Matt asked for help and received support.

As a mental health professional, I understand that one of my most important tasks is to work hard to end stigma. One of the many possible ways to accomplish this is by praising human differences; Emphasising that there are innumerable ways to be a human and they can’t all be fit in boxes or separated by social labels. There are expressive people like Matt, and there is nothing wrong with that. We all have different backgrounds, different genders, different bodies, different abilities and disabilities, different beliefs, different moods, different ways of expressing ourselves, different tastes, and different trajectories. All we have is difference! We are rich in diversity, but as society we insist in creating social categories and excluding those who do not fit in. This indicates our difficulty of dealing and living with our differences. Perhaps we could encourage ourselves to make small changes to challenge this; we could push our boundaries, expand our acceptances and understand that social exclusion and stigma kill people. We could develop more empathy. We could save lives.

References:

[1] Baptista, L. A. (1993). A atriz, o padre e a psicanalista: Os amoladores de faca. In L. A. Baptista. A fábrica de interiores. Rio de Janeiro: UFF.

[2] Kinderman, P. (2014). A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing. Palgrave Macmillan.

[3] Homosexuality and Psychology. (n.d.). In Wikipedia. Retrieved July 15, 2015, from https://en.wikipedia.org/wiki/Homosexuality_and_psychology#cite_ref-3

[4] Sculthorp, T. (Producer and Director), Thomas, C. (Editor), & Jack, S. (Reporter). (2015). A Suicide in the Family [Documentary]. United Kingdom: BBC One. From http://www.bbc.co.uk/iplayer/episode/b05rcrx0/panorama-a-suicide-in-the-family

  • Jul 01 / 2015
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Academia

What Twitter can tell you about our health: Some insights from the 17th International Symposium for Health Information Management Research 2015 (#ISHIMR2015)

By Siobhán O’Connor (@shivoconnor):

The 17th International Symposium for Health Information Management Research 2015 (http://www.ishimr2015.com/) was a real eye opener for me as I got an insight into the power of Twitter analytics and how it can be applied in public health research. A poster presentation by Professor Peter Bath (@PeterABath) from the University of Sheffield on one of his doctoral students’ work demonstrated the value of this amazingly powerful digital health tool. Wasim Ahmed (@was3210) the PhD student in question is using Twitter to understand the Ebola outbreak in Western Africa by collating all the hashtags on #Ebola.

IHAWKES blog 1

Speaking to Wasim after the presentation I was shocked to hear his dataset was in the region of 26 million!!! No small feat for a PhD student to get to grips with. Not surprisingly his poster described the methodological challenges with gathering and analysing this data and some possible solutions for other researchers to follow in the future. No doubt Twitter will become an important data source for numerous health related topics, in particular global health, as more people get online and share their experiences and ideas on the platform. Researchers are only starting to tap into its potential to monitor health related events as they happen in real-time and the wide ranging impact they have on people across the world.

IHAWKES blog 2

Determined to show me some of the nifty analytics that could be done on Twitter, Wasim encouraged me to tweet through the conference at St John’s University in York and showed me his results at the end. It turns out you can very quickly do a lot of clever things on the back of Twitter data such as network analysis and visualisation through a free open-source (love it!!) piece of software called the NodeXL (@nodexl) which creates network overviews and graphs of data through Microsoft Excel. It’s such a quick and easy process that Wasim had the analysis of all the Twitter chat on #ISHIMR2015 done by that very evening the conference finished, after I’d returned to the University of Manchester two hours later. What a turnaround – if only all research analysis was that quick and easy!! PhD students would be laughing!

IHAWKES blog 3

As it turns out, thanks to Wasim’s subtle prompting I became the “most influential” Twitter chatterer at the conference thanks to retweets and favourites by other people who were attending and following online. As you can see from the more advanced analysis image the main discussion revolved around one of the plenary speakers, Professor Frances Mair (@FrancesMair), from the University of Glasgow, and her talk on “Bridging the Translational Gap: Key Issues in Health Informatics Implementation” as she raised several thought provoking ideas around treatment burden and how digital tools can both add to and reduce this for patients.

Well it’s certain, Twitter is becoming an important digital tool that will not just help patients in the future but also public health agencies and frontline doctors, nurses and other staff on the ground by providing them with rich data from which they can make critical decisions to solve health issues facing our society.

  • Jun 17 / 2015
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Current Research

Enabling patient-centred care through information and technology

By Siobhan O’Connor:

A snapshot of this year’s Kings Fund Digital Health and Care Congress in London highlighted the focus on enabling patient-centred care through information and technology. Beverley Bryant, Director of Digital Technology for NHS England outlined the NHS’s Five Year Forward View and the Department of Health’s Personalised Health and Care 2020 framework. These two important strategy documents outline how health services in the United Kingdom will be transformed through information technology over the next fives years.

***

Mike Clark ‏@clarkmike  4h4 hours ago

#kfdigital15 @Beverley_Bryant Director of Digital Technology – plans to enable patient-centred care – underpinning @nhsengland strategies

****

At the heart of these are a number of key commitments including:

  • Patients will have access to and write into their health records,
  • Citizens will have a single point of access to all their health transactions,
  • NHS111 urgent care services will be digitised and linked to nhs.uk,
  • uk will be customizable to reflect specific local needs,
  • Personalized, mobile care record for parents of newborns will be tested,
  • The impact of digital developments on inclusion and equity across the care spectrum will be considered,
  • Individual digital care accounts will be piloted.

These promise to address some current issues between health and social care such as a poor ‘customer’ experience, digital exclusion, security concerns in relation to accessing health data, the modernization of the underlying technical infrastructure and working across professional silos among others.

***

Amit Bali ‏@amitkbali  4h4 hours ago

@Beverley_Bryant describes need to modernise way we offer services – the public want it. Usability vs security balance is key. #kfdigital15

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Ali Rogan ‏@AliRogan  4h4 hours ago

#kfdigital15 important to learn from banking industry for citizen confidence in data security. @beverley_bryant

***

siobhan kings

In particular, Beverly highlighted the progress made in primary care with greater flexibility in booking GP appointments online, better access to electronic prescriptions, more ways to communicate with family doctors over web-based media and now plans are underway to enable patients to register with a GP practice online to further reduce bureaucracy and remove barriers to access for citizens.

***

The King’s Fund ‏@TheKingsFund  4h4 hours ago

.@Beverley_Bryant: we’re aiming to enable people to register for GP online – more convenient and save admin burden #kfdigital15

***

The crux of her discussion was taken up by Dr Paul Rice, Head of Technology Strategy for NHS England, who went on to outline a roadmap for local delivery of these strategies in the form of a digital maturity programme. This requires NHS trusts to have a number of key organisational capabilities including decision support, asset and resource optimisation, remote and assistive care and citizen activation. Some practical examples were given of current roadmaps in Bristol and Cumbria to demonstrate how trusts can move towards a paper-free environment by 2020.

***

Siobhan O’Connor ‏@shivoconnor  4h4 hours ago

@paulricenhs talks digital maturity in the #NHS pockets of excellence will spread “paper free” by 2020 #kfdigital15 @TheKingsFund

***

So what does all this mean for researchers in the health and wellbeing fields? Well as always, robust evidence is required to underpin these new approaches, validate them as worthwhile investments and explore their impact on the health and social care landscape in the UK.  So if you have an interest in all things eHealth then check out the presentations from all the speakers at this year’s King’s Fund conference here.

***

The King’s Fund ‏@TheKingsFund  4h4 hours ago

Patients in control of own info is ‘on roadmap’ says @PaulRiceNHS. Doc/patient views on online records: http://www.kingsfund.org.uk/reports/thefutureisnow/#patient-and-doctor-views #kfdigital15

  • Jun 03 / 2015
  • 1
Academia, Current Research, David Blane

Public health, health inequalities and neoliberalism

Photo by Darko Stojanovic. © Dec. 10, 2014. © CC0 Public Domain via Pixabay.

Photo by Darko Stojanovic. © Dec. 10, 2014. © CC0 Public Domain via Pixabay.

By David Blane

Neoliberalism is bad for your health.  That was the take-home message from Professor Paul Bissell, the invited speaker for the Institute of Health & Wellbeing’s Maurice Bloch seminar series on April 20th 2015.  Prof Bissell began his talk by summarizing the now familiar arguments of Richard Wilkinson and Kate Pickett, from their book The Spirit Level.  Their main thesis, supported with considerable empirical evidence, is that those advanced capitalist countries with the greatest income inequality do worse across a range of health and social outcomes compared to those that are more equal (a case also made in a recent IHAWKES Election Special guest blog by Professor Andy Gumley). Continue Reading

  • May 27 / 2015
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Anna Isaacs, Current Research, Methods

Is there a ‘cognitive dissonance’ in public health research and if so how can we address it?

Photo by Leroy Skalstad. © 2015. © CC0 Public Domain via Pixabay.

Photo by Leroy Skalstad. © 2015. © CC0 Public Domain via Pixabay.

By Anna Isaacs

It has been seven years since the WHO Commission on the Social Determinants of Health launched its report demonstrating categorically the profound impact of social and economic inequalities on health outcomes and declaring that “social injustice is killing people on a grand scale”.  The powerful effects of socioeconomic, structural and political influences over individual behaviours on our health are well known and well discussed. Yet, so often in public health research, we seem to park this knowledge at the door and continue working on behavioural health interventions that bring minimal, short-term benefits, if any at all. We may nod to the importance of culture, or socio-economic status, or even incorporate a socio-ecological perspective, but it is incredibly rare for such research to challenge, or even examine, the more fundamental factors that result in ill health. Continue Reading

  • May 20 / 2015
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Matt Jamieson, PhD Experience

Networking advice for introverted researchers

Photo by Samuel Zeller. © 2014. © Creative Commons Zero via Unsplash.

Photo by Samuel Zeller. © 2014. © Creative Commons Zero via Unsplash.

By Matt Jamieson

Every researcher has to network in order to develop their career. However for some this can feel like a difficult and potentially stressful task. Personally I find the idea of approaching admired professors and researchers at conferences daunting, and the prospect of engaging in intellectual conversation as equals seems unlikely. A bit like trying to impress Beyoncé by challenging her to a dance off. With this in mind I asked a few more experienced colleagues how they networked successfully at the beginning of their career and curated together the following pieces of advice: Continue Reading

  • May 06 / 2015
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Current Affairs

IHAWKES election special part III: Professor Rory O’Connor

Have the major Scottish political parties prioritised mental health in their manifestos?

Although nearly half of all ill-health among people under 65 years of age is attributable to mental ill-health, it is estimated that only about a quarter of those with mental health problems are in treatment (Centre for Economic Performance, 2012).   In addition, a recent analysis has revealed the historic and chronic under-funding of mental health research in the UK (MQ Research, 2015). Add to this the rising rates of suicide in the UK; there are approximately 6,000 deaths each year, with more than three quarters of all suicide deaths accounted for by men (ONS, 2015). The personal costs of suicide are devastatingly clear but many people do not know that the economic burden of suicide is also vast. Take Scotland, for example: it is estimated that the economic and social cost of each death by suicide is £1,290,000 (Platt et al., 2006).   Taken together, it is self-evident, therefore, that the challenge of improving mental health research and treatment is urgent and long overdue. In recent months, mental health has become more visible on the political agenda. However, I was keen to look beyond the media representation to investigate to what extent mental health features in the manifestos of the four major Scottish parties (based on having MPs and/or MSPs). To do so, I simply searched for any mention of mental health in their manifestos. Here’s what I found:

Scottish Conservatives (http://www.scottishconservatives.com/wordpress/wp-content/uploads/2015/04/Scottish-Manifesto_GE15.pdf)

There are two mentions of mental health in their manifesto. They will “provide significant new support for mental health benefiting thousands of people claiming out-of-work benefits or being supported by Fit for Work.” The only other reference to mental health is in terms of using social impact bonds and payment by results with a focus on mental health (as well as youth unemployment and homelessness).

Scottish Greens (http://www.scottishgreens.org.uk/wp-content/uploads/downloads/2015/03/SGP-Westminster-2015.pdf)

There is only a single mention of mental health in their manifesto. The Scottish Greens aim to improve both physical and mental health by tackling poverty and health inequalities including via the Living Wage as well as affordable housing and a fairer social security system.

Scottish Labour (http://www.scottishlabour.org.uk/blog/entry/the-scottish-labour-manifesto-2015)

There are 12 clear references to mental health in the Scottish Labour manifesto. They highlight the scale of the challenge of mental health as well as the 10-fold increase in young people waiting more than a year to be treated by mental health services. They also mention the issues of parity of esteem with those with physical health problems as well as the need to address the, often debilitating, consequences of mental health stigma. They pledge to invest £200 million in a new Mental Health Fund to help those who are vulnerable and to “improve child mental health by focusing on prevention and early intervention.”

Scottish Liberal Democrats (http://www.scotlibdems.org.uk/manifesto2015)

A document search yields at least 17 hits for mental health within the Scottish Liberal Democrat manifesto. A guarantee of equal care for mental health is on the front page of their manifesto. The Lib Dems pledge that the Scottish Parliament will have the resources it needs “to make sure mental health has equal status with physical health”. There is also specific mention of helping “people struggling not to harm themselves” by providing emergency help at A&E. In the context of helping people find work, they pledge to help provide work placements tailored for those with mental health problems. They also pledge to fund the NHS properly, “ending the discrimination against mental health which has existed too long, and delivering equal care.” They also highlight the scale of mental ill-health, the stigma faced by many and the difficulty accessing services. They propose to expand the provision of psychological treatments as well as developing “new provision to support young people who need urgent mental health support”. If pilots as successful, they may also role out the provision of trained mental health professionals in A&E departments. They also plan to simplify and streamline back to work support for those with mental health problems. Furthermore, they will also establish “a world-leading mental health research fund, investing £50 million to further our understanding of mental illness and develop more effective treatments.” Support for veterans with mental health problems is also mentioned.

 Scottish National Party (http://votesnp.com/docs/manifesto.pdf)

Mental health is mentioned four times in the SNP manifesto. Within the context of ensuring fairness in the welfare system, they “will demand an urgent review of the conditionality and sanctions regime” taking account of the “needs of people with mental health issues.” They also pledge to increase the £15 million already committed to a mental health innovation fund, stating that they will “increase this investment to £100 million over the next 5 years”. They will also focus on treatments in the primary care sector and aim to focus on investment in child and adolescent mental health services.

Comment

Mental health appears to be a priority for Scottish Labour, the Scottish Liberal Democrats and the Scottish National Party. It is encouraging to see the specific pledges made by each of these parties in terms of the provision of mental health services. However, as a researcher who knows first hand how poorly funded mental health research is, I was particularly pleased to see the Scottish Liberal Democrats pledge to establish a world class mental health research fund – with funding ear-marked. Whoever (and in whatever configuration) is in power after May 7th, it is incumbent on each of us to hold the Government to their election promises!

Disclaimer: I acknowledge that my search strategy was crude but each manifesto was subject to the same ‘analysis’, and therefore, I believe it provides a valid (albeit high level) overview of the each party’s pledges on mental health. Due to idiosyncrasies of search functions in pdfs, I may have missed one or two mentions of mental health in the manifestos that contained multiple references to mental health.

References

Centre for Economic Performance (2012). How mental illness loses out in the NHS. A Report by the Centre for Economic Performance’s Mental Health Policy Group. http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf

MQ Research (2015). UK mental health research funding: MQ landscape analysis. http://www.joinmq.org/news-opinion/entry/new-analysis-reveals-historic-under-funding-of-uk-mental-health-research

ONS (2015). Statistical Bulletin. Suicides in the United Kingdom, 2013 Registrations. http://ons.gov.uk/ons/rel/subnational-health4/suicides-in-the-united-kingdom/2013-registrations/suicides-in-the-united-kingdom–2013-registrations.html

Platt, S et al (2006). Evaluation of the first phase of Choosing Life: The national strategy and action plan to prevent suicide in Scotland: Annex 2 – The Economic Costs of Suicide in Scotland in 2004. Edinburgh: The Scottish Government http://www.gov.scot/Resource/Doc/146980/0038521.pdf

  • May 06 / 2015
  • 1
Current Affairs

IHAWKES election special part II: Professor Andy Gumley

£1 doesn’t mean the same thing to all:

One remarkable moment in the electoral campaign was David Cameron’s reassurance to the UK public that the proposed Conservative budget cuts amounted to a £1 reduction for every £100 – something that every family or business could cope with. I guess in a society where the principle of equality is cherished and where policies are geared towards improving equality and minimizing inequality then such reassurances are well grounded.

Equality is related to better physical health, greater feelings of trust and lower levels of violence. Inequality measured by how much richer the top 20 percent than the bottom 20 percent is in each country, is related to increased rates of mental illness (r=0.73) and drug problems (r=0.63).

Psychosocial factors are key in understanding the associations between income inequality and health where social hierarchical organisation favours those ranked highly and disfavours those ranked at the bottom. Internal threats arising from the experience and perception of inequality increase stress through feelings of shame, threat and distrust, which acts on psycho-neuro-endocrine mechanisms. External threats acting on the person include exposure to antisocial behaviour, reduced civic participation, less social capital and reduced social cohesion increase feelings of disconnectedness, loneliness and paranoia.

Not just perception of rank but the availability of resources within systems are key to understanding the health effects of social hierarchies. Lynch and colleagues (2000) argued “the effect of income inequality on health reflects a combination of negative exposures and lack of resources held by individuals, along with systematic underinvestment across a wide range of human, physical, health, and social infrastructure” reflecting the manifestation of the sum of historical, cultural and political-economic processes.

In the past 30 years alcohol and drug-related deaths, violent deaths and suicide have increased to a greater extent in Scotland compared to the rest of the UK and Europe. Physical health inequalities have increased in Scotland relative to the rest of the UK evidenced by premature death due to cardiovascular disease, cancer and stroke. McCartney and colleagues have shown that these increasing inequalities are associated with the Index of Economic Freedom (or in other words the extent to which neoliberal or monetarist economic policies predominate).

So £1 isn’t the same to every individual and neither is £1 the same to every community or every nation within the UK. Problems of inequality and its terrible consequences cannot solved by austerity. Austerity can only further hit the more vulnerable groups in our society who already experience greater risks of disconnection, alienation and hopelessness. What’s happened in Scotland during the last 30-years in terms of inequality and what is happening in Scotland during this election provides an important opportunity for UK based parties to start to seriously rethink the impact of policies that increase inequality, and the associated costs to us all. Maybe adopting a principle of Equality in the UK would be a good start.

References:

Lynch, JW., Davey Smith, G., Kaplan, GA. & House, JS. Income inequality and mortality: importance of health of individual income, psychosocial environment or living conditions. BMJ. 2000 April 29; 320(7243): 1200–1204.

McCartney, G, Walsh, D., Whyte, B., & Collins, C. (2011) has Scotland always been the ‘sick man of Europe’? An observational study from 1855 to 2006. European Journal of Public Health, Vol. 22, No. 6, 756–760