An equal footing

The Improvement Service (IS), the organisation which works with councils and their partners to help improve the efficiency, quality and accountability of local public services in Scotland, has recently carried out an innovative piece of work focusing on the relationships between patterns of life outcomes and deprivation levels across Scotland over the past 10 years.

The 1000 Communities report seeks to understand the impact of the various Scottish Government and NHS policies around health, education and justice to make sense of the impact they have had on geographic areas experiencing different levels of social and socioeconomic deprivation. Three groups [cohorts] were selected, consisting of the 330 most deprived neighbourhoods, 330 central neighbourhoods and 330 least deprived neighbourhoods in Scotland.

The study uses publicly available data from the Scottish Neighbourhood Statistics and the Scottish Index of Multiple Deprivation (SIMD) websites. 1000 Communities is a neighbourhood study, therefore all data used in the analysis is expressed on this level. The data zones are geographies and represent areas of approximately 500 to 1,000 people with the size ranging from 1.2 hectares to 115,963.2 hectares depending on the population density. There are currently 6,505 data zones across the whole of Scotland and the boundaries have been created to respect physical borders, natural communities and, where possible, to include households with similar social characteristics.
Report author Hannah Derbyshire said: “These cohorts were profiled using key life outcome indicators from 2002/03 to 2011/12, depending on availability.

“1000 Communities further studied the relationships between different domains of deprivation; learning and educational attainment; income levels and benefit dependency; health and crime. The report focused on inequality by deprivation as opposed to other dimensions such as gender, ethnicity, age, disability or religion. This is not to suggest that women, ethnic minority groups, disabled people and older people are not disproportionately affected: this would require further analysis and is beyond the remit of this paper.”

The findings of the report were interesting. In terms of educational attainment, the research found it had increased in fourth and fifth year of secondary school. The gap between the most and least deprived areas has also decreased on some level for both S4 and S5 tariff scores. Variation, however, remains vast and increased in S4 attainment. Despite improvements, nearly 45 per cent of the most deprived cohort (aged 16 and above) in 2011 had no qualifications and just over 12 per cent had qualifications at Level 4 or above; vice versa for the least deprived cohort with just over 47 per cent with qualifications at Level 4 or above and under 12 per cent with no qualifications.

In health, the report said that despite improvements across Europe, inequalities continue to persist between and within countries. It states people with lower income, lower occupational class, or lower education levels tend to have a higher risk of health problems and lower life expectancy, with health improvements often benefitting higher socio-economic classes at a faster rate than those in lower socio-economic classes.

Scotland is no exception to this, with substantially divided health outcomes between socio-economic groups. In 2005, the National Framework Advisory Group reported a need to address the general health across Scotland and work towards “preventative, anticipatory care rather than reactive management”. Focusing on prevention could lead to better health overall but also greater efficiency in monetary terms. Within Scotland there is a substantial disparity in health between affluent and deprived communities. The annual report of the Chief Medical Officer for Scotland 2011 focused specifically on the problem of health inequalities in Scotland, stating: “Why should a child born today, and living in the poorest areas of Scotland, be faced with living 10 or 12 years less, and struggling with considerably more ill health than a child who will live in an affluent area?”

Overall between 2002 and 2011, emergency and planned hospital admission rates increased across Scotland, according to the IS findings. This increase was experienced across Scotland but variations have also continued to widen. Meanwhile, rates in areas with the highest admission levels are growing faster than elsewhere across the country, especially among the population aged 65 years and over. For this demographic, variation between the areas and variation between the highest and lowest rates across Scotland both increased by approximately 15-16 per cent. The results also suggest a significant relationship between deprivation levels and emergency hospital admissions. The rise in emergency hospital admission rates across Scotland reflects that the aims presented in the Scottish Government policy report, Delivering for Health, 2005, were not achieved by 2011.

Since 2002, there has been a slight drop in the disparity of income deprivation between the most and least deprived groups, the report found unemployment rates remain greatly segregated, though these figures are also difficult to compare due to changes in the benefit system over this period. Although all three experienced an increase in 2008, the sharpest increase over this period was experienced by the most deprived cohort. By the end of 2012, the number of people who were on Jobseeker’s Allowance (JSA) in the most deprived areas was over 10 times higher than for the least deprived.

Regarding crime, the report noted there have been several studies taken forward by the Scottish Government to review the connection between neighbourhoods, housing and crime, and a number of policies over the past 10 years have focused upon reducing crime rates. 1000 Communities noted that despite the substantial concentration of crime rates, variation in Scotland and variation between and among cohorts has reduced to some extent. Across Scotland, the difference between the 10 per cent highest and lowest rates reduced by 22 per cent between 2004 and 2010/11, and the gap between the least and most deprived cohorts in 1000 Communities reduced by nearly 19 per cent.

On a neighbourhood level, the range of income deprivation has had a higher impact on emergency hospital admission rates than age demographics. The relationship between levels of income deprivation and average S4 tariff scores has decreased to some extent since 2002.

Derbyshire continued: “Overall, in terms of multiple deprivation, there has been limited change for the three cohorts selected within 1000 Communities. Over 80 per cent of these 990 data zones remain in their original 15 per cent of rankings [SIMD 2004 to SIMD 2012], over 90 per cent for the most deprived cohort and over 95 per cent for the least deprived cohort.

“Within the cohort study the strongest improvements were experienced in educational attainment and SIMD crime rates. Educational attainment has increased for all three cohorts and the Scottish average, and SIMD crime rates have steadily decreased since 2004. Averages for emergency hospital admissions, however, were less positive. The percentage of the population claiming Jobseeker’s Allowance has also increased significantly since 2007, and by 2011, the proportion of income deprived population in the most deprived cohort was still over 2.5 times higher than the Scottish average.”

The main outcomes of the research revealed there are strong, significant relationships between positive and negative outcomes in Scotland, with areas experiencing one form of deprivation tending to be disadvantaged in several other sectors too. The disparities in multiple life outcomes are generally persistent and in some cases, continuing to grow. The report’s findings indicate Scotland cannot afford a continued rise in public expenditure which questions what these percentages may look like in the decade ahead of us, with public budget cuts on the horizon. 

The results from the analysis in this study revealed the relevance of income and employment-related factors as determinants of other negative and positive outcomes. In light of this, it states successful economic development could improve wellbeing across many aspects in life, thereby reducing pressure on public services. In this respect, successful economic development is itself a form of prevention for a whole range of services.

Colin Mair, chief executive of IS, said: “Results from the 10 per cent most and 10 per cent least deprived data zones selected individually per indicator, year-on-year, reflected similar patterns. Disregarding SIMD crime rates, variation among indicators have all either grown or remain largely as they were in 2002. This reflects the perpetuation of inequalities throughout Scotland.

“The disparities in multiple life outcomes are generally persistent and in some cases continuing to grow. It is recognised that this study has been profiled over the beginning of an economic recession; this is very recognisable within particular outcomes, such as the proportion of JSA claimants which rose dramatically in 2008. It is outside of the remit of this report to speculate as to what the figures would show had the level of public spending not been spent over this period. However, the economic climate is far from recovery and Scotland cannot afford a continued rise in public expenditure. It also brings into question what these percentages may look like in the decade ahead of us, with public budget cuts on the horizon.

“The limitations to this research should also be considered. The majority of indicators profiled in this report are only available up to 2011. This fails to capture possible impacts or progress from more recent and current policies. This does not, however, deter from the apparent stability of unequal outcomes across Scotland up to 2011.

“The relationships examined represent neighbourhoods rather than individuals or households, which raises another significant observation: people born into a deprived neighbourhood in Scotland have a higher chance of being income deprived, of needing emergency hospitalisation, being a victim of crime, and achieving poorly in education. In this respect, the neighbourhood in which you live can have a substantial impact on your future experiences and outcomes.

“Literature for improving equity, whether with respect to education, health or crime and community safety, tends to emphasise the wide and disperse social influences on inequality. This argues for multiple agency response and partnership delivery. In this sense, each sector focuses on the social determinants of disadvantage whether that is poor health, low education attainment or high crime levels. These social determinants are evidently interlinked; therefore if these determinants can be successfully targeted they have the potential to improve inequality within many sectors.”