The Strategic Narrative

1. The Strategic Narrative Challenges • Demography • Scotland’s public health • Economic outlook

2. Life expectancy trends Portugal Scotland

3. Life expectancy trends Portugal

4. Trends in male life expectancy: Scotland Richest 20% Poorest 20%

5. Public health in Scotland

6. Public health in Scotland-turning 5 decades of failure into success!

7. Public health in Scotland-turning 5 decades of failure into success-with some lessons from riots along the way!

8. Health Deficits approach We focus on problems, needs and deficiencies We design services to fill gaps and fix problems We make people passive recipients of services We do things to people rather than with them.

9. Sense of coherence.... “.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement."

10. Health Assets • A health asset is any factor or resource which enhances the ability of individuals, communities and populations to maintain their health and sustain wellbeing. The assets can operate…as protective and promoting factors to buffer against life’s stresses Morgan and Ziglio 2009

12. Health • Everyday experience tells us health is NOT a state • It is the outcome of a set of processes which are continually at work as we interact with others and our external environment

15. Diagnosed disease Underlying risk factors

16. Health improvement or life improvement? • Health is a property which emerges in individuals living in a fair and civilised society. • Individuals who live in such a society understand how it works, can manage the challenges they face and participate fully in the life of the community. • Such individuals are likely to feel in control of their lives and are likely to be healthy and feel well.

19. Horst Rittel and Melvin Webber

20. Wicked ProblemsRittel and Webber 1973 • There is no definitive formulation of a wicked problem. • It is not clear when wicked problems are resolved • Solutions to wicked problems are not true-or-false, but better or worse. • Every attempted solution to a wicked problem counts significantly because it changes the problem. • The planner has no right to be wrong (planners are liable for the consequences of the actions they generate).

21. Tackling wicked problems – Australian style • Authoritative or collaborative strategies? • Narrow or broad approach? • Firm trajectory or innovative “hunches?” • Organisational focus or cross organisation? • Tight governance or “project review?” • Regulation or persuasion?

22. Management of complex systems The importance of instability – “never waste a good crisis” Order generating rules – develop a common vision of what you want the future to be Emergence of solutions – accept that the outcome may not be exactly what you anticipate

24. Building on assets • Economic assets • Government and the private sector • Environmental assets • Local government, community • Social networks as assets • Community, 3rd sector • Personal sense of control • Community, 3rd sector

27. Places for people

28. Places for people?

29. Building on assets • Economic assets • Government and the private sector • Environmental assets • Local government, community • Social networks as assets • Community, 3rd sector • Personal sense of control • Community, 3rd sector Relevance to people

30. Transforming lives • Prolonged, non judgemental relationship builds trust • Individual learns of alternative lifestyles • Realises he is free to choose • Supported while he realigns his life • Supports others in turn • Success lies in the quality of the interactions between the individual and his supporters

31. Types of communication • Debate - winners and losers • Discourse - persuasion • Dialogue – joint pursuit of a new insight

32. Types of communication • Who are you lookin’ at? • Debate - winners and losers • Discourse - persuasion • Dialogue – joint pursuit of a new insight

33. A common vision? • A healthy society • Low criminal conviction rate • Low teenage pregnancy rate • High educational attainment • Economically active

34. Self-control gradient and adult outcomes Moffitt T E et al. PNAS 2011;108:2693-2698 ©2011 by National Academy of Sciences

38. Numbers to remember • 700 per second – the numbers of new neuronal connections in babies • 18 months – the age at which speech disparities begin to appear • 90-100% - the chance of developmental delays when a child experiences 6/7 adverse experiences • 3:1 – the odds of heart disease in adulthood when experiencing 7/8 adverse experiences • £5-£10 – the amount returned in childhood for every £1 invested in early programmes

39. Developmental delay and adversity

40. Risk of heart disease and early adversity

41. Vocabulary and social class

42. Compassion • Are we ready to plan for a compassionate society?

43. Jimmy Reid 1971

44. Rectorial Address • “Let me right at the outset define what I mean by alienation. It is the cry of men who feel themselves the victims of blind economic forces beyond their control. It's the frustration of ordinary people excluded from the processes of decision making. The feeling of despair and hopelessness that pervades people who feel with justification that they have no real say in shaping or determining their own destinies....”