Holyrood visits the penultimate Scottish Government pilot tackling health inequalities
In attempting to tackle the deep-set health inequalities that have ravaged Scotland for decades, each of the Equally Well pilot sites have taken on, undeniably, ambitious challenges, and in seeking to address the twinned issues of alcohol misuse and antisocial behaviour, the pilot in Fife is no exception.
This pilot hopes to “develop greater interagency work in the management of antisocial behaviour, problem underage drinking and alcohol-related injury in Fife,” while simultaneously, “tackling the underlying determinants of deprivation and ill-health”.
The area selected, Templehall and surrounding North Kirkcaldy, has a higher than average proportion of young people aged between 15 and 25, coupled with higher than average unemployment, teenage pregnancy rates and hospital admissions for alcohol abuse, says Mark Steven, Equally Well coordinator, Fife Council. While police-led work tackling antisocial behaviour has been under way in the area for some time, which Steven says has led to a “radical fall” in crime, he says they are keen to progress this to a more prevention-led focus in a bid to tackle the underlying issues.
“Community safety work was ongoing in Kirkcaldy and we saw an opportunity to tie those strands together and think about health inequalities in relation to the work we were doing on antisocial behaviour and alcohol and young people and have a health perspective on that as well,” explains Steven.
Their first task, says Wendy McCartney, NHS Community Safety Officer, who is leading the pilot along with Steven, has been to gather information. “We had a meeting in the community centre where we invited a number of frontline staff to bring them together and we are hoping to use that information and intelligence to inform our work,” says McCartney.
Indeed, this information is crucial for building their understanding of the area as unlike some of the other Equally Well pilot sites that have sought to establish a high profile from the start with the community they are working in, Steven says they are still building up to engaging directly with the local community.
“Kirkcaldy is quite well served with different services and I think that would be a quick way of antagonising everybody if we came in and said, by the way, we are Equally Well and there is this government report and we are going to sort out all the problems in your area.
We’d get run out of town and quite rightly so because there are lots of projects there already who have been working for years and years, says Steven.” Instead, they hope to remain in the background, helping to connect and support those services which already have established relationships and links into the community.
“We are trying to be consistent,” Steven adds, “so it doesn’t feel that you are coming in as another set of new people but are using the eyes and ears already there and coordinating it.” McCartney highlights the Cottage Family Centre, as one example of a service already making inroads in the community.
The centre is a voluntary-run service that was originally developed by a group of local parents more than 20 years ago. It aims to provide a safe, secure, nurturing environment through which it can help families to improve their life and social skills, build their confidence and self-esteem, reduce isolation and help them integrate within the local community, and improve access to information and services.
“Some of the families who come here live in the high rises and don’t have a garden so when it is sunny we make the most of it and try to get everyone playing outside,” says children’s development worker, Sarah. Learning how to play is a crucial part of their development, she says.
“I remember when I was young, heading off up those hills on my bike for the day and you didn’t come back until you were starving,” says one gran. “But people don’t feel safe letting their kids out these days.” “That’s why this place is great,” a mum adds, “it is an enclosed space so they can be outside running about, learning how to make friends and you don’t have to worry.” However, while Steven says the centre is an excellent example of early intervention that he hopes will help break the cycle of antisocial behaviour in the long term, he adds they are also keen to support groups working with young adults that provide alternative entertainment than underage drinking.
He highlights the local YMCA, which, he says, runs lots of music-focused projects for young people in the area, the drugs awareness project ‘Clued-up’, which aims to provide “youth friendly” support and information for young people in Fife, and the recently started free running, or parkour, groups, that, he says, have been doing some “excellent” work with young people in the area.
Stuart Wilson, who runs the free running groups, says that while the sport is a lot of fun, the groups are also about educating youngsters that it is not just messing about, and that they come to learn not just free running but also how to be more responsible and respectful of their area.
“A lot of them have had family problems so it is an escape as well,” he adds. “It is somewhere to come hang with friends and get rid of any anger by running and jumping about.” The groups are made up of young people from the Templehall area, but also all over Fife, says Wilson, which he says gives them a chance to socialise with different people.
“So they are building their confidence as they are talking to new people and learning new tricks.” Tricks such as wall flips and vaults, are very demanding, physically, which, Wilson says, is a powerful motivation for those taking part to think more carefully about their other lifestyle choices.
“They are taking care of their bodies, eating healthily, not drinking and smoking, and not because I’m telling them to but because they want to get better. So it is having a really positive impact.” Steven says the council has been “quite enlightened” in its early response to the groups, helping to set up the initial pilot that led to the creation of the groups in Kirkcaldy and letting them use council property at night to practice on. “The council has recognised that this is something the young people enjoy, are focused on and is good for them as it is physical activity,” Steven says. He says the council is now looking into how it could offer more support to the groups, possibly by developing a special area for the free runners.
And the success of such a specialist group has also provided them with a valuable lesson, he says.
“The thing about Equally Well is we are learning as we go along. We are picking up that one of the things we could have an influence on is bringing people together and giving them the opportunity to learn from different approaches.
“But you have to listen to and react to what people want, you can’t prescribe,” he adds. “You have to give them the chance to choose.”