Life chances are often shaped even before we are born

Written by Dr Jonathan Sher on 26 May 2016 in Comment

Dr Jonathan Sher on how preconception health, education and care matter more than has been realised

On an evening bus, I passed a closed shop featuring the sign: ‘Shut happens!’

Of course, some things do just happen. Life continues to offer us surprises (good and bad). However, most significant things don’t ‘just happen’.

They result from reasonably predictable events, an element of planning and a degree of inertia.

The composition of the fifth Scottish Parliament is a good example. Is anyone amazed the SNP won the largest number of constituency MSP seats – or that UKIP will not be leading the new Scottish government?

Did the campaign itself entirely determine the outcomes? Were the results merely a matter of luck, fate or unforeseeable events? ‘Of course not’ is the only sensible answer to these questions.


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The 2016 Scottish parliamentary election results were largely determined by what was true about the parties, the candidates, the political environment and the Scottish electorate during the pre-election period – that is, in the weeks, months and years before the 2016 campaign officially launched.

Enormous amounts of time, energy, thought and resources were invested in preparing for this election well in advance of the actual campaign.

The outcomes largely mirror both the pre-existing conditions and the quality of preparation.

The wellbeing and life chances of Holyrood’s Baby Kirsty were also shaped in large measure by key individual realities and powerful societal forces in place before her conception.

The pregnancy itself was akin to the parliamentary campaign. It mattered greatly, but was not the alpha and omega of the outcomes.

Election night can be likened to childbirth – exciting, tense, sleep-depriving and ultimately either a joy and blessed relief or a source of pain and disappointment.

Now, both Kirsty and the fifth cohort of MSPs are in their infancy. Holyrood magazine will be closely monitoring Kirsty’s development.

Holyrood’s staff and expert advisers will analyse how her immediate progress, and her long-term trajectory, are affected by the decisions and actions (or failures to act) by MSPs, the Scottish Government and other key policymakers and practitioners.

Holyrood’s emphasis will rightly be on the impacts and implications of what happens over the next five years.

But Kirsty’s future wellbeing – like Scotland’s (and the Scottish Parliament’s) – is profoundly and enduringly influenced by history, that is the legacy of past individual and collective choices, as well as the previous opportunities either embraced or squandered.

Kirsty’s godmother (Holyrood editor, Mandy Rhodes) revealed that Kirsty was born into a relatively deprived Scottish family and community. Statistically, this context of inequality already significantly reduces the chances of Kirsty finding that Scotland really is ‘the best place to grow up’.

But babies born into deprived families and communities can flourish.

Conversely, birth defects, child maltreatment, dysfunctional families and other sources of life-scarring, adverse childhood experiences also affect those born into middle-class families and wealthy communities.

Kirsty is illustrative of the 70,000 known conceptions in Scotland last year. Only 54,000 ended in a live birth.

And many thousands of those babies face serious developmental difficulties and environmental challenges.

For instance, had Kirsty been one of the (at least) 500 Scottish babies born each year with the lifelong brain damage caused by fetal alcohol exposure, her life would be compromised before she even drew her first breath.

By contrast, if Kirsty was born healthy and has at least one caring, competent adult consistently in her life, then her chances of success dramatically improve.

As Sir Michael Marmot and Sir Harry Burns remind us, the degree of inequality across our society is a matter of choice, not destiny.

During the tenure of this Scottish Parliament, more than a quarter of a million more babies will be born here.

What quality of life will they enjoy and what ongoing inequalities will they have to struggle hard to overcome?

There are three messages MSPs should take to heart and act upon.

First, preconception health, education and care matter far more profoundly than has been realised and taken into account across Scotland.

Just as the outcomes of the 2016 election depended heavily upon what was true before the campaign itself, so too, the wellbeing of Kirsty and the 250,000 forthcoming bairns and weans were strongly shaped by their parents’ health and wellbeing prior to pregnancy.

Second, what will happen (for better or worse) to Kirsty and the next generation of Scots is not inevitable.

Just as the Scottish election results from 50 years ago – indeed from only 17 years ago – differed greatly from those earlier this month, so too, pregnancy and birth outcomes and child wellbeing are now much better. Such progress must increase during the next five years.

Third, the ‘silver bullet’ for Kirsty – and her hundreds of thousands of future fellow Scots – is preventative action, not just rhetoric.

An ‘all hands on deck’ effort to advance preconception health, education and care would profoundly benefit these babies throughout their lives.

Preventing gaps from opening in the first place, starting before pregnancy or birth, is the best way of delivering on cross-party promises to enhance health, education and social justice.

Better preparation and supporting the next generation of parents is central to Scotland’s ‘preventative spending’ ideals.

Prospective Scottish mothers and fathers – a large, albeit largely unrecognised, block of voters – already deeply desire three outcomes: a safe pregnancy, a healthy baby and a rewarding parenthood.

Unfortunately, these three fundamentals remain unrealised aspirations for many future parents across Scotland.

That is both an old shame and a new chance for our society, including Scotland’s public sector.

In both politics and pregnancy, the wisdom of Scotland’s own Alexander Graham Bell is well worth heeding: Before anything else, preparation is the key to success.

Dr Jonathan Sher is an independent consultant based in Edinburgh

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