Interview with Sir Harry Burns
There are lessons to be learned from Scotland’s past experience of austerity
Sir Harry Burns, Scotland’s highly-esteemed former Chief Medical Officer and now Professor of Global Public Health at the University of Strathclyde, has been a key figure in Scotland’s efforts to understand and tackle health inequalities.
However, he nearly set out on an entirely different trajectory.
“I always wanted to be a pilot and fly aeroplanes,” laughs Burns.
“I was absolutely absorbed by them when I was a young boy. The thing that got me into medicine was the fact that a lot of my friends were doing medicine. My father also wanted me to do medicine, so there was an awareness of medicine and at the end of the day, I had about five or six friends who had all been accepted to do medicine at Glasgow University, so I thought, ‘Och well, I will go along with that.’ So it all started there. It always struck me as being a fascinating subject – much more interesting than law or, God preserve me, accountancy.”
On completion of his surgical training, Burns was appointed Honorary Consultant Surgeon and Senior Lecturer in Surgery at the Royal Infirmary in Glasgow.
“As a surgeon at the Royal it was very clear to me that there was something going on in terms of whatever it was that was damaging health in the east end of Glasgow. It also became apparent quite quickly that it wasn’t just the fags and the fatty foods.”
He began to research the metabolic response to illness and injury – “basically, when you get sick how does your biochemistry and physiology get screwed up”.
This research, and a nudge from good friend and former neurosurgeon and politician Sam Galbraith, were ultimately what “provoked” Burns to move into public health.
“Sam and I have been friends since we were junior doctors. We went climbing, skiing together. I was Sam’s best man when he got married and one New Year we were sitting at Sam’s house up in Kingussie – it was two or three years after he had gone into Parliament – and I had been saying that I was not convinced that surgery was, in the long term, going to be satisfying for me. And he said, ‘Why not do public health?’ So I got into that to try and understand a bit more about what the links were between social circumstances and these biological changes that we were seeing.”
Burns stresses that he has never been a member of any political party, “nor would I ever want to be”. Instead, it has always been the science that holds his interest.
“And this wasn’t about opinion. It wasn’t about ideology. It wasn’t about left versus right. It was the fact that if you put young people, particularly babies, in insecure circumstances they change the way they respond to external events for the rest of their lives.”
During his eight years as CMO, Burns consistently championed the importance of early years so he is “pleased” that through the world-leading Early Years Collaborative, Scotland now has a ‘bottom-up’ method for changing the system.
“People talk about the policy levers. The idea that there is a lever you pull and the machine just changes and spits out a different kind of result is just baloney. It is a complex system and therefore you need to change the complex system using a different kind of approach. And I think we’ve been immensely fortunate in having guys like Derek Feeley [former chief executive of NHS Scotland] who understands this, and Jason Leitch [clinical director of the Scottish Government’s Quality Unit] who is great at putting it into action. And therefore we’ve got a method for early years, we’ve got a method for raising attainment, and we are beginning to approach offending in different ways. It is not something that will produce changes overnight and the critical thing is we need to stick at it. This is not something that is going to produce something within a four-year political cycle. We are in this for the long term.”
While there has been much discussion around the socioeconomic determinants of health, Burns refers to research from the University of Oslo that suggests we should turn our attention to the political determinants of health.
“Although we talk about socioeconomic determinants of health, what they recommend is that we should start talking about the political determinants of health because the social economic circumstances in which we live are politically determined. And it is very important that politicians realise that this isn’t something that they can ignore. It is their decisions that ultimately set the pace of change.”
One politician who he worked well with during his time as CMO was former Health Secretary, now First Minister, Nicola Sturgeon, who Burns describes as “very impressive”. Sturgeon returned the compliment when she appointed him to her Government’s Council of Economic Advisers to help look further at the issue of inequality, and earlier this month, she also presented him with the Lifetime Achievement Award at Holyrood magazine’s first Scottish Public Service Awards in recognition of his lasting contribution to public service in Scotland.
When Burns announced his decision to stand down as CMO earlier this year he tweeted an assurance that he was “changing position, not leaving the field”.
“What I think we’ve done is we’ve managed to describe how adverse circumstances cause problems,” he says. “What I’m interested in doing now is trying to describe what kind of circumstances create wellness.”
His decision has also meant that he can discuss such issues in public without having to choose his words quite so carefully. Recently he has been highly critical of the UK Government’s austerity measures. He tweeted: “If the NHS treated people who miss their appointments the way DWP do there would be a huge outcry. Sanctioning is inhuman” – and suggests there are lessons to be learned from Scotland’s experiences.
“What I’ve started to try and articulate is that in Glasgow, in west central Scotland, we had austerity in the 1970s as the shipyards and the industry closed and sustainable jobs never reappeared. What we’ve been living with in west central Scotland for the past 30, 40 years is what is happening in many places in Europe just now. I would predict a poor future for those places unless there is a different approach.”
While he says there are “huge strengths” in some of these areas, there are also families who are in their third generation of worklessness.
“People talk about the lack of sustainability in population terms – not enough young people to support all these ageing people. Actually, it is worse than that because a significant proportion of the young people are never going to contribute. They are the ones who fail at school, they are the ones who get into trouble, the kids who are going to be looked-after – all of which costs society a lot of money. And they are the same people who are going to get chronic ill health early on in life.”
This is why early years is key, he explains.
“If we were to invest much more in terms of giving people a meaningful life, giving parents the ability to look after their children properly in the early years through support and employment and so on, then you’d have much more creativity, more innovation, much more wealth generated and people would live healthier lives for longer.
“And yet, we seem hell-bent on this path of austerity that just continues to condemn people at the lower end of the social scale to more and more hopelessness.”
During the referendum campaign, Burns remarked that if people feel more in control of their lives in an independent country then that would be “very positive” for their health. His comments were taken as an endorsement of independence, so I ask if that was how they were meant.
“Yes. It was,” he acknowledges.
He explains: “The most convincing arguments for voting Yes were the ones that [former Prime Minister] Gordon Brown offered.
“Gordon Brown said there is no question of the health service being privatised. He was clearly out of touch because the health service will have to be privatised if this Transatlantic Trade Investment Partnership goes through.”
The psychological mindset that is the most predictive of wellbeing is a sense of control, he explains.
Therefore, it is no coincidence that following the vote a statistically significant correlation was found between areas that voted Yes – for example, Glasgow and Dundee – and life expectancy.
“So the people whose lives were blighted, I suppose you could say, or felt least in control as measured by life expectancy, were the ones most likely to vote for change – and the young people of course,” he says.
“It was characterised as hope versus fear and that is pretty much the way the figures looked at the end of the day.”
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