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by Sir Harry Burns, professor of global public health, University of Strathclyde
03 June 2016
Sir Harry Burns: The clock is ticking for Kirsty

Sir Harry Burns: The clock is ticking for Kirsty

All babies born in Scotland should have an equal opportunity to achieve their full potential in life.

That concept seems to me to be a matter of justice. It’s also a matter of common sense. As our population ages we will need the intellect, commitment and contribution of every young person in our society if we are to survive the stresses and strains already apparent across the world in the 21st century.

Yet, despite decades of research and debate, the chances that a young girl born in the most economically deprived parts of Scotland – and most of these are in the West of Scotland – will achieve a happy, fulfilled adulthood are less than if she were to be born in one of the more affluent areas.

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However, it is important to emphasise that her chances of success in life are nowhere near zero.

Despite hardship and difficulty, a great many families are doing their best for their children and those efforts need to be acknowledged. But while life expectancy in the poorest parts of Scotland has risen in recent decades, it has risen more amongst the affluent and, as a result, the gap in life expectancy has widened. 

So, it looks as if our Holyrood baby might experience a shorter life than she might if she were born to parents in Bearsden or Barnton. In fact, our baby is likely to live about a decade less than her more affluent neighbours. Not only will it be shorter but more of it is likely to be lived while suffering from a chronic illness. 

The gap in healthy life expectancy between rich and poor is even wider than the gap in actual life expectancy. Many will assume that the root causes of this shortened life expectancy are due to the choices that our baby makes as she grows up. She is likely to smoke more and drink more alcohol. She is more likely to take drugs and become pregnant as a teenager. So, it’s all her fault, then?  

For decades, this was the conventional wisdom. People who made bad choices in life were simply short of information. After all, we humans are rational and if we get the correct information in a form we understand, we will make the sensible choices, won’t we?

Well, not really. There are many reasons why we differ in the choices we make. Suggesting that better understanding of what causes illness will mean that everyone avoids illness misses the fact that we differ in the value we place on our health.

When I was a consultant at Glasgow Royal Infirmary, I lost count as to how often I would tell a patient that his drinking would probably kill him. “Ach, why should I bother?” would come the reply. “What have I got to live for? Drink’s the only pleasure I get in life.” Numerous studies tell us that the choices we make in life, the way we interact with each other are determined to a large part by the experiences we have in early life.

Children who experience chaotic, affectionless childhoods are more likely to experience mental health problems and do badly at school. They are more likely to become alcoholics, misuse drugs, experience teenage pregnancy and end up in jail. They are also more likely to have earlier onset of chronic disease such as diabetes and heart disease.

If our Holyrood baby falls into that group of children who experience neglect and abuse, then her outlook is poor. But, it is not just the poorest 10 per cent of families whose outcomes are worse than the rest. Across society, there is a stepwise gradient in risk. Those who are just a little worse off than the wealthiest have outcomes which are a little bit poorer than the best and so on, all the way down the socioeconomic scale. The harder a family has to struggle, the more likely the babies are to have a poorer outcome.

I believe that the purpose of the public sector should be to ensure that all citizens in a country should have equal opportunity to achieve their full potential. This chimes closely with the Scottish Government’s stated aim of creating a more successful country with opportunities for all to flourish through increasing sustainable economic grow. Achieving that aim is entirely possible.

In recent years, Scotland has used innovative approaches to transform safety in hospitals and improve important markers of child wellbeing by reducing stillbirth rates and infant mortality. Support for families in difficulty, the mentoring of young people at school, help for looked-after children are all areas where we can transform the lives of those most in need. The necessary methods are already in use in Scotland. We know how to do it.

If our Holyrood baby is to become the superstar she might have the capacity to be, we need to scale up our efforts soon. The clock is ticking for her. 

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