Hounding mums won’t fix our child health crisis
THERE was little positive to be found in last week’s shocking report into the health of Scotland’s children. The Royal College of Paediatrics and Child Health (RCPCH) study, The State Of Child Health – Scotland, revealed a situation that’s “among the poorest in western Europe”, with 28 per cent of Scottish children overweight or obese, and the health gap between rich and poor widening. Some “29 per cent of pregnant women in the most deprived areas are smokers, compared to just 4.5 per cent in the least deprived”, the report continued. Half of new mothers in wealthy areas exclusively breastfed their children for six weeks, but that figure dropped to 15 per cent in the most deprived areas.
This is a depressingly familiar story, one that forms a close parallel to the so-called Glasgow effect, or Scottish effect: the mystery of why in Glasgow, and Scotland more widely, people living in deprived areas live less long than those in the similarly deprived parts of some other cities. We know that in poor parts of Scotland adults die young. We also know from the RCPCH report that children in those demographics are likely to have mothers who smoke and do not breastfeed. We’re not getting better. In fact, compared to other countries in Europe, we’re falling still further behind.
In the face of such statistics, it does little good to cling on to the same old hopes that getting out good public health messages and creating rules so people do the right thing will do the trick. Yet much of the reporting on this study has homed in on its key proposals for more education around breastfeeding, and bans of parents smoking outside schools and in playgrounds. Here we have fresh targets and more driving home of messages which have been pushed for some years. Breast is best. Smoking kills.
Such suggestions dilute the more profound lesson from the report, which is that poverty is the problem. And not just any poverty. Scottish poverty, whose peculiar character and history leads to the Scottish effect.
Lack of breastfeeding and maternal smoking are, after all, just indicators, not the source of the problem. They tell us something about the toxic type of inequality we have here, one with a history which continues to shape the society we have now. For the Scottish effect can be linked, according to a Glasgow Centre for Population Health (GCPH) study, to “the processes of urban change in the post-war decades”, the transplanting, following the slum clearances, of communities to highrise developments and poor quality council estates. As a result of such changes Glasgow has been found to have less “social capital” — less of the kind of networks and connections, the glue that holds communities together – than Liverpool, a city with similar deprivation.
Reports into the Glasgow effect frequently speak of “psycho-emotional distress”. According to a study published last year by Joe Cowley of the University of Lancashire, such distress probably contributes even more greatly to the Scottish effect than “behavioural, socio-economic and physiological factors”. Health inequality, it said, was primarily caused by “life-stressors” (anything from traumatic events through to the daily hassles of growing up in impoverished conditions).
This distress has been passed down from generation to generation. Therefore, breaking the cycle of trauma and stress can seem like trying to crack into an impenetrable box. It’s easy to see why we might want to give up and resort to ramming home another set of rules and education strategies. But this psycho-emotional distress is more likely to be alleviated by changes in community and physical environment than rules and behavioural nudges. It’s time we more fully acknowledged that it doesn’t help those who are struggling to be living in temporary accommodation, often isolated from support. Nor does it help when the urban environment they live in is grim or unsafe, and does not invite them to do one of life’s most mood-enhancing activities, which is to walk around in nature.
Meanwhile, there is a fairly clear line connecting the decline in community connections and some of the factors that impact upon child health. When you lose that sense of social connectedness and support, you don’t let your children go and play outside. A recent study on activity in children placed Scotland joint last of 38 countries and blamed this partly on parents’ wariness of letting their children play outside. When children don’t experience outdoor play, they miss out not just on obesity-countering physical activity, but on the profound and proven benefit that time in nature brings to both mood and attention span.
For some time, Harry Burns, professor of global public health at Strathclyde University, has been saying that the Glasgow effect is a “psycho-social problem that will not be fixed by targeting conventional risk behaviours” alone.
Yet here we are again, fixating on mothers smoking outside schools and not breastfeeding enough. We can huff and puff, but “thou shalt not smoke at the school gates” is not going to save Scotland’s children.
Half of new mothers in wealthy areas exclusively breastfed their children for six weeks, but that figure dropped to 15 per cent in the most deprived areas