The Current Landscape of Community Regeneration in Scotland: A Perspective

I want to offer a perspective on the current landscape of community regeneration in Scotland. At the recent SURF annual conference, this was described as a landscape in which participants were ‘navigating uncertainty’, in pursuit of ‘resilience’. It’s a landscape which can seem to get bleaker by the day – with ever more news about cuts and ‘hard choices’.

I will offer a perspective from two vantage points: firstly from the vantage point of someone who recently spent some years out of the UK; secondly, from the vantage point of population health.

So, in 2019, after many years at what is now the University of the West of Scotland, I took a job at the University of the Faroe Islands. I returned to Scotland at the beginning of 2023, to work at the Glasgow Centre for Population Health (GCPH).

The Faroe Islands is a small society – less than 55,000 people. They live mostly from fishing and fish farming. But they are able to do remarkable things – completing huge infrastructural projects, like their remarkable undersea tunnels, with little discernible fuss. It’s a very different landscape.

On coming back to Scotland and Glasgow, I felt in too many ways like I had arrived in a less developed society; the signs of degeneration and hardship seemed more visible than the signs of regeneration and wellbeing. I had a Faroese friend visit, and when someone asked them how they found Glasgow, they answered, really lovely people, but many seem to be having a very hard time; and the place is in ways amazing, but it is really run down, neglected and dirty.

So, for me, on my return, the days of ‘Glasgow’s miles better’ and the high hopes for regeneration that followed in the eighties and nineties seemed pretty distant. And it wasn’t just Glasgow – many other places, perhaps most, seemed, albeit to varying degrees, similarly affected.

This connects to a wider observation of real significance. Danny Dorling, amongst others, has been telling us about it for some time. What we are seeing in our towns and cities is, by the standards of other wealthy societies, really quite extreme – the UK is increasingly an outlier in terms of what is happening to its people and its places.

Of course, back in the days of high hopes for regeneration, we spoke rather less about resilience – in fact we barely spoke about resilience at all. The term resilience in fact has a longer history in the field of disaster management than in the field of regeneration. In disaster management, it is used as a way of understanding that what are often called ‘natural’ disasters are due largely to social vulnerabilities which are ‘man-made’. Building resilience is understood as a way of offsetting those vulnerabilities – to reduce risk of harm.

When the language of disaster management becomes so prominent in the routine discussions of how we need to operate as communities, and as a society, then that is telling us something. We are increasingly creating forms of vulnerability to loss and to harm, and we are increasingly asking society and communities themselves to face this, and to pursue their own resilience.

The perspectives of disaster management are more widely relevant to what has been unfolding here in recent years. This is perhaps best crystallised by the trends in population health and health inequalities which GCPH and others have been charting over the past 20 years – and especially by the trends over the past decade.

These trends are, of course, highly relevant to those interested in regeneration, because they tell us about how well we are doing in creating a society and communities that allow individuals and families to live reasonably well and achieve health and well-being. This is to say that the health of the population reflects access to various ‘social determinants of health’ – such as:

• the start in life we give to children
• the quality and security of housing that people get to live in
• the experiences of education
• the quality and security of employment and adequacy of income people get to have
• how well people are supported in times of need
• the social fabric of local communities
• being able to live free from discrimination, prejudice, stigma and shame
• the quality of the environments people have access to

These are the kinds of things that make for good health – physically and mentally. They are also the kinds of things that those involved in community regeneration historically have been seeking to contribute to in various ways – sustaining and improving access to positive determinants of health, often especially for those ‘on the receiving end’ of inequalities. At national level, these are also the kinds of things that resonate strongly with the outcomes of the National Performance Framework – currently in the process of being updated.

So, what do the trends tell us about how we are doing in these respects? Here we come back – unfortunately – to the language of disaster.

If we go back to the first decade of this century, there is a sense in which we could say population health in Scotland was already something of a disaster. In Scotland, there were around 5,000 excess deaths each year compared to the rest of Britain – and this was after taking account of the higher deprivation in Scotland.

When we think about disasters, we might think of the horror that was Hillsborough. 97 people died there. That is about the same as the number of excess deaths in Scotland each week in the noughties.

But to keep this in perspective, these excess deaths reflected a situation in which health was actually improving in Scotland for the population as a whole – but was doing so more slowly than for the rest of Britain, thus leading to a widening excess gap.

But starting about a decade ago, things started to get worse. Population health improvement slowed then stopped, and then slipped into reverse. This is quite unprecedented in modern times, and the trend predates covid by several years. As GCPH research has shown, it was largely set in motion by the overarching ‘austerity’ policy of the UK government after 2010.

This policy led to very large cuts to local government spending, reductions in social security eligibility and payments and more general reductions in key aspects of public spending. All of that led to highly adverse and rapidly impactful shifts in people’s access to key, positive social determinants of health. The more vulnerable amongst them were quite quickly showing decreases in both their life expectancy and their healthy life expectancy. If, for instance, one looks at premature mortality for women in the poorest 20% of areas in Glasgow, the data is horrific.

Seen in this perspective, covid looks like a worsening of an already established trend – in a way, we were already in an ‘austerity crisis’ before the covid crisis. All of this is before we get to the cost-of-living crisis, which is necessarily also, as night follows day, a population health crisis. It’s also before we get to what we might call the current ‘fiscal crisis of the state’.

My point is that these trends are one rather effective way of summing up what has been going on, and is going on, in the landscape of regeneration. They tell us that what people involved in regeneration are doing really matters, ultimately in the raw calculus of life and death. But they also tell us that, while there is lots of great work being done in various places by people working in all kinds of creative and innovative ways to serve their communities and their society, overall, at societal level, it amounts to an ongoing disaster.

Some population health scientists have been, understandably, loudly protesting all of this: ‘this should not be happening in a wealthy, democratic society’. I have a lot of sympathy with that, but as a social scientist I also read it another way. The health trends tell me that we are not living in what we have previously thought of as a wealthy, democratic society. We are becoming poorer as a society – a minority is getting wealthier, but increasingly they are detached from society. Democracy is no longer working for society in the way we previously expected – its scope has been steadily reduced, to the extent that it increasingly it seems to be about mitigating, dispensing or passing on cuts. Democracy has lacked resilience.

At GCPH we have been discussing this developing scenario since early 2023. The conclusion that we quickly reached was that things were indeed, given what politicians were saying and doing, highly likely to continue to get worse before they got better. We argued that, sadly, it made little sense to continue to talk about reducing health inequalities when all the indications were that they would continue to increase. So, we argued the case for focusing on mitigation – trying to slow the rate of deterioration, to halt it where possible, and to focus beyond that on recreating the conditions in which more and better than that could be achieved.

Towards the end of last year, colleagues in SG asked for our reflections: What should they be doing on population health, taking cognisance of the financial constraints that were becoming increasingly apparent. If they could find some money, where should it be deployed?

Our response was entitled “Mobilising People to Protect Health” and it advocated a national mission across government to do just that. We said that “the priority policy focus should be on maximising the protection of the population, and especially the most vulnerable groups and communities, from the continuing impacts of the adverse economic and fiscal context” (p.6).

A key part of that, in the short-term, involved drawing on the experience of community responses to covid. We recommended “supporting the development of a network of community-based organisations able to deliver support in a locally responsive manner” (p.10). In the medium term, amongst other things, we advocated “further development of local social infrastructure – in the voluntary and community sector – to support more meaningful community empowerment and participation” (p.13).

And those latter things – empowerment and participation – matter also from the point of view of trying to regenerate democracy. This is arguably the most important thing, if we are to use more of the actual wealth of our society to create more and better possibilities for people to access positive social determinants of health, and thus to work our way out of the current disaster. For all the talk of empowerment in recent decades, population health is telling us another story – about actual disempowerment.

This will likely be a long haul, but we know, based on facts and evidence, provided by research conducted across many fields and disciplines, that it can be done – it has been done before, both here, and in other places too. It was a long haul then too. But it is doable. Definitely doable, if we get the leadership that is required, at all levels, across many organisations and sectors, including of course, in a really important and serious and leading way, the community sector.

This blog is the first in a series of follow on blogs from the SURF Annual Conference. Read the next blog from Rachel Searle of Foundation Scotland HERE