1. GoWell is a collaborative partnership between the Glasgow Centre for Population Health, the University of Glasgow and the MRC Social and Public Health Sciences Unit, sponsored by Glasgow Housing Association, the Scottish Government, NHS Health Scotland and NHS Greater Glasgow & Clyde. Glasgow Community Health and Well-being Research and Learning Programme: Investigating the Processes and Impacts of Neighbourhood Change

2. Understanding and Investigating Regeneration’s Impact Upon Health: View from the [Far] North Ade Kearns University of Glasgow

3. Today’s Talk Understanding the Linkages. The Glasgow context. The GoWell study. Some health-related findings.

4. I. Understanding the Links

5. Social Determinants of Health Starting Point: –WHO Commission on Social Determinants of Health report on health equity ‘closing the Gap in a Generation’ (2008) –Earlier report by Wilkinson, Marmot et al on Social Determinants of Health (2003). Tackle immediate things: ‘Daily Living Conditions’, e.g. healthy places, and macro things ‘Power, Money and Resources’, e.g. progressive taxation, gender equality, political empowerment etc.

6. Social Gradient Absolute and relative disadvantage have cumulative effects. Lower social groups suffer more disease and earlier death. Chronic Stress Impacts upon the cardiovascular and immune systems. Increases vulnerability to infections, diabetes, high blood pressure, strokes. Early Life Poor pregnancy conditions. Poor infant experience: low stimulation etc. Retarded growth. Low educational attainment. Problem behaviours. Social Exclusion Inability to enjoy social participation. Effects of stigma, discrimination and hostility. Increased risk of divorce, illness, addictions.

7. Work Lack of control, inadequate rewards, stressful relationships at work are harmful. Mental health problems. Lower back pain. Cardiovascular disease. Unemployment & Job Insecurity Psychological problems. Higher risk of heart disease. Addictions. To escape or numb pain of harsh social conditions. To improve mood. Don’t work! Poor mental health. Cause of many health problems and premature death. Strongly associated with crime and asb.

8. Food Over-reliance on calorie-rich foods with high fats and salts. Eating processed food. Obesity. Diabetes. Cancers. Heart disease. Transport Heavy through traffic. Respiratory illness. Accidents. Lack of paths for walking and cycling. Divisions caused by roads. Poor connections to other places. Social isolation. Social Support Supportive and cohesive social relations make people feel valued and are protective of health. Absence of such things is linked to higher stress; depression; poor recovery from illness; more disability.

9. Tackling Health Inequalities The Scottish Government’s Task Force on Health Inequalities reported on local requirements to meet 5 main Govt aims: –Smarter [Early Years and Young People] –Wealthier & Fairer –Greener –Safer & Stronger –Healthier

10. Smarter (Early Yrs & Young People) Quality interactions: parents/children. Providing opportunities of all sorts. Healthy lifestyles. Ethos of achievement & ambition. Wealthier & FairerReduction in poverty-related stress. Reduction in worklessness & ill health. Financial inclusion & anti fuel poverty. GreenerSafe spaces for children to be active. Environmental ‘goods’ to foster physical & mental health. Environmental volunteering to enhance social engagement, health and wellbeing.

11. Safer & StrongerRaising educational attainment as a preventative measure. Reducing alcohol and drug dependency. Mentoring & supporting young people. HealthierReducing smoking in deprived areas. Improving mental health. Tackling depression. Increasing resilience and hopefulness.

12. Ten Lessons… 1.Stress is a Big Issue: stress has psychological effects but also works through biological mechanisms to shorten life. Neighbourhood environment can be a major source of stress and anxiety, but also others. 2.Mentoring and personal support are required for individuals and families to cope with problems and find a route towards personal progress. This is a big part of the People bit of People & Place.

13. 3.Community Development is needed both to enhance cohesion (interaction; mutual support; harmony), and as a route towards empowerment. 4.Status and self-esteem often need enhancement in deprived areas: this is a people:place interaction that needs pro- active intervention where areas are stigmatised.

14. 5.Young people need more priority. They need to be brought into regeneration / transformational processes as there is a real chance to shift ambitions. 6.Activity rates need boosting. Not just paid employment (where quality matters) but also education and training, and voluntary and community activity This will help achieve multiple aims.

15. 7.There is a big role for other services, especially Education and Public Health. Health behaviours, for example, are partly a function of residential context but they are also a product of personality and upbringing, and so are hard to shift. 8.The local social and physical environment is important not just for physical health and security, but also for mental health, psychological disposition and social integration.

16. 9. It matters how regeneration is done, as well as what is done. Empowerment Sense of control over their own lives and area. Self esteem: that they are treated with same respect as others. Sense of progress. Boosting trust in institutions. Optimism for the future. Visible change, esp. early on.

17. The Regeneration Process Participation and Involvement Self Worth: feeling valued; feeling that people are interested in them. Self Actualisation: helping people realise their own knowledge & skills Sense of hope. Sense of progress. Sense of accomplishment Building resilience Keeping people informed Problem solving approach

18. Health Policy & Programmes Regeneration Policy & Programmes Healthier Communities Healthier Individuals 10. There is a two-way relationship between regeneration & health

19. Contribution of Mental Health to Regeneration Goals Good Mental Health Economic Goals: Employability Willingness to take up education & training Health Goals: Closing the mental Health gap Reductions is drinking smoking and drugs Social Goals: Willingness to take part in community Activities Reduction in anti-social behaviour

20. Regen. & Residential Change Cultural Capital Economic Capital Community & Neighbourhood Context Physical Health Mental Health & Wellbeing Social Health Fixed Capital Environmental Capital Social & Community Capital Human Capital

21. II. Glasgow Context

22. Area Deprivation 48% of Glasgow’s data-zones (statistical neighbourhoods) are within the most multiply-deprived 15% in Scotland, the highest of any local authority. 9% of the total area of the city is vacant and derelict land.

23. Housing A third of the city’s population live in social rented housing. Ownership has been increasing. In 42% of the data-zones in Glasgow, the largest housing tenure is social renting. Only a quarter (27%) of the dwellings in Glasgow are houses; the rest are flats, including over 200 medium- and high-rise blocks. In 2001, a third of all dwellings in the city were deemed to be in ‘urgent disrepair’. Glasgow’s 80,000+ council dwellings passed to the Glasgow Housing Association in 2003.

24. Health Inequalities Life expectancy in Glasgow is the lowest in the West of Scotland. Men in Glasgow have high mortality from lung cancer, liver disease and mental disorders, compared to all men in Scotland. There is a 14 year gap in male life expectancy in Glasgow between the least deprived and the most deprived areas. Alcohol related deaths are 8 times higher for men (3 times for women) in the most deprived areas compared with the least deprived parts of the city.

25. Interventions: Housing Improvement of the existing GHA housing stock: –45,000 secure doors (to date) –40,000 new kitchens and bathrooms –35,000 central heating systems Demolition of housing stock deemed unsustainable: –19,500 units to be demolished –Majority in tower blocks (100 blocks out of 200 to go) Construction of new rented homes: –3,000 by GHA and 3,000 by RSLs

26. Housing Demolition of tower blocks. New build housing: 9,000 units in 8 areas. Reduction in densities. Less social housing. Mixed tenure communities, e.g. from 90% social renting to 40 or 50%. Fewer flats and more houses with front and back doors, and gardens.

27. New Neighbourhoods Glasgow City Council is promoting the construction of 4 new neighbourhoods on cleared land in or near social housing areas within the city. These are being built by private contractors to provide owner occupied housing at mid-market prices. Around 1,000 homes each. To attract and retain families in the city.

28. Area Regeneration GCC and GHA have jointly identified 8 social housing areas as Transformation Areas to receive comprehensive renewal over the next 15 years or more. Including large scale demolition. In addition, GHA has identified a further 7 Local Regeneration Projects: multi-dimensional change on a smaller scale. Less demolition. Together, these areas cover 35,000 people, or 6% of the city’s population.

30. III. GoWell Programme

31. Study Areas 15 GoWell communities in 5 types of area i.Transformation areas: - Red Road, Sighthill, Shawbridge ii.Local regeneration areas: - Scotstoun MSFs, Gorbals Riverside, St Andrews Drive iii.Housing investment areas: -Houses and Flats: Riddrie, Carntyne, Govan -MSFs: Townhead/Drygate, Birness Drive (MSFs) iv.Areas surrounding MSFs: - Wider Scotstoun, Wider Red Road (Balornock/ Petershill/ Barmulloch) v.Peripheral estates: - Drumchapel (including a New Neighbourhood), Castlemilk …in the context of the city as a whole

32. Transformation Areas Local Regeneration Housing Improvement GoWell Study Areas Peripheral Estates Wider Areas (around MSFs)

42. 1 Community Survey Repeat, random, cross-sectional surveys of the 15 communities every 2 years. –First survey in 2006, second in 2008. Up to 6,000 interviews in total each time. Head of household or partner is interviewed. To tell us: –How community composition is changing –How perceptions of neighbourhoods and communities change as regeneration and housing investment and newbuild occurs.

43. 2 Tracking/Panel Study To follow and re-interview every 2 years around 1,000 - 2,000 people who live(d) in the Regeneration Areas. This will involve three groups: –Stayers –Out-Movers (voluntary and involuntary) –In-Movers (new residents and returners) To tell us: –The impacts upon people of the experience of the regeneration process. –What the net effects upon communities are of out-migration versus in-migration –Whether people who leave and do not return fare better or worse than those who remain or return to regeneration areas.

44. 3 Ecological Study of Glasgow Examining trends in small area data for Glasgow’s communities (c700 data zones) Classifying small areas by dwelling type and dwelling mix and relating this to outcome data such as for education, crime and health. To tell us: How the intervention areas fare over time compared with other deprived areas in the city. Whether there are outcome effects associated with the residential environment. The extent of area inequalities and how these change.

45. 4 Qualitative Research Governance, Participation, Empowerment and Cohesion: Focus groups with residents. Interviews with community ‘steering groups’ Interviews with practitioners, e.g. consultants. To examine processes of community engagement and involvement in the management of housing and the planning and implementation of regeneration. To investigate issues of community cohesion as communities are changed in terms of housing tenure mix, and as immigrant communities and other newcomers ‘settle in’

46. 5 Monitoring the Intervention(s) Reviewing policy documents for changes in emphasis, priorities and approach. Interviewing practitioners about the nature and pace of intervention and change. In order to: Provide the background context for our reporting of community changes. Understand what the different partners are doing that might impact upon our study participants. Assess the degree and pace of change between the waves of our community survey.

47. 6 Nested Studies of ‘Wider Actions’ We are currently studying 3 initiatives: Community Janitors (Environmental Employability). Youth Diversionary Projects. Play Area Improvement Projects To see Whether such initiatives should be ‘mainstreamed’ Whether they have community level social effects as well as impacts upon recipients/users Whether the effects are sustained or temporary.

48. IV. Initial Health-Related Findings

49. Physical Activity Overall measure of physical activity computed from respondents reports of the number of days per week they undertook moderate or vigorous physical exercise, plus walking around their neighbourhood. Based on IPAQ: International Physical Activity Questionnaire. Modelled the results to control for personal characteristics and included objective and subjective assessments of the local neighbourhood environment.

50. …findings… Housing: Neither building type nor floor level occupied had any effect on physical activity rates. Physical Environment: physical activity rates higher amongst those who rate their local environment as of higher quality, and with fewer incivilities, and cleaner, more attractive. Community: physical activity rates also higher where people have higher levels of trust in, and reliance on, neighbours. Activity is lower where people have contact with their neighbours less than on a weekly basis. Amenities: quality of local amenities was not associated with levels of physical activity.

51. Effects of High Rise Living Analysis restricted to British citizens. Including controls for personal characteristics and area deprivation. Looked at the effects of storey height as well as building type. Highly pertinent to debates surrounding tower block demolition and regeneration in Glasgow.

52. …findings… Physical health indicators generally worse among people living in high rise flats compared with other flats, with increased probability of long-term illness, recent health problems, and poor general health. In relation to mental health, the effects of high rise living appear to be an increased likelihood of: low sense of empowerment over decisions affecting the local area; and failure to derive as many psyshosocial benefits from home (e.g. privacy, control, safety, sense of progress etc.)

53. …continued… Dissatisfaction with dwelling 3 times higher, and with neighbourhood nearly 2 times higher, among those living in high rise flats, compared with those in houses. Those in high flat are 2.6 times as likely to have multiple serious problems with anti-social behaviour in their area. Higher dwelling dissatisfaction particularly acute in relation to internal noise and poor security of the home.

54. Psycho-Social Neighbourhoods Where you live is important to how you feel about yourself, but… Only in Housing Improvement Areas do most people feel that ‘Living in this neighbourhood makes me feel I am doing well in life’ This is true of just a quarter of people in Transformation Areas and a third of people in Local Regeneration Areas.

55. Internal Reputation GoodBad Transformation Areas2516 MSF Surrounding Areas4512 Peripheral Estates2910 Agree or Disagree with the statement: “People who live in this neighbourhood think highly of it”

56. External Reputation GoodBad Transformation Areas942 MSF Surrounding Areas2441 Peripheral Estates1443 Disagree or Agree with the statement: “Many people in Glasgow think this neighbourhood has a bad reputation”

57. Analysis of Newspaper Coverage Looked at coverage of the Sighthill Estate from 2002 to 2008 across Glasgow based newspapers: broadsheet and tabloid, morning and evening press. 734 articles in total over 7 years. Negative articles about Sighthill out-weighted positive ones by 3 to 1. 35% of the negative stories mention asylum seekers. Positive articles reference primary school improvements and regeneration, but many regeneration pieces are ‘mixed’ rather than positive.

58. Next Steps We will begin analysing the Wave 2 data. We will soon be conducting our first survey of the longitudinal outmovers cohort. We will be looking at our data to investigate the effects of housing tenure mix within our study areas. We will be establishing a longitudinal qualitative study of the experience of living through the regeneration process.

59. www.gowellonline.com