Cuts, Community Resilience and the new relationship between

the state and citizens’Dominic Harrison

@BWDDPH

Issues• Food Poverty & Wellbeing: A Case study of

emerging challenges• Cuts in NHS and Local Government• Who are our ‘citizens’ anyway?• Inequalities• Resilience perspectives• Inter-generational resilience• State, citizens & problem solving ‘defaults’• Conclusions

Food Poverty

BwD: Community Wellbeing 2012/13

Local Authority Cuts & Risks to Community Resilience Barr et al (2013) BMJ Letters; BMJ 2013;347:f4208 doi: 10.1136/bmj.f4208Higher premature mortality ( deaths under age 75) in Local Authority areas with higher budget cuts & Local Authority budget cuts are systematically higher in north than south

BwD : A growing population…

White

IndianPakistani

• population set to grow by 3% by 2021• biggest growth in the 65+ age group (+17%)

Key: changing population structure and projected increase in number of older people

BwD: Births and deaths 2012

A diverse population by birth . . .

More than 70 main languages spoken - most common English, Gujerati, Urdu, Punjabi Polish

Diverse by Ethnicity…..(2011 Census)

Bw

DA

ge break

dow

n b

y Coun

try of Birth

B

wD

- 20

11

Censu

s (Table D

C2103EW

)

Country of birth Number of residents85+ 2,055 1.7%75-84 5,326 4.4%65-74 8,473 6.9%50-64 18,645 15.3%35-49 23,332 19.1%25-34 15,570 12.7%16-24 15,832 13.0%0-15 32,955 27.0%85+ 63 1.8%75-84 240 6.8%65-74 526 15.0%50-64 1132 32.3%35-49 934 26.6%25-34 293 8.4%16-24 183 5.2%0-15 136 3.9%85+ 38 6.4%75-84 107 18.0%65-74 164 27.6%50-64 190 32.0%35-49 51 8.6%25-34 28 4.7%16-24 5 0.8%0-15 11 1.9%85+ 24 2.4%75-84 94 9.4%65-74 84 8.4%50-64 188 18.9%35-49 201 20.2%25-34 159 16.0%16-24 116 11.7%0-15 129 13.0%85+ 28 1.4%75-84 40 2.0%65-74 27 1.3%50-64 151 7.5%35-49 341 17.0%25-34 829 41.4%16-24 303 15.1%0-15 282 14.1%85+ 18 6.5%75-84 16 5.8%65-74 15 5.4%50-64 26 9.4%35-49 76 27.4%25-34 44 15.9%16-24 41 14.8%0-15 41 14.8%85+ 7 0.3%75-84 42 1.8%65-74 108 4.6%50-64 678 29.1%35-49 916 39.3%25-34 307 13.2%16-24 136 5.8%0-15 135 5.8%85+ 1 0.1%75-84 2 0.2%65-74 11 1.2%50-64 57 6.3%35-49 244 26.9%25-34 395 43.5%16-24 126 13.9%0-15 72 7.9%85+ 0 0.0%75-84 7 2.1%65-74 11 3.3%50-64 62 18.3%35-49 91 26.9%25-34 90 26.6%16-24 51 15.1%0-15 26 7.7%85+ 96 0.7%75-84 448 3.3%65-74 904 6.7%50-64 3425 25.3%35-49 4377 32.3%25-34 2986 22.0%16-24 780 5.8%0-15 530 3.9%85+ 4 1.2%75-84 4 1.2%65-74 11 3.2%50-64 51 14.9%35-49 154 45.0%25-34 74 21.6%16-24 31 9.1%0-15 13 3.8%85+ 11 2.4%75-84 34 7.3%65-74 22 4.7%50-64 95 20.5%35-49 139 30.0%25-34 83 17.9%16-24 43 9.3%0-15 37 8.0%

13546

342

464

995

Age distribution

Other

122,188

3507

594

2001

277

2329

908

338

Europe other

Africa

Middle East

Eastern Asia

Southern Asia

SE Asia (& Central Asia)

England

Rest of UK

Ireland

Other EU Member Countries as at March

2001

EU Accession States

BwD: Female Life Expectancy

BwD: Male Life Expectancy

Burnley Life Expectancy

2005/7 – 2010-12

Economic, social & health inequalities

Healthy Life

Expectancy estimates for 2009-11

by upper-tier local authority, based on

the Annual Population Survey

Healthy Life Expectancy is the number of years an individual can expect to spend in ‘good’ or ‘very good’ general health, based on answers to the following question: How is your health in general? Is it… : Very Good, Good, Fair, Bad, Very Bad?

US army spends $117m on soldiers' psychological resilience

A scheme to build the emotional resilience of American soldiers has been established as rates of suicide and

depression rise. UK Telegraph August 2013

Type 1 and Type 2 ‘Resilience Narratives’

Resilience Type 1Resilience for the ‘dispossessed’ to cope with the

‘hollowing out of the state’

Resilience Type 2 Resilience for the ‘challenged’ to cope with increasingly rapid societal fracture, stress

and dysfunction

Where does community resilience best reside?

Individual Collective

Connection to the StateMost

Resilience?

Least Resilience

?

Resilience Agents & Capacities

Resilience, Recession and Social Outcomes

Intergenerational Resilience in Blackburn with Darwen (2012)Intergenerational Resilience in Blackburn with Darwen (2012)Adverse Childhood Experience (ACE) & Adult Health OutcomesAdverse Childhood Experience (ACE) & Adult Health Outcomes

Pregnant or got someone accidently pregnant Under 18 x 4.5

Liver or digestive disease x 2.3

Stayed overnight hospital in last 12 months x 1.5

Had a sexually transmitted infection x 30.6

Morbidly Obese x 7.2

Heroin or Crack user x 9.7

Regular Heavy drinker x 3.7

Been hit in last 12 month x 5.2

Hit someone last 12 months x 7.9

Been in prison or cells x 8.8

Increased risk (adjusted odds ratio) having health behaviours and conditions in adulthood for individuals experiencing four or more ACEs in

childhood.

Public Services

PolicyCommunity

State & Citizens & ‘problem solving’ defaults? State & Citizens & ‘problem solving’ defaults?

Do with others

Do ourselves

Get others to do

Lobbying & advocacy?

(hold others to account?)

Invest in CVFSector?

Cuts, Communities & Resilience1. Change in civic problem solving ‘defaults’.2. Most communities are already wonderfully resilient in ways professionals and the

state poorly understand-but key determinants of community resilience are being undermined by the current ‘hollowing out of the state’.

3. Resilience has a major temporal (inter-generational ) dimension.4. The key role of public services & the community faith & voluntary sector at this

time in supporting community resilience is to:– Support: work to maintain access to the 4 ‘capitals’ required by communities to

maintain their resilience - across all local public sector spend (4 Capitals are: Mental, Financial, Human, Social)

– Prevent: Re-direct significant resource & programme investment away from investment in problem consequences towards strengthening community resilience and self autonomy

– Take a Generational Perspective: Review evidence for inter-generational resilience determinants.

5. Public services should be both an agent of community resilience transformation and disclosure ( i.e. making visible the consequences of loss of community resilience capacity that are ‘hidden’ outcomes of public policy decisions).

6. Develop wider community asset-based approaches.7. Integrate around citizens and ‘align’ public community and voluntary sector

infrastructure/ services/ skills – develop a ‘one community’ approach.