Glasgow Community Health and Well-being Research and Learning Programme:

1. Glasgow Community Health and Well-being Research and Learning Programme: Investigating the Processes and Impacts of Neighbourhood Change 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.

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.

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

12. Ten Lessons… • 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. • 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. Community Development is needed both to enhance cohesion (interaction; mutual support; harmony), and as a route towards empowerment. • 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. Young people need more priority. They need to be brought into regeneration / transformational processes as there is a real chance to shift ambitions. • 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. 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. • 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. Sense of control over their own lives and area. Self esteem: that they are treated with same respect as others. Empowerment Visible change, esp. early on. Sense of progress. Boosting trust in institutions. Optimism for the future.

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

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

19. Contribution of Mental Health to Regeneration Goals

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

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 • Transformation areas: - Red Road, Sighthill, Shawbridge • Local regeneration areas: - Scotstoun MSFs, Gorbals Riverside, St Andrews Drive • Housing investment areas: • Houses and Flats: Riddrie, Carntyne, Govan • MSFs: Townhead/Drygate, Birness Drive (MSFs) • Areas surrounding MSFs: - Wider Scotstoun, Wider Red Road (Balornock/ Petershill/ Barmulloch) • Peripheral estates: - Drumchapel (including a New Neighbourhood), Castlemilk …in the context of the city as a whole

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

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.