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Social Justice ...a Scotland where everyone matters - Annual Report 2002

Ella Cairns, Helen Gow
and Anne Paterson

Perspectives on Social Justice

INDEPENDENT ARTICLES HAVE BEEN COMMISSIONED ON THE FOLLOWING SUBJECTS:

• Transport issues faced by residents in deprived areas in urban Scotland
  Julian Hine, Professor of Transport, University of Belfast.
• Interaction between social and environmental justice
  Kevin Dunion, Chief Executive, Friends of the Earth.
• Community Safety Partnerships: Delivering the Social Justice Agenda
  Philip Walker, Director, Community Safety Partnership, Glasgow City Council.
• Inequalities in health in older people: is there cause for concern?
  Dr Rachael Wood & Dr Marion Bain, NHSScotland.

The following four articles have been prepared by independent academics and writers. They are intended to contribute to the understanding of our social justice strategy. The views expressed are the author's own and not necessarily those of the Executive. They cover key issues for enhancing the development and implementation of social justice.

Perspectives on Social Justice
Transport issues faced by residents in deprived areas in urban Scotland

Julian Hine, Professor of Transport, University of Ulster

Introduction

Transport disadvantage is a key issue in deprived areas. This disadvantage is also linked more generally with poor housing conditions, low incomes, unemployment and lack of access to jobs. Although car ownership and use is present in these communities, walking and public transport dominate trips made to a variety of facilities (Hine and Mitchell, 2001). This article provides information on transport issues faced by residents in deprived areas in urban Scotland. The material used in this article is taken from a report completed for the Scottish Executive and published in 2001 on the "Role of Transport in Social Exclusion in Urban Scotland". ¹⁸ The article concludes by updating policy developments, that have taken place since publication of the report, that seek to reduce social exclusion and as a consequence improve transport options for residents in deprived urban areas.

Transport issues in deprived areas

In deprived urban areas public transport and walking are more important forms of transport than the car. Levels of car access in terms of licence holding were notably lower in the three case study areas than for Scotland as a whole. Some 41% held a full driving licence and 42% stated they had never held a driving licence. This compares to 63% who hold a full driving licence and 29% who have never held a licence for the whole of Scotland. ¹⁹ In the UK as a whole people from households on low incomes make fewer journeys overall but about twice as many journeys on foot and three times as many journeys by bus as those households in the two highest income deciles. Higher income groups make more journeys by car and tend to travel further. Nationally half of the households in the top 20% income group now have two or more cars (Table 1). For the lowest 20% income group nearly two households in three did not have a car in 1995/97. Nonetheless this group has seen a reduction of 11% in proportion of households with no car over the period 1985-86 to 1995-97.

Table 1 Household Car ownership by income band, 1985-86 and 1995-97

Source: Focus on Personal Travel, DETR (1998)

In Scotland 77% of men compared to 53% of women aged over 17 held a full driving licence. In comparison in the deprived areas 32% of women and 56% of men held a full driving licence. Among women in "high income areas", 80% have a licence, whereas among women in council-rented flats, the comparable level is only 21% (Scottish Executive, 2001). Younger women are more likely to have a full driving licence (Scottish Executive, 2001; DETR, 1998).

Public transport tends to be used less by those in higher income groups (DETR, 1998; Hine and Mitchell, 2001). For those on low incomes local bus services for the journey to work are extremely important accounting for 63% of journeys for those on gross weekly incomes of ?100-?149
(Table 2). 38% of residents in Leith and Castlemilk stated that they used the bus to travel to work. In Coatbridge, the third case study area, bus services were much poorer, as a consequence the proportion travelling by car as a passenger and driver was higher than in the other two areas. In terms of access, 99% of residents in Leith and 87% in Castlemilk stated that the bus stop they used most often was up to a 6 minute walk away. ²⁰ Service frequencies, however, were found to be lower or non-existent on Saturdays and especially Sundays. Public transport services were also often found to be inadequate where shift work was involved.

I work for a security firm in Edinburgh and we do security at Murrayfield Stadium and I do night shift there sometimes. And getting home from there when I've finished in the morning is just a nightmare. The first bus I can get is half-past 6 from Edinburgh and I finish at 4 o'clock (male).

Table 2 Household Income and Travel to work Mode, Deprived Areas Scotland ²¹

In deprived areas 59% stated that they used the local bus service in their area everyday and up to two or three times per week. Most of these respondents had no access to a car. Typically the main issues for bus users are fares and availability of services. Overall most users felt that the service was of reasonable quality; buses were on time, frequent and safe. However, buses were felt not to perform well in terms of: protection against weather; lack of facilities at the bus stop; inconvenience of changing buses; access to travel information, cheapness of fares and value for money. Reductions in services at weekends are a particular problem. Users also felt that their use of bus transport was constrained by concerns about personal safety after dark, lack of information and routes served. In the case of bus fares the average cost is ?3.79 per week. In Scotland lower income groups (with gross household incomes below ?100-?149 per week) were found to spend more on bus fares than higher income groups. There is a clear need for discounted travel for those on low incomes:

I reckon for unemployed people, the bus fares should be a lot lower, if they can they should be able to bring the price down by a good 20p or something so it's like 50p or 70p but they should be able to give you a pass or something to say that you're on benefit, obviously not for the people that get a lot of benefit money but like the people who don't get that much, I think they could bring the prices down for everybody like (male, Wester Hailes).

Transport considerations can also play a significant role in access to jobs, education and training. Respondents in deprived areas considered that transport played a significant role for the unemployed in being unable to accept a job offer (35.9% of those unemployed). For those in education most felt that lack of transport played a greater role in preventing you looking for a job (21% of those in education or a training scheme). When using public transport:

You can only plan one interview a day, by the time you take the transport thing into consideration. So it's not been very .... well it's been really unsuccessful bus wise. Sometimes it's a case o'trying to borrow a car rather than trying to take public transport because you don't know, you can't rely on it (female, Seafield).

For many women the small local area is of more significance to them as they live most of their lives bounded by the local shops, school and bus stop. This in itself reflects the reliance on public transport and walking. Personal safety when using or trying to access transport infrastructure is also a major consideration for this group (DETR, 1999; Hamilton et al 1992). Work undertaken by System 3 (1998) showed that generally women took substantially more trips on foot and by public bus than men. This is also the case in deprived areas in Scotland where women have less car access than men and are more reliant on "lifts" or sharing transport. Studies have also identified problems experienced by disabled and mobility impaired people in relation to their use of bus services. This includes waiting, boarding and moving around buses.

The average time taken to access facilities varies by gender, but only slightly. Interestingly there is for women less variation for many of the access times compared to men. This may illustrate less travel choice. Conversely, for men where car use is more prevalent there is more variation in time. Public transport contributes to larger average journey times, and its use is higher amongst women, single parents, single adult families and older people. This is also the case nationally. So there is a clear issue about household structure and household location with regard to access on to the public transport network.

Access to health facilities is a key issue for deprived areas. In deprived areas individual stated health conditions are worse than that found nationally in Scotland. ²² Work has also indicated that journey times are the highest for accessing health facilities in these deprived areas especially for those reliant on public transport. In an interview in Broxburn a woman indicated that:

Our doctor is actually in Broxburn which to us is quite a distance so if I need to take my son to Broxburn or that, I have to arrange a lift because trying to get a bus and especially in emergency situations .... just trying to get a bus .... it's a nightmare (female, Seafield).

Taxi use and minicab use is also higher amongst non-car owning households. Taxis often fill the gap when there was no public transport alternative available, and are an important form of demand responsive transport. Their share of journeys increase for journeys to the hospital for example. However, they are viewed as an expensive form of transport albeit one which is fast, convenient and direct. They are most often used when there is no local bus service alternative available. Taxi-cards, which reduce the cost of fares, were found to be used by only 5% of people in deprived areas. As well as introducing shared taxi schemes there is scope to increase the provision of taxi-cards.

Walking, however, remains the dominant mode of transport for people from households on low incomes, but in particular for non-car owning households that make up to 60% of households in the lowest income quintile. About 60% of all journeys made by people in this group are made by people on foot (Grayling, 2001). Walking plays a key role in these deprived communities. Overall 84% of people in deprived areas were found to walk everyday and around 2-3 times per week. In Scotland nationally this figure is around 30% lower at 53% (Scottish Executive, 2002b). For journeys within the local neighbourhood walking accounts for 60-74% of journeys to the local shop, post office and chemist. This modes share of journeys to other activities is not insignificant. Walking accounts for 36% of trips to the supermarket, 38% of trips to the bank, 42% to the doctor, 39% to the dentist, 46% to the library and 41.2% to church. Road safety within these neighbourhoods is therefore an important issue. Pedestrian accident data have shown that children in poorest areas and lower economic and social groups in Scotland are more likely to be killed and seriously injured than children in higher socio-economic groups (Abdalla et al, 1997). There is a clear need to improve pedestrian and cycling infrastructure in these areas.

Community transport schemes, such as dial-a-ride, shopping buses, and social work buses, are a way in which transport can be provided in deprived areas. They are often viewed by policy makers as an alternative option to mainstream public transport. Although an important intervention, only a small proportion of people in deprived areas (4.8% (n=11)) stated that they used these schemes. This is often due to the eligibility criteria of particular schemes (namely age and disability). A revision of scheme criteria may represent an improvement in transport choices in deprived areas. However, a key issue, that needs to be resolved to improve the effectiveness of this form of travel, is there is often little co-operation between different providers and local authorities have little knowledge of community schemes in operation in their respective areas.

The communities in deprived areas are often close-knit and characterised by strong local networks. 36% stated that they had close friends and relatives residing close by within the neighbourhood. 52% stated that they had up to four friends living within a mile of them. Within these networks people feel they can rely on family and friends in a variety of situations. ²³ People were also found to like living in their neighbourhoods. 90% stated that they liked living in their neighbourhood. Only 5% stated that they would move to improve transport links and accessibility.

Best practice and policy innovation

The following section highlights interventions that are a feature of the policy environment in this area. Current directions in policy have highlighted an approach that attempts to tackle the link between transport and deprivation in terms of promoting public transport and a range of other initiatives. The Transport Delivery Report published in 2002 (Scottish Executive, 2002a) highlights an investment programme aimed at tackling social exclusion.

Community transport

People in our survey who had transport access problems demonstrated a high degree of awareness of specialist community transport services for elderly and disabled people. These services were not available to them and so a need for community transport, on a demand responsive basis is clearly evident. Specialist services are typically provided by the voluntary sector. These services typically consist of: group hire bus services; dial-a-ride services and voluntary car schemes (Beecham and Associates, 1995; DETR, 1999). The objectives of dial-a-ride services were originally to provide a demand responsive service serving low-density suburban areas and offer a door-to-door service. As a concept they have been around in the UK since the early 1970s. Often, however, there is little co-ordination of resources between different transport providers in a local authority.

Edinburgh City Council has recognised this and have set up a cross-departmental task force. The Rural Community Transport Fund has sought to introduce community transport services in remote areas. In East Lothian for example this has resulted in the introduction of a demand responsive system (Gaberlunzie) where trips can be booked using the phone. The Scottish Executive is currently developing pilot programmes for demand responsive integrated community transport projects.

Bus Policies

Low-income households spend more on bus fares than rail fares (Grayling, 2001). An established method of improving access to bus services is through a general or targeted subsidy. The 1985 Transport Act, which deregulated bus services in Great Britain, heralded the end of low fares policies, in other words passenger transport authorities and local authorities could no longer subsidise bus services except those that were deemed to be socially necessary and unprofitable. Donald and Pickup (1991) found that deregulation in Merseyside and resultant fares increases were the main cause of reduced use. More recently, there has been some movement on this under the Transport Act (Scotland) 2001 where quality contracts allow local transport authorities to set fares within a franchise. Such interventions that produce a general fare subsidy would be a positive step for low-income groups. Quality partnerships under this legislation are a step forward as they are a way in which operational standards and the use of facilities can be agreed. Under this mechanism, however, it is only possible to set a minimum service frequency and there is no control over fares.

Work has suggested that the cost of subsidies and fare reduction are less than has been previously thought (Grayling, 2001). A fare reduction in metropolitan areas in money and time savings to passengers and other road users could outweigh the costs of the subsidy. This approach is, however, not possible due to the deregulated system, but could be implemented through quality contracts (Hine and Mitchell, 2001; Grayling, 2001).

Targeted subsidies is another approach that is used to grant concessionary travel to pensioners, disabled people, children under 16 and students aged up to 18 years in full-time education. From 30 September 2002 free off-peak local bus travel will be provided for elderly and disabled people. Research indicates that these schemes encourage travel - those with concessions travel more often and further (O'Reilly, 1989; O'Reilly, 1990; Bonsall and Dunkerley, 1997). Nonetheless, it is possible for other groups to be included in a concessionary scheme at the discretion of the concession provider (Grayling, 2001).

Ticketing initiatives were felt to be an extremely important area of activity but the current emphasis is clearly geared towards encouraging use of the bus over the car. There are examples of operators working together to allow season ticket holders to use services run by another operator. An integrated ticketing scheme is being trialed in the South East of Scotland. As well as encouraging bus use it is anticipated that it will reduce travel costs for those on low incomes.

Taxis

Taxis are the most flexible transport service (Beuret, 1994) and are a popular alternative to other modes of transport but are expensive. To combat the high-cost taxi-card schemes exist as a subsidy for travel by this mode (Trench and Lister, 1994). This is a way in which discounted taxi travel could be provided to other excluded groups as long as the eligibility criteria were widened to other groups beyond people with disabilities. Two forms of taxi operation have developed. Essentially there are those taxis that are run through voluntary driver schemes and taxis operated by commercial firms. Voluntary car schemes have been concerned with transporting people for social services, health and education purposes, however, this role has expanded to shopping and leisure based trips (DETR, 1999). These schemes have been effective although funding and volunteer resources do dictate their availability, which is restricted according to specific eligibility criteria (DETR, 1999).

Provision of public transport in new developments

Land-use planning is regarded as extremely important in terms, not only of the provision of community facilities, but also in terms of the location of new employment and retail centres that could be easily served by public transport. Operators also view favourably those developments such as new housing schemes and new industrial estates where bus facilities have been incorporated into the development. Public transport provision in new developments is essential if they are to be accessible to those groups who are more reliant on public transport; particularly those located at edge of town or out of town locations.

New planning and guidance (NPPG 17) issued by the Scottish Executive stresses this point (Scottish Executive, 1999). Recently there has been a move towards maximum parking standards away from minima standards for developments, the idea being to minimise the number of parking spaces in new developments. In Edinburgh revised parking standards also reflect the proximity to public transport and the location of the new development (Scottish Executive, 2000) and the consideration of public transport in key sites has been given more emphasis (Scottish Executive, 2001a). In Scotland a number of local authorities now use targets for the share of each mode of transport to a development as part of the development control process. The first application of this kind was the Ocean Terminal development at Leith in Edinburgh where mode share targets and monitoring were written into the planning agreement. Also in Edinburgh, a similar arrangement was put in place for the Fountain Park leisure development and the Gyle shopping centre.

In Aberdeen, mode share targets were set for the Robert Gordon University as part of the planning agreement associated with their move to Garthdee (Scottish Executive, 2001b). Recently, Glasgow City Council has been given funding to start the development of a comprehensive transport plan for the Clyde corridor looking at access to development sites and addressing social inclusion issues.

Provision of cycling and walking infrastructure

Walking is a very significant mode of transport for people in deprived areas. Cycling on the other hand accounted for less than 2% of journeys to all types of activities. In Leith and Castlemilk respondents commented on the need to move to improve their transport links and accessibility - investment in cycling and walking infrastructure will help to promote patterns of sustainable transport use. The Scottish Executive has allocated ?21.15 million for a four-year period, 2000-04, for walking and cycling projects including safe routes to school.

In 1997 the Scottish Cycle Challenge initiative sought to integrate cycling with other policy areas. 25% of projects under this scheme addressed social inclusion as a key theme (Scottish Executive, 2001c). Projects covered include: Cycle route construction; Secure cycle parking; facilities and other support for cycling to work; Safer Routes to School schemes; Publicity and cycle promotion; Cycle purchase and cycle hire schemes; Integration of cycling with public transport; Support for cycle training, information, and cycle clubs.

Travel information

Travel information is very important and was flagged-up by residents in the case study areas of the social exclusion study as an issue. Traveline Scotland was set up in January 2001 this organisation operates the national public transport information service. Not only does this service provide travel information it also provides the ability to book and pay for journeys at the time of making the enquiry (see http://www.traveline.org.uk ). In addition to this service, many local authorities operate travel information services for public transport (for example Fife, City of Edinburgh Council). In the West of Scotland public transport information is provided by Strathclyde Passenger Transport. Also a number of operators have improved the provision of information at bus stops most notably Lothian buses in Edinburgh. In Glasgow and Coatbridge there were complaints about the lack of timetable information at bus stops (Hine and Mitchell, 2001).

Conclusion

Since the publication of the report into links between transport and social inclusion (Hine and Mitchell, 2001) there have been many developments in policy. These initiatives are aimed at improving the delivery of public transport. Over the last 18 months, for example, an integrated ticketing experiment has started, free off-peak concessionary local bus travel has been introduced, and programmes improving pedestrian infrastructure are also planned, and the Transport Act 2001 now provides those mechanisms to ensure that socially necessary services are protected. Many of these programmes clearly meet stated social inclusion objectives. Nonetheless there are still concerns about how the transport needs of deprived areas, and for that matter individuals as well, are met where encouraging car drivers to switch to public transport is the main objective. Policy and programmes must be carefully crafted and appraised to avoid such difficulties.

References

Abdalla, I., Raeside., Barker, D.J. and McQuigan, D.R. (1997) "An Investigation into the Relationships between Area Social Characteristics and Road Accident Casualties", Accident Analysis and Prevention, Vol 29, No. 5.

Bonsall, P. and Dunkerley, C. (1997) "Use of concessionary travel permits in London: results of a diary survey", Public Transport Planning and Operations, Proceedings of Seminar G held at the PTRC European Transport Forum, London.

Beuret, K. (1994) "Taxis: The Neglected Mode in Public Transport Planning", in Provision for Accessible Transport Services, Proceedings of Seminar F held at the PTRC European Transport Forum, London.

DETR (1998), Focus on Personal Travel, TSO, London.

DETR (1999) Review of Voluntary Transport, Available on line at: http://www.mobility-unit.detr.gov.uk/rvt/report/1.htm

Donald, R.G. and Pickup, L. (1991) "The effects of local bus deregulation in Great Britain on low income families: the case of Merseyside", Transportation Planning and Technology, Vol. 15 (2/4), pp. 331-47.

Grayling, T. (2001), "Transport and social exclusion", Paper presented to the Transport Statistics User Group, January.

Grieco, M., Pickup, L. and Whipp, (1989), Gender, Transport and Employment, Gower, Aldershot.

Hamilton, K., Hoyle, S.R. and Jenkins, L. (2000), The Public Transport Gender Audit, TSO, London.

Hamilton, K. and Jenkins, L.(1992), Women and Transport, Ch6 in (Roberts, J et al eds) Travel Sickness, Lawrence and Wishart, London.

Hine, J.P. and Mitchell, F. (2001), The Role of Public Transport in Social Exclusion, Scottish Executive Central Research Unit, Edinburgh.

O'Reilly, D.M. (1989), Concessionary Fares and Children's Travel Patterns: An Analysis based on the 1978/1979 National Travel Survey, Department of Transport, (Research Report 203), London.

O'Reilly, D.M. (1990), An Analysis of Concessionary Bus Fare Schemes for OAPs using the 1985/86 National Travel Survey, Department of Transport (Research Report 291), London.

Scottish Executive (1999), National Planning Policy Guideline 17 Transport and Land Use Planning. Available at: http://www.scotland.gov.uk/library/nppg/npg17-00.htm

Scottish Executive (2000a), Scotland's People - Results from the 1999 Scottish Household Survey, TSO.

Scottish Executive (2000b), Integrated Policy Approach to the Transport and Land Use Planning aspects of Development Applications, Central Research Unit, Edinburgh. Available at: http://www.scotland.gov.uk/library3/transport/ipaf-00.asp

Scottish Executive (2001a), Planning for mode share in new development, Central Research Unit, Edinburgh: Available at: http://www.scotland.gov.uk/library3/planning/pfms-00.asp

Scottish Executive (2001b), Key Sites Appraisal Methodology for Development Planning, Central Research Unit, Edinburgh. Available at: http://www.scotland.gov.uk/library3/planning/ksap-00.asp

Scottish Executive (2001c), Evaluation of the Scottish Cycle Challenge initiative, Central Research Unit, Edinburgh. Available at: http://www.scotland.gov.uk/cru/kd01/blue/cycle-00.htm

Scottish Executive (2002a), Transport Delivery Report for Scotland. Available at: http://www.scotland.gov.uk/library3/transport/stdi-00.asp

Scottish Executive (2002b), Household Transport in 1999 and 2000: Some Scottish Household Survey Results. Statistical Bulletin, TRN/2002/4

System 3 (1998), Travel Patterns in Scotland 1997: Results of an analysis of Travel Diaries, Central Research Unit, Scottish Office, Edinburgh.

Trench, S and Lister, A (1990), "Changes in taxi Services - Can New Developments help people with a mobility handicap?", Public Transport Planning and Operations, Proceedings of Seminar D, held at the PTRC Transport and Planning Annual Meeting. London.

Perspectives on Social Justice
Interaction Between Social & Environmental Justice

Kevin Dunion, Chief Executive, Friends of the Earth Scotland

When Jack McConnell made his first major policy speech on the theme of environmental justice, he seemed to catch many by surprise. The fact that he had chosen a platform addressing an environmental issue rather than jobs, health or education was notable. But even for that audience the focus on environmental justice, a term which is more associated with campaigning organisations rather than with the mainstream of environmental protection and improvement was challenging. The message was uncompromising which is that the people in Scotland who live in the most disadvantaged circumstances are also likely to face the consequences of historical development decisions which have exposed them to a greater risk of pollution and a poorer quality of environment than those who are better off. Furthermore the systems put in place to inform, advise and protect those people are perceived not always to work in a way which prevents pollution, punishes polluters or includes those who are affected in decision making about their lives. As the First Minister himself said, "communities do not always believe the system is on their side". ²⁴

In the meantime those who have been working on the social justice agenda may be wondering where this has all come from. Some may see environmental justice as a sub set of the wider social justice agenda. Others may see it as a muddying of the waters, particularly as recently there has been a harnessing of environmental and social justice.

Environmental justice is closely associated with social justice but it is neither a recent or opportunistic manifestation nor is it entirely a subset of the social justice agenda. As a term it originated from the activism of the early 1980s in the USA where black communities in particular identified that the dumping of toxic waste disproportionately was carried out in black communities. In some cases it could be argued that this is done unwittingly, responding solely to the availability of cheap land in black communities. In other cases, however, it was clear that this was done deliberately in the expectation of less resistance from poor black communities as compared to the response which might be expected from white, middle-class communities if the same polluting development was proposed. Originally, therefore, the concern was over what was dubbed environmental racism. However, over the years it is clear that poor communities are disproportionately exposed to the risk of pollution from toxic dumps, industrial processes, waste incinerators and so on. A study carried out in Massachusetts, USA analysed the income based and racially-based biases to the geographic distribution of 17 different types of environmentally hazardous sites and industrial facilities. These range from power plants to toxic waste dumps. The study found that communities with median household incomes of less than $30,000 averaged nearly two-and-a-half times more hazardous sites than communities with median household incomes of $40,000 and higher. ²⁵

Official recognition of this was provided by the signing of an executive order in February 1994 on 'Federal actions to address environmental injustice in minority populations and low income populations' which required that each federal agency shall make achieving environmental justice part of its mission by identifying and addressing as appropriate disproportionately high and adverse human health or environmental affects of its programmes, policies and activities on minority populations and low income populations in the Unites States.

Another government to recognise the need to make legislative provision for ensuring environmental justice is South Africa. The Bill of Rights, section 24 in the South African Constitution upholds peoples right to a clean and healthy environment. This is carried into effect by the Environmental Management Act of 1999 which makes specific provision for sustainable development, environmental justice, equity and participation. So there should be no misconception that environmental justice has simply been conjured up in Scotland by appropriating social justice terminology.

The issue to be addressed therefore is whether environmental injustice is being experienced and what measures need to be taken to improve circumstances for disadvantaged communities.

One way of doing that, as in Massachusetts, is to see who is living next to the most polluting activities. Friends of the Earth researchers in England correlated the Environment Agency's factory emissions data with the Government's "Index of multiple deprivation." They established that of the 11,400 tonnes of carcinogenic chemicals emitted to the air from large factories in England in 1999, 82% were from factories located in the most deprived 20% of local authority wards.

A similar exercise in Scotland would be more difficult to undertake given the manner in which the data is held but it is to be hoped in the future that work could be done with the Scottish Environment Protection Agency to establish the correlation here, not least because planning authorities should be taking it into account when considering the cumulative impact of planning decisions.

Another approach might be to consider whether there is evidence of health impact from living next to potentially polluting activities. This is notoriously difficult to establish. Some studies have shown that there is a correlation between proximity and increased risk. For instance a European study of landfill sites showed a 33% increase in the risk of non-chromosomal anomalies (e.g. neural-tube defects; cleft palate; cardiovascular, gastro-intestinal, and central-nervous-system disorders) for residents living near hazardous waste landfill sites. ²⁶ A similar increase in chromosomal abnormalities has also been reported. However, it is not established from this research that the anomalies are caused by living next to the landfill nor was it clear what chemical exposures the mothers had been exposed to prior to or during pregnancy.

Only a limited number of detailed site studies have been carried out in Scotland, e.g. on the chromium contaminated land, Cambuslang and Rutherglen, and this appears to show no correlation with cancers or leukaemia.

Where does this leave us in respect of environmental justice for Scotland?

First, we should proceed on the basis that it is likely, given experience elsewhere, that poor populations live next to the most polluting or the most environmentally degrading activities such as oil refineries, chemical works, cement works, landfills, opencast mines and so on.

Secondly, the impacts upon their lives should not be measured by extreme consequences such as fatal or chronic conditions. It is usually experienced as a degraded quality of life - living in a noisy, dusty, noxious, traffic generating environment, with episodes of severe diminution due to accidents and operational failings. Public health officials are increasingly addressing the mental health of populations and so far as hazardous sites are concerned have argued that community health is affected by a combination of fearing ill-health from exposure to pollutants and having no sense of control over circumstances.

It is not suggested that people and the environment are without protection. Sites in Scotland are subject to environmental laws and monitoring by public authorities. Pollution episodes which break the terms of the licence for the operation may lead to prosecution in certain circumstances. However, there is a concern in Scotland, and indeed even expressed by SEPA that the number of cases actually coming to court are less than might be expected. 65% of the cases taken by SEPA to the Procurator Fiscal for the west of Scotland were returned marked no proceedings. Overall, in Scotland in 1999-00 there were 2306 pollution incidents recorded by SEPA which resulted in 84 cases being reported to the Procurators Fiscal. In around one-third of the cases no action will be taken. This compares to action being taken in 87% of all cases reported. The view is held in some quarters that environmental crimes are not taken as seriously as other categories - a view no doubt which will be challenged but which must be understood when communities feel that not only are they exposed to the risk of pollution but there is a reasonable chance of polluters escaping either detection or prosecution.

Environmental justice is not just or even usually about illegal pollution. It is more to do with the outcome of a decisions which allow legally-permitted operations to cluster next to poor populations and where, in turn, these environmentally undesirable features compound other economic and social adverse indicators giving rise to a poor quality of life. A mother living in a damp, hard-to-heat home which contributes to wheeze or asthma in her children is likely to be more concerned about dust and emissions from a nearby opencast site or chemical factory. If spending the day at home through unemployment or as a carer she will have to put up with disturbance from operational activities.

The argument is made is that these activities have to take place somewhere and to object to them exhibits a selfish, not-in-my-backyard attitude. However, environmental justice links with the sustainable development agenda, in arguing that the situation is made much worse than it need be for poor communities. For instance we live in a throwaway society where we have not yet been able to decouple our increase in national and personal income from the consumption and discard of resources (we have been able to achieve a degree of decoupling with energy use). As a result our paper, construction debris. packaging, left-over food, old tyres have to go somewhere, preferably if we are well enough off nowhere near our backyard. Scotland generates 12 million tonnes of waste annually, 2 million tonnes of which are household/domestic waste. Yet we recycle only 6% of our domestic wastes. ²⁷ By comparison England recycles 10%; Germany 30%; USA 31.5%; Netherlands 45% and Switzerland 52%. There is a legitimate case to be made by communities living next to landfills and incinerators that they are unnecessarily experiencing a reduced quality of life and being exposed to potential risk. The case for reducing consumption of resources and generating fewer wastes is a social one not just out of environmental concern for the depletion of scarce resources.

Environmental justice is about decency and fairness. Are there people in our society who are disproportionately exposed to degrading and potentially unhealthy commercial and public operations? Are the operations necessary - are we assessing alternatives as well as risks? Have we set the regulatory standards and fiscal measures which ensure that polluters truly bear the costs rather than permitting undesirable impacts to be borne by local people and the environment? Have we made sure that the communities have a real voice in the decision-taking process and that there is adequate means of redress where they are aggrieved or standards are breached?

A number of companies are addressing environmental justice concerns by producing Corporate Social Responsibility reports in combination with or incorporating environmental reports. Scottish Power has won an award for the quality of its report and across the UK 50 of the top 250 companies now have such reports. Friends of the Earth Scotland, with funding from the Scottish Executive and the Scottish Environment Protection Agency, is researching the applicability to Scotland of US-style Good Neighbour Agreements. These are local agreements between companies and residents covering issues such as access to site information, regular liaison and agreement by the company to exceed minimum regulatory standards in operation.

So stating concerns and pointing up failings is not to suggest that nothing is being done. In Scotland detailed plans are being drawn up to eradicate fuel poverty by 2016. The outcome will improve the comfort and health of low income households; reduce their fuel bills and improve the energy efficiency of their homes. The national waste strategy should redirect biodegradable and other wastes away from landfill and incineration into composting, re-use and recycling. The massive investment in water and sewerage will mean high quality drinking water and cleaner rivers and beaches. The combination of the Freedom of Information Act and the new Environmental Information Regulations should mean that a more proactive stance on providing useful information to communities will be taken which may reassure them or quite rightly equip them if they wish to question or challenge polluting activities.

A Cabinet Sub Committee on a sustainable Scotland has been formed which does not just draw upon the Ministers and officials in the Environment and Rural Affairs Department, but also the Minister for Finance and Public Services, Deputy Minister for Enterprise, Transport and Life Long Learning and the Deputy Minister for Social Justice. The personal commitment of the First Minister is evident as he chairs the meetings. From this has come the indicators of sustainable development which include a number drawn from the social justice milestones. It is also notable that the imperatives set out the 2002 spending review were to contribute to achieving sustainable development and closing the gap. This is informed by the knowledge that there is a strong synergy between the two.

It should be clear is that there is no zero sum game, where attention to environmental justice is at the expense of social justice. We should be capable of addressing a number of issues at the same time, neither dismissing environmental degradation as a consequence to be borne for maintaining economic activity in poor areas; nor as an irrelevance given other health and social impacts such as smoking or poor diet. Communities and households do not demarcate their lived experience in this fashion. Having a job; being able to get there by affordable transport; having a decent home with access to nearby social, leisure and retail facilities; living with a good environment in terms of air and water quality and in pleasant surroundings free from exposure to pollution. These are criteria for a decent overall quality of life - and they were articulated as such over 30 years ago. It should still be our aim to bring them about for everyone in Scotland.

Perspectives on Social Justice
Community Safety Partnerships Delivering the Social Justice Agenda Policy in Practice in Glasgow:

Philip Walker, Community Safety Partnership, Glasgow City Council

1. The Development of Community Safety Policy in Scotland

In 1999 the Scottish Executive published Safer Communities In Scotland - "Guidance for Community Safety Partnerships". It demonstrated the broad range of issues that affect safety in communities across Scotland and put forward a range of measures that could be introduced to help address these issues with local authorities taking the leading role. This document and the subsequent work carried out by the Scottish Executive coincided with a dramatic rise of interest in community safety issues in many local authorities at a grass roots level. These factors have led to an increased importance being attached by the Scottish Executive and local authorities to tackling crime and accidents within communities as an important part of the wider social justice agenda.

2. Defining Community Safety

It is generally accepted that community safety encompasses crime and fear of crime. These issues are highlighted time and time again in the media and in various documents as the two areas in which work in community safety can have a significant impact. However, the old and the very young are generally more at risk of injury from accidents, particularly in the home than they are of becoming a victim of crime.

The common crime related perception of community safety often fails to realise the impact of accidental injury to individuals, families and communities and the subsequent cost of accidents in the community. RoSPA estimated that on average one accident costs the NHS ?1,551.91 (this figure was based on 1991 costs). In 1999 the Paediatric Epidemiology and Community Health (PEACH) Unit at Yorkhill Children's Hospital using the Canadian Hospital Injury Reporting and Prevention programme (CHIRP) data collection system showed that 10,030 children aged 0-14 years attended the Accident and Emergency Department as a result of an accident. Using the cost to the NHS 1991 figure this would equate as a cost to Greater Glasgow NHS Board, and subsequently the community, of ?15,565,657.

A broad approach to community safety therefore adheres more closely with the wide-ranging Social Justice Agenda by addressing all of the safety factors that affect socially disadvantaged communities.

3. Developing A Framework for Action

Tackling crime and accidents within communities are traditionally the concerns of the Police, Fire and Health Services. It became necessary, therefore, in order to bring these agencies together, with the local authority taking a prominent role, for local authorities to establish either new partnership frameworks for community safety or to integrate joint planning for community safety into existing planning structures. As a result of a range of approaches every local authority in Scotland now has a Community Safety Partnership of some kind.

To further ensure that the necessary structures are in place at all appropriate levels, a National Community Safety Forum has been established with representatives from the Scottish Executive, Emergency Services, local authorities and other relevant agencies.

4. Making the Partnerships Work

In an effort to strengthen local community safety partnerships and provide them with the resources to assist in tackling local community safety issues in a strategic and co-ordinated way, the Scottish Executive reviewed its CCTV and Community Safety Challenge Fund. This review led to the Community Safety Partnership Award Programme being established. This new approach guarantees a fixed amount of funding to the partnerships for three years and a variable award allocated annually that rewards innovation and effectiveness. This approach encourages strategic thinking and financial planning over a realistic timescale enabling partnerships to fund staff posts, resource a broad range of new work programmes to tackle drug misuse, domestic security etc. or to consolidate existing programmes such as CCTV.

This new approach to funding coupled with mainstream council resources and the increase in funding being allocated by the Scottish Executive through other mechanisms such as the Better Neighbourhood Services Fund and the New Opportunities Fund provides greater opportunities for partnerships to resource their plans for tackling community safety issues in their area.

However, financial resources alone do not make partnerships work. There needs to be a strong commitment from the partners to work together to a common agenda, an open and transparent communication framework, an acceptance that individual efforts still have to be co-ordinated as part of the wider partnership approach and a willingness to share information; if it is available.

Information collection and sharing is vital if the interventions that are planned such as domestic security or accident prevention programmes are to be targeted correctly to close the gap between areas that experience high levels of housebreaking or accidents in the home and those areas of the City where these occurrences are less prevalent. Correct targeting can only be achieved if the partners have the information they need to inform their decisions. There is a growing requirement to establish systems that gather relevant accurate information to allow partnerships access to data that enables them to precisely plan and measure the impact of their strategies at a local level.

5. Linkages to Other Key Strategies and Issues

Community safety by its very nature cuts across a range of other key policy areas for both central and local government. It is very often a key area within the community planning process and an issue that has very high levels of community interest and support.

Drug abuse is also high on the community safety agenda and this is usually reflected in the close working of the Drug Action Teams (DATS) and the Community Safety Partnerships. The Children's Services Plan, The Youth and Criminal Justice Plans, and the broad inequalities agenda are all critical areas that affect community safety and are being increasingly reflected in community safety plans across the country.

6. Key Issues and Inequalities in Community Safety

Safety is an issue that affects all sections of the community, however, communities experiencing high levels of disadvantage and poverty are also subject to significantly higher levels of crime and accidents than communities that are more affluent.

In order to close the gap between the communities and groups who experience greater levels of issues that affect their safety and the more safe and secure communities and groups in the city, there is a requirement to ensure that new services are targeted into areas or at groups that experience high levels of exclusion. This could mean in practice the prioritisation of services that provide safety and security to women and children, who experience domestic violence, or the installation of safety measures into the homes of older people to address their fear of crime, etc.

Examples of this approach include the proposal to establish a new interactive experiential safety education facility for children and young people "Safetown" in Greater Easterhouse. The continued installation of public space CCTV systems and the expansion of domestic security, smoke detector and home safety equipment programmes into the SIP areas of the city.

7. Community Support and Participation

Getting and keeping local community representatives involved in the process is absolutely essential. Only if there is strong community identification with both the issues and the means of resolving them can long-term sustainable change be generated within communities. There is nothing quite like local solutions to local concerns.

Even with a strong commitment to involve communities, it is often difficult to get a balanced community perspective that takes cognisance of the concerns and issues that affect under- represented or excluded groups. Young people, ethnic minorities and the disabled are some key groups that can often find themselves excluded from community consultations. Extra efforts have to be made to ensure that such groups are given opportunities to articulate their views and become part of any local solution.

8. Community Safety in Practice

One of the most important elements of any strategy is how it impacts at a local level. What is it that we do that makes a difference to the lives of the people it was designed to help?

Across the country a wide range of programmes and projects have been established by the agencies that make up Community Safety Partnerships. The following illustrate just some of the programmes that have been established as a result of partnership working in community safety in Glasgow. An underlying principle of all of these programmes is that of partnership working and a commitment to ensure that those demonstrated to be successful move into mainstream service provision.

9. The Future

It is still early days for most of the Community Safety Partnerships across the Country. The recent progress made by the Scottish Executive and local government in relation to community safety will, however, accelerate their development and their capacity to deliver the community safety elements of the Social Justice Agenda.

Perspectives on Social Justice
Inequalities in health in older people: is there cause for concern?

Dr Rachael Wood, Specialist Registrar in Public Health Medicine
Dr Marion Bain, Consultant in Public Health Medicine
Information and Statistics Division of NHSScotland, Trinity Park House, Edinburgh

Introduction

Inequalities in health relating to socio-economic circumstances in the younger and working age populations have received much attention both in terms of research endeavour and policy development. Until recently, by contrast, inequalities in health in the older population have received relatively little focus. Several reasons may account for this, including technical difficulties involved in studying inequalities in the older population, and misplaced assumptions that discount the possibility of significant inequalities in health existing in older age groups. These include the idea that if older people from disadvantaged socio-economic circumstances "make it" into old age they must be intrinsically resilient and therefore healthy or, conversely, that old age is a time of inevitable ill-health and disability for people from all socio-economic groups.

Over recent years, however, increasing recognition of the challenges posed by population ageing has focused more attention on older people's issues in general, including the issue of inequalities in the older population. It is therefore now timely to:

• Outline the extent of socio-economic inequalities in health in the older population of Scotland;
• Consider what strategies may be effective in combating these inequalities; and
• Discuss whether current policy is heading in the right direction.

This is of direct relevance to the Scottish Executive's Social Justice Strategy, which recognises that "every older person matters" and explicitly aims to increase the number of older people enjoying active and healthy lives.

How big is the problem?

Evidence from the literature

A growing body of literature examining the extent of socio-economic inequalities in health in the older population has become available over recent years. In general this research demonstrates that substantial inequalities in health persist into old age, although the gradients tend to diminish somewhat in the oldest age groups, and (as is the case in the younger population) they are generally stronger in men than women. ^{1 2 3}

The association between poor health and low socio-economic status in the older population is very consistent across a wide range of measures of health including:

• Physiological measures of health, for example lung function and blood pressure;
• Self-assessed health, that is the likelihood that an individual will rate his or her own health as good;
• Certain specific diseases, for example cardiovascular disease;
• The presence of a long-standing illness that limits an individual's day-to-day activities;
• The presence of disability including difficulty in performing basic activities of daily living;
• Overall healthy life expectancy, and
• All cause mortality and total life expectancy.

In addition, a number of studies are now available that show that low socio-economic status is not just correlated with the presence of ill-health at any one point in time, but also with the rate of deterioration in health as older people age further. ⁴

The situation in Scotland

Information available on the presence and extent of socio-economic inequalities in health in the older population of Scotland is consistent with the research evidence. Social Justice Milestone 22 shows that older people from deprived areas are substantially more likely than those from affluent areas to have chronic respiratory disease and to die from coronary heart disease.

Results from the Scottish Household Survey show the percentage of older people (by sex and age group) reporting their own health as good and, separately, reporting that they have a long-standing illness that limits their day-to-day activities (Table 1). In general, health deteriorates with increasing age, and is similar between the sexes in the young elderly, but in the oldest age group the proportion of women reporting limiting long-standing illness is substantially higher than in men of the same age. Results from the Scottish Health Survey show that substantial socio-economic inequalities in these measures of health exist in the 65-74 year age group.

FIGURE 1: Self-assessed health and limiting long-standing illness, persons aged 65-74, by deprivation quintile, Scotland 1998

Source: 1998 Scottish Health Survey
People living in private households only

Table 1: Self-assessed health and limiting long-standing illness, persons aged 65 or over, by sex and age group, Scotland 1999-2000

Source: 1999 and 2000 Scottish Household Survey
People living in private households only
Note that the results for males aged 85+ are based on a small sample of 113 men and hence are subject to considerable uncertainty

What do these results mean in terms of the numbers of older people in Scotland experiencing poor health? The Health Survey figures suggest that if the total population of Scotland aged 65-74 years (estimated to number almost 440,000 persons in 2000) experienced the level of health enjoyed by those living in the least deprived areas of Scotland, around 44,000 more people of that age would consider their health to be very good or good, and around 36,000 fewer people would consider themselves to have a limiting long-standing illness. Therefore, the effects of material deprivation on older people's health are substantial. This is compatible with the results of one study that suggested that socio-economic inequalities account for a five year "disability gap" in older people; that is, people from social class V in all older age groups experience disability rates equivalent to or higher than those seen in people five years older from social class I. ⁵

Inequalities are evident in death rates as well as in levels of ill health. Table 2 shows that in Scotland a substantial socio-economic gradient in life expectancy persists into older age. The gradient continues to be apparent for men until at least 85 years of age, although it is no longer evident for women by this age. Although the absolute differences in numbers of expected years of life at age 65 between those living in the least and most deprived areas of Scotland are not as large as those seen at birth, in relative terms (as seen in the ratio between expected years of life for the least and most deprived) they are even more substantial.

Table 2: Life expectancy in years at birth and age 65 and 85 years, by sex and deprivation quintile, Scotland 1990-1992

Source: 1990-1992 death data and 1991 census population data
Total population

What can be done about it?

When considering effective strategies to reduce inequalities in health in the older population it is useful to consider both today's older people and future older generations.

Today's older people

The Independent Inquiry into Inequalities in Health in England which reported in 1998 ⁶ examined the issue of socio-economic inequalities in health in the older population and made a series of relevant policy recommendations based around:

• Promoting material wellbeing;
• Improving the quality of homes;
• Promoting the maintenance of mobility, independence, and social contacts; and
• Improving health and social services.

Specific recommendations included:

• Reducing income inequalities and promoting the uptake of benefits in older age groups;
• Improving home insulation and heating to provide affordable warmth, and home design to reduce accidents;
• Promoting community safety and affordable integrated public transport; and
• Ensuring the provision of accessible health and social services that are distributed according to need.

In general, approaches to reducing socio-economic inequalities in health in the younger population have, appropriately, focused relatively little attention on the role of health and social services. As the Independent Inquiry recognised, however, given that older age groups are more likely to experience health problems, these services do have an important role to play in combating inequalities in the older population.

It is the case for older people, as for the population as a whole, that there may be conflict between measures that provide maximum health gain and measures that most effectively reduce inequalities in health. For example, inadequate physical activity is a major constraint on the health of older Scots in general, and increasing activity levels in the older population would undoubtedly result in substantial health gain, but, as Milestone 22 shows, physical activity rates are fairly similar across socio-economic groups. Although specific evidence for Scotland is lacking, it is likely that socio-economic inequalities in smoking and diet continue into older age, and thus contribute more to inequalities in health in the older population than inadequate exercise levels.

When considering the targeting of interventions to reduce inequalities among older people, it is useful to consider which groups require particular attention. Groups within the older population that are particularly vulnerable in terms of their socio-economic circumstances, their health status, and/or their ability to access services include:

• Women from the oldest (85 years and over) age group, especially those who live alone,
• Older people living in long-term care settings;
• Older people from ethnic minority communities; and
• Older people living in remote rural areas.

The vulnerability of women from the oldest age group deserves particular emphasis as this group is at the highest risk of a range of adverse socio-economic circumstances (for example having a low income, living alone or in long term care, experiencing fear of crime, and having no access to a car) and also experiences particularly poor health (for example has high rates of limiting long-standing illness and disability). ^{3 7}

Future older generations

Population ageing means that there will be a substantial increase in the number of older people in Scotland over coming years. Currently there are approximately 787,000 people aged 65 years or over living in Scotland (15.4% of the total population). By 2040 current projections suggest that this figure will have increased to 1,238,000 people (27.0% of the total population). ³ This should be seen as a success story as it reflects falling death rates in all age groups, however, it does bring with it some specific challenges. ⁸ For example, as ill health becomes more common with increasing age and older people are therefore the major users of health and social services, particular concerns have been raised about the implications of population ageing for the provision of these services. These concerns have helped to focus attention on the promotion of healthy ageing in future generations of older people.

The literature on the promotion of healthy ageing has often had only an implicit focus on the reduction of socio-economic inequalities in health in future older generations. It is clear, however, that maximising the chances of healthy ageing for all members of society ultimately relies on the reduction of socio-economic inequalities across all age groups. Inequalities in health in old age are not simply the result of the socio-economic circumstances that older people find themselves in once they are old (although these continue to be important), but rather they reflect the accumulated "stacking up" of the adverse influences on health associated with low socio-economic status that people have been exposed to throughout their lives. Specific effective measures across the life course to promote healthy ageing that have been advocated include: ^{2 9 10}

• A good start in life with avoidance of maternal smoking and poor nutrition and increased breastfeeding;
• Positive early years with good nutrition and adequate exercise and a sound education;
• Healthy adulthood with secure and rewarding work and healthy lifestyles;
• Supportive social networks at all stages of life; and
• Effective health services geared towards health promotion and disease prevention.

Recognition of this fact shows how intricately linked the issues of healthy ageing and social justice are: indeed it could be argued that the opportunity of a healthy and active old age for all citizens is the ultimate end product of a socially just society.

Are we heading in the right direction?

Finally, it is useful to consider:

• Whether current policy is likely to be effective in reducing inequalities; and
• Whether we can accurately measure progress.

Current policy

In general there has been a much increased focus on the issues facing the older population seen in both UK and Scottish policy over recent years. There are numerous examples of positive policy developments that are likely to reduce inequalities in today's older population, for example increases in financial support for the least well off through the benefit system, improvements in access to central heating and home insulation, and provision of free off-peak local bus travel to all pensioners.

As the major users of the health service, older people will also be the principal beneficiaries of the planned increases in NHS funding, however, care will need to be taken to ensure that improved services reach those most in need. It could be debated whether the recent implementation of free nursing and personal care for older people in Scotland will reduce inequity. Some observers have commented that this measure will be of most benefit to better off older people who would not previously have qualified for means tested help with the costs of long term care. In our view, however, free care is a positive development that will make an important contribution to removing the fear of requiring long term care across the older population generally.

Looking to the future, whilst it is very difficult to predict likely trends in inequalities, concerns have been raised that the generations that were young during the period of rapid social polarisation seen in the 1980s and early 1990s are at risk of carrying forward particularly marked inequalities in health as they get older unless appropriate action is taken. ¹¹ The recognition of the importance of social justice generally and the links between socio-economic circumstances and health specifically (as evidenced by the Social Justice Strategy and the Public Health white paper, Towards a Healthier Scotland) is therefore to be warmly welcomed. The life course approach to promoting social justice adopted by the Scottish Executive sits well with what is known about promoting healthy ageing for all members of society. There is little doubt therefore that current policy is heading in the right direction; the only remaining question is whether it is bold enough to address the size of the challenge facing us.

Monitoring progress

The final question to address is whether we have the necessary information to accurately monitor trends in socio-economic inequalities in health in the older population. The indicators contained in Milestone 22 (inequalities in exercise levels, the prevalence of respiratory disease, and mortality from coronary heart disease) are useful but provide a rather limited picture. In addition to monitoring inequalities in the socio-economic circumstances of older people (for example see Milestone 19), it would be beneficial to monitor socio-economic inequalities in the older population in a variety of health related behaviours (including smoking and diet) and also in health outcomes (particularly healthy life expectancy).

Healthy life expectancy provides a measure of the length of time individuals can expect to live in good health, and the discrepancy between this and total life expectancy therefore gives an indication of the length of time people can expect to live in poor health. Research from England has shown that healthy life expectancy varies substantially with socio-economic status in the older population (Figure 2). ¹² No healthy life expectancy data exist for the Scottish population at present, although a group (including the authors of this paper) is currently working to produce this information. Monitoring of healthy life expectancy at age 65 years by sex and deprivation quintile would provide a very useful summary indicator of trends in inequalities in health in the older population.

Figure 2: Healthy and disabled life expectancy at age 65-69 years, by sex and social class, four areas of England 1987-1991

Extracted from Melzer, 2000
Data derived from the Medical Research Council Cognitive Function and Ageing Study
Disability defined as physical (needing help with activities of daily living) and/or mental (possible dementia) disability
People living in private households and long-term care homes

Finally, there are particular issues about the coverage of the older population in important national surveys that provide information on health related behaviours and overall health status. Older people have been excluded from the Scottish Health Survey in the past and the abolition of the upper age limit for future rounds of the survey is welcome. The Scottish Household Survey has no upper age limit, however to be useful for inequalities monitoring, the results of this survey need to be made available by deprivation category as soon as possible. One major drawback of both the Health and Household Surveys in relation to the older population is that they only provide information on people living in private households. Obtaining comparable information to that provided by the surveys from older people living in long-term care settings should be considered as a matter of urgency.

Perspectives on Social Justice

References

1. Victor C.R. (1989) Inequalities in health in later life. Age and Ageing 18:387-391.

2. Khaw K.T. (1997) Healthy ageing. BMJ 315:1090-1096.

3. Wood R., Bain M.R.S. (2001) The health and well-being of older people in Scotland: insights from national data. Edinburgh: Information and Statistics Division.

4. Grundy E., Glaser K. (2000) Socio-economic differences in the onset and progression of disability in early old age: a longitudinal study. Age and Ageing 29:149-157.

5. Arber S., Ginn J. (1993) Gender and inequalities in health in later life. Social Science and Medicine 36:33-46.

6. Acheson D. (1998) Independent Inquiry into Inequalities in Health Report. London: The Stationery Office.

7. Grundy E.M.D. (1996) Population reviews (5): the population aged 60 and over. Population Trends 84:14-20.

8. Dunnell K. (2001) Policy responses to population ageing and population decline in the United Kingdom. Population Trends 103:47-52.

9. Stein C., Moritz I. (1999) A life course perspective of maintaining independence in older age. Geneva: World Health Organization (Programme on Ageing and Health).

10. Wilkinson R., Marmot M., eds. (1998) Social determinants of health: the solid facts. Copenhagen: World Health Organization (Europe).

11. Evandrou M., Falkingham J. (2000) Looking back to look forward: lessons from four birth cohorts for ageing in the 21st Century. Population Trends 99:27-36.

12. Melzer D., McWilliams B., Brayne C., Johnson T., Bond J. (2000) Socioeconomic status and the expectation of disability in old age: estimates for England. Journal of Epidemiology and Community Health 54:286-292.

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