Chik Collins

Reducing health inequalities remains a challenge for policy makers across the world. Beginning from Lewin’s famous dictum that “there is nothing as practical as a good theory”, this paper begins from an appreciative discussion of ‘fundamental cause theory’, emphasizing the elegance of its theoretical encapsulation of the challenge, the relevance of its critical focus for action, and its potential to support the practical mobilisation of knowledge in generating change. Moreover, it is argued that recent developments in the theory, provide an opportunity for further theoretical development focused more clearly on the concept of power (Dickie et al. 2015). A critical focus on power as the essential element in maintaining, increasing or reducing social and economic inequalities – including health inequalities – can both enhance the coherence of the theory, and also enhance the capacity to challenge the roots of health inequalities at different levels and scales. This paper provides an initial contribution by proposing a framework to help to identify the most important sources, forms and positions of power, as well as the social spaces in which they operate. Subsequent work could usefully test, elaborate and adapt this framework, or indeed ultimately replace it with something better, to help focus actions to reduce inequalities.

This article uses John Kingdon’s multiple streams framework as an analytical tool to consider how the policy issue of ‘job quality’, in the guises of ‘decent work’ and ‘fair work’, developed a ‘career’ in Scotland between 2013 and 2017. The aim is to understand why, despite the efforts of a variety of policy entrepreneurs and the openness of the Scottish Government to this policy problem, job quality did not arrive on the Scottish Government’s decision agenda. The article finds that the crucial ‘policy window’ did not open due to the 2016 ‘Brexit’ decision dramatically changing the political landscape.The article demonstrates the applicability of Kingdon’s framework for agenda-setting analysis in a parliamentary environment and constitutes a rare application of the framework to a ‘live’ policy issue.The authors were involved in a research and advocacy project on ‘decent work’ that was undertaken in Scotland during 2015 and 2016 and therefore were amongst the policy entrepreneurs seeking to place job quality on the Scottish Government’s agenda.

American Journal of Public Health (AJPH) from the American Public Health Association (APHA) Austerity and Mortality in Spain: The Perils of Overcorrecting an Analytic Mistake, an article from American Journal of Public Health, Vol 109 Issue 7

Paisley's Ferguslie Park had been designated as an urban policy 'Partnership Area' under a new government programme labelled New Life for Urban Scotland. In this chapter, the authors need to understand the apparently consensual language of 'partnership' in which the New Life programme was elaborated. New Life has created a platform that, with good continuation partnerships and fair economic weather, gives residents the chance of a sustainable improvement in their quality of life. It has long been known that improvements to housing stock and the environment are the least difficult part of 'urban regeneration'. One of the main aims of New Life was to reduce 'dependency' by increasing labour market participation. The evaluation report uses the term 'quality of life' to encompass a 'diverse and subjective' range of aspects of regeneration - including education, crime, poverty, health and community activity.

It is known that population health is socially and politically determined. A gap, however, between the evidence and policy (where behavioural approaches dominate) is evident. This study used semi-structured interviews in two deindustrialised areas in Scotland to explore understandings of the causes of (ill)health in local communities. Using Raphael’s Discourses of Social Health Determinants (2011), we found that participants typically had highly integrated explanations of health, including vivid articulation of links between politics, policies, deindustrialisation, damage to community fabric and impacts on health. This understanding contrasts with that identified by research elsewhere. We posit explanations for our findings and discuss their implications.

This article reports findings of research into the far-reaching plan to ‘modernise’ the Scottish economy, which emerged from the mid-late 1950s and was formally adopted by government in the early 1960s. It shows the growing awareness amongst policy-makers from the mid-1960s as to the profoundly deleterious effects the implementation of the plan was having on Glasgow. By 1971 these effects were understood to be substantial with likely severe consequences for the future. Nonetheless, there was no proportionate adjustment to the regional policy which was creating these understood ‘unwanted’ outcomes, even when such was proposed by the Secretary of State for Scotland. After presenting these findings, the paper offers some consideration as to their relevance to the task of accounting for Glasgow's ‘excess mortality’. It is suggested that regional policy can be seen to have contributed to the accumulation of ‘vulnerabilities’, particularly in Glasgow but also more widely in Scotland, during the 1960s and 1970s, and that the impact of the post-1979 UK government policy agenda on these vulnerabilities is likely to have been salient in the increase in ‘excess mortality’ evident in subsequent years.