Information Scotland The Journal of the Chartered Institute of Library and Information Professionals in Scotland ISSN 1743-5471 Issue contents | Journal contents | About the online edition of the journal June 2004 Volume 2 (3)

CILIPS conference: Health partnerships

Working for a healthy city

Norma Greenwood and Pamela Tulloch explain the Access Glasgow health partnership initiative.

Scotland is often referred to as the sick man of Europe and within Scotland, Glasgow and the West of Scotland is viewed as having some of the worst health statistics in Europe. Since the 1980s national initiatives have been devised to target these statistics and improve Scotland’s health. The White Paper Towards a Healthier Scotland (1999) and subsequent plan Our National Health: a plan for action, a plan for change (2000) reinforced the need to tackle poverty and deprivation as the root causes of ill health. Partnership for Care the recent health white paper has Health Improvement as a key driver for the NHS and Local Authorities

Glasgow is described as a city of two parts. A wealthy, vibrant city centre contrasts with some of the most deprived areas in Europe which lie just outside the city centre. Poverty, poor health, poor housing, high unemployment all contribute to the profile. In many ways poverty of aspiration is the most difficult factor to overcome.

Glasgow’s health profile

NHS Glasgow’s annual report in 2002 reflected that the health profile had improved but that Glaswegian men are still twice as likely to die before the age of 65 as the men of England and Wales. Greater Glasgow’s problems are rooted in more than its fair share of deprivation. Some other key health facts in the report included:

• Of the people in Greater Glasgow aged under 75 who died in 2001, 18.8% died from Coronary Heart Disease compared with 20% in 2000.
• Of the people in Greater Glasgow aged under 75 who died in 2001, 32% died from Cancer compared with 30.25 in 2000.

Social Inclusion Partnerships (SIPs) have been instrumental in government policies to tackle inequalities. Social Justice: a Scotland where everyone matters (1999) put in place a framework for tackling poverty and injustice and established milestones against which the SIP partnerships could measure their progress.

A study commissioned by Greater Glasgow NHS Board in 1999 provided baseline data from the SIPs on a set of core indicators. A follow up study in 2002 showed few statistically significant changes but there was some indication of improvement in quality of life and healthy living. Within the SIP areas people’s perceptions were that they felt more in control of decisions that affect their lives. Some key areas of difference to note were: increased participation in the decisions about their treatment; more say in how services were delivered; increased access to information; and increased understanding of residents views and circumstances. There was also a decrease in the proportion of residents with no educational qualifications and an overall decrease in the proportion of households without any adult employed. This may well reflect the 18% growth in employment in Glasgow from 1995-2001. This has to be balanced against the statistic that 9 out of every 10 new jobs in Glasgow is taken by commuters.

However, the effects of partnership working do seem to be influencing the broader determinants of health and the strategies that are in place are beginning to make a positive impact on the work and lives of the people of Glasgow.

Within Glasgow a number of strategies are in place to support partnership working. In 2001 the Glasgow City Health Development Plan was published and closely aligned to the Glasgow Alliance. Partnership between agencies and Glaswegian communities is at the heart of sustainable health improvement. This plan aims to improve Glasgow’s health profile over a five-year period by ensuring that the key agencies work in partnership. Both Glasgow City Council and NHS Glasgow are committed to the plan. In addition the Glasgow Healthy City partnership has the lead role for taking forward the Joint Health Improvement Plan for the City.

It was from this strong base that the information work which NHS Glasgow and Libraries, Information and Learning were starting. The fact that both organisations did not have to establish the principle of working in partnership (as at a senior level by the City Council elected members and the NHS Glasgow Board were committed to partnership working) was a benefit and one which went some way to ensuring a good working rapport from the start. A predictor of success for health partnerships is a shared model from which to work. The Evans and Stoddard model of health offers a a whole system approach to health improvement. Their concept is of a health field that embraces the wider social determinants that impact on health within four principal domains: lifestyle, environment, human biology and healthcare organisation.

The role of libraries, information and learning

Glasgow’s model for better health recognizes that health is not just about the absence of illness. It is about a state of well being for individuals within their communities. It is especially about people being able to follow their own potential to lead productive and fulfilling lives. There is a shared acknowledgement in Glasgow of the health links between people’s social and economic circumstances, their lifestyles, and their state of well-being.

One of Glasgow City Council’s five key priorities is to “promote social inclusion and tackle poverty and improve health and well-being”. As such the aims and objectives for Libraries, Information and Learning are quite clear. Engaging citizens who live in areas that are socially excluded is essential. Libraries, Information and Learning’s role is key in facilitating access. It might seem easy with 22 of the 34 community libraries situated in areas which are designated as social inclusion priorities; nevertheless, there are many barriers to participation:

• Adult literacy and numeracy
• High unemployment
• Lack of access to transport
• Poor housing
• Poor health
• Poverty of aspiration.

Consequently, Glasgow’s Libraries are not as well used as they might be. It takes an extra effort to engage with this section of the community and passively providing services is not enough to reach the intended audience. Together with NHS Glasgow, Libraries, Information and Learning is involved in a number of imaginative projects through Access Glasgow, the REAL partnership, the Community Learning Partnership, working locally with health professionals and the traditional role as gatekeeper of public health.

Access Glasgow: Access Glasgow is a partnership between key agencies in the city which aims to deliver the Modernising Government agenda. Glasgow City Council is the lead partner with Greater Glasgow Health Board being one of the principle partners. Health and inclusion is one of the main priorities for Access Glasgow. Two projects which highlight joint work on the ground are the Sandyford Initiative and the Access Glasgow Health Information website. Under the auspices of Access Glasgow, Libraries, Information and Learning has linked with the Sandyford Clinic to provide access to book stock and health information. This project has involved making Sandyford’s library holdings available through Libraries, Information and Learning’s Opac and also making the library’s stock available to Sandyford users. Reciprocal borrowing rights were established. From modest beginnings over 1,000 items a month, from Libraries, Information and Learning stock, are now issued by Sandyford.

A health information website has been developed to provide support primarily to the citizens of Glasgow under the partnership opportunities which Access Glasgow has brought (www.accessglasgowhealth.org.uk). This website provides information which is tailored to local issues and also provides a gateway to the national support groups which hold information not easily found on the web. It is this added value that makes a difference to individuals who can be swamped by a “google” return or question the authenticity of the health information which is supplied.

REAL Learning Cafés: Libraries, Information and Learning works in partnership in a number of ways to support the Joint Health Improvement Plan for the City. Through the REAL partnership and the city’s library-based REAL learning centres a number of initiatives have been implemented to engage this excluded section of the community. An example of this is the Learning Café which enables people to learn something new in an informal, relaxed, welcoming environment. It focuses on developing “soft” skills rather than formal training and is about helping individuals to realise their potential and build confidence. The workshops have taken place in community libraries in Drumchapel, Hillhead and Ibrox. Courses include: Speak Up – self-expression, speaking in public, putting your point across confidently; Look Good, Feel Good – First impressions, personal grooming, colour analysis; Writing with Surprise – Fresh perspectives on creative writing; and Tall Order – Building confidence and self-esteem, communicating assertively, dealing effectively with difficult situations and people. A total of 142 learners participated in the free workshops. (Further information: www.intoreal.com)

Adult literacy and numeracy is a major issue for Glasgow and a barrier to participation. Individuals who experience literacy and numeracy difficulties frequently have these brought to light when they experience a life changing event. Projects which are looking to support this community included the big + plus Helpline based within Information Services in the Mitchell which financed the Glasgow Community Learning Strategy Partnership. The Helpline, by using the trained expertise of information specialists, has referred over 600 individuals to a service which will assist them.

The Community Learning Strategy Partnership continues to see tackling literacy and numeracy as a key way to improving people’s health and well-being. To this end the partnership is directing £2.2 million to action initiatives supporting adult literacy and numeracy within the city.

The “Self Help” Project: Anxiety and depression are by far the most common problems GPs deal with (more common than high blood pressure, infections and back problems). There is recognition that there is a strong link between mental health and poorer areas of the country. It has been identified that the Greater Glasgow area has over 80% of the poorest parts of Scotland. Statistics show that within Glasgow, 1 in 6 people have a mental health problem. It is estimated that around 50% of people with mental health problems do not attend their GP and of those who do it is recognised that at least half do not follow the medical advice offered. Within the medical profession it is accepted that too many people will not seek help and that their condition is likely to worsen with time.

The “Self Help” project, due to launch this month, is designed to improve knowledge about mental health, help individuals recognize the signs earlier, act as a sign post for help, prevent more serious problems from developing, boost confidence and self-esteem, help prevent future mental health problems.

A leading Clinical Psychologist in the city has secured £14,000 from the Greater Glasgow Primary Care NHS Trust to provide stock in seven libraries in the south area of the city. This enlightened approach by the medical profession reinforces the role which public libraries play in their local community. Viewed as accessible, non-threatening environments which are non-institutional and free from stigma, public libraries can provide a space where individuals can take responsibility for their own health.

The above projects are a sample of the proactive approach which Libraries, Information and Learning and NHS Glasgow are taking. To a certain extent partnership working is nothing new. Librarians and information professionals have always been keen to assist each other and work towards the greater good which has tended to be mutually beneficial. The public library continues to be that depository for public health. The Mitchell holds many of the NHS archives, a living archive which the public can consult. The Mitchell also holds a rich record of the changing face of public health through the Poor Law records, Glasgow Collection and photographic collections relating to the city.

Partnership working is not finite. More can be achieved building on experience, and projects progress. Formally adopting this model and continuing to promote and invest in initiatives which help improve the general state of well-being will continue to contribute to a healthy city.

Norma Greenwood is Programme Manager, Public Health Information and Education, Greater Glasgow NHS Board and Pamela Tulloch is Information Services Manager, Glasgow City Council, Libraries, Information and Learning.

Information Scotland Vol. 2 (3) June 2004

Information Scotland is delivered online by the SAPIENS electronic publishing service based at the Centre for Digital Library Research. SLAINTE (Scottish libraries across the Internet) offers further information about librarianship and information management in Scotland.