6. Significant changes are taking place in our population
Analysis of demographic trends is essential to plan health and services for the future, in order to provide facilities and services that meet the needs of a changing population, to improve the overall health of the community, and to provide value for money.
Demographic changes in the population of Greater Glasgow and Clyde are having a significant and increasing impact on public sector service provision. These changes include ageing populations, changing household structures, changing social class and the introduction of new populations of asylum seekers and economic migrants (43).
Together with data on other life circumstances – such as the levels of income within a population, and housing changes – this information can improve our understanding of our changing population and help to identify opportunities for making the best use of local resources for the benefit of the population as a whole (44).
Among the most important changes are:
In the coming years, the Scottish population will reduce in size, but the number of households will increase as single parent and single adult households increase. This is most marked in Glasgow City. By 2016, single adult households will account for 49% of all households in Glasgow City, compared to 31% and 32% in East Renfrewshire and East Dunbartonshire respectively, and single parent households will make up almost 50% of households with children (Figure 6.2).
Glasgow will continue to become a more middle-class city. The proportion of Glasgow’s population in Social Class I or II has more than doubled since 1981 and in the 2001 census four out of 10 adults in Glasgow City were classified as being in one of the top two social classes. There will continue to be wide variations in the distribution of income across the city.
Glasgow’s population will continue to change through migration in and out of the city. While its indigenous population has been falling, Glasgow has been the leading council in Scotland providing accommodation for asylum seekers and refugees since 2001. Using GP registrations, it is possible to estimate that there are more than 11,000 current or recent asylum seekers living in Glasgow (Figure 6.3).
Economic migrants from central and eastern Europe are now a significant feature of the population of the West of Scotland. A recent report estimated that in June 2007 there were more than 5,000 migrants from new EU member countries living in Glasgow and that by June 2008 this could rise to 6,700 (45).
How NHS Greater Glasgow and Clyde and its partners are responding
Some changes in populations happen over a period of years, such as the decline in the number of people living in Glasgow City, and others happen quickly, requiring the public sector to respond at short notice to unfamiliar issues. For example, an influx of asylum seekers can bring people suffering from trauma resulting from torture or a sudden increase in the number of cases of tuberculosis. As well as having to respond appropriately to new situations or crises, public sector organisations need to develop structures for ongoing planning that is responsive to population changes.
As an example of current practice, this section describes the structures for ongoing planning for the City of Glasgow and gives a summary of the health and social services’ response to asylum seekers and recent European Union migrants in the city.
The public sector has two planning processes that are designed to ensure that appropriate and cost-effective services are available to the people of the city. The first is Glasgow City Council’s statutory planning of the development and use of land to meet the population’s needs for homes, jobs, leisure and mobility. This process also encourages positive change in villages, towns and cities; and protects historic buildings and the countryside. The second is planning for people, which usually involves a wide range of partners.
The 2006 Planning etc (Scotland) Act (46) stipulated that councils, when they are planning for the built environment, have to consider public involvement and sustainable development in their development plans. Development plans are sometimes made up of two plans: a structural plan (for large conurbations around Scotland’s largest cities) and a local plan.
The Glasgow and Clyde Valley Joint Structure Plan is prepared by eight councils: East Dunbartonshire, East Renfrewshire, Glasgow, Inverclyde, North Lanarkshire, Renfrewshire, South Lanarkshire and West Dunbartonshire (47). The plan aims to enhance wellbeing and a high quality of life through sustainable development, focusing on economic competitiveness, greater social inclusion and integration, sustaining and enhancing the natural and built environment, and integrating land use and transportation.
A linked Health Action Programme is designed to improve the quality of the built environment and the quality of life of individuals and communities by linking planning and good health, building on the relatively new concept of healthy urban planning. The programme acknowledges that improved health depends on factors such as employment, housing, transport, safety, education, poverty and access to services, and aims to support a better understanding of the links between land use planning and health.
Some councils’ local plans – which have to conform to the structure plan – are beginning to incorporate a health dimension. For example, the Glasgow City Plan includes health along with social renewal and sustainable development as the Council’s vision for making Glasgow more attractive to existing and prospective residents and investors. This plan is designed to help improve residents’ health by providing access to green space, cultural and sporting activities; helping to curb traffic-related pollution; and providing facilities for increased walking and cycling.
A second type of planning process is also designed to improve quality of life, but through focusing on people, and this is usually carried out by partnerships across the public sector with input from the public. Each council has a slightly different configuration for its community planning partnership.
The Go Well study led by the Glasgow Centre for Population Health brings together planning for the built environment and planning for people by investigating the health effects of neighbourhood change on individuals, families and communities. Go Well includes an ecological study to monitor health status, housing market changes and changes to the social and physical environments across all communities in Glasgow City during the next 10 years; a longitudinal study of people moving from the study areas; and community engagement in partnerships for neighbourhood change (48).
A practical example of a recent response to population changes has been Greater Glasgow and Clyde’s response to asylum seekers. Asylum seekers, who are legal residents of the UK, usually apply for asylum to escape countries where they faced human rights abuses and repression. They are often vulnerable as a result of being persecuted and possibly tortured and raped. A BMA report on asylum seekers’ health in 2002 (49) showed that a significant number of asylum seekers are prone to particular health problems, including a range of communicable diseases such as tuberculosis, Hepatitis and HIV/ Aids, the physical effects of war and torture such as rape or sexual assault, landmine injuries, beatings and malnutrition, and social and psychological problems such as depression, stress and anxiety, and racial harassment.
In addition, the health of asylum seekers may get worse after they enter the United Kingdom. Failed asylum seekers do not have the same rights of access to services as those whose case has not been settled, and there are concerns that emergency life-threatening conditions and transmissible diseases might go untreated.
In Greater Glasgow and Clyde, the particular health issues of asylum seekers have included mental and physical conditions resulting from persecution, and a need for support for families with children. A range of direct service and partnership developments has been designed to meet the housing, health and social care needs of asylum seekers in the Glasgow area.
However, the UK Government has introduced a New Asylum Model, which will have implications for the current system, including growing numbers of cases entering the system, decisions being made about legacy cases where long-term asylum seekers have assimilated into Glasgow citizenship without the required legal status, and new imperatives to provide information that might prevent some people seeking essential medical and social help.
Another example of how population changes are influencing the planning process is the recent influx of substantial number of economic migrants from the eight new European Union countries. For example, the Slovak Roma community has an unprecedented range of complex support needs. To ensure that the public sector planning process knows enough about the Roma community to meet its needs, the South East Glasgow CHCP is gathering information about the community. The results of this work will provide an accurate assessment of the size of the Roma population and ensure that the community knows about and can access appropriate services, such as health protection and immunisation, child protection, education, translation and interpretation services, employment registration procedures, benefits entitlement, social services and housing.
Key public health messages and priorities for action
Populations are in a constant state of change which can be slow and developmental or rapid in response to changes in other parts of the world. There are sources of information that can map current and past situations and to some extent predict further changes for the future, but there are also gaps in our data gathering and use of intelligence.
In order to take into account our changing population the following needs to happen: