CIH Scotland interview with Sir Harry Burns
We recently caught up with Sir Harry Burns, Professor of Global Public Health at the University of Strathclyde and former Chief Medical Officer for Scotland, to get his perspective on the links between housing and improving public health.
Can we start with some background. You trained as a surgeon and then shifted to public health - what was the catalyst for this move?
There are two main reasons.
I was working as a surgeon at the Royal Infirmary in Glasgow, one of the poorest parts of the UK and I realised the burden of poverty affected people differently. When I spoke to people about their lifestyle and how it was killing them, many would simply shrug their shoulders. For them drinking was their only pleasure and the loss of a few years of life was an acceptable trade off. I knew then that surgery would not address their health issues.
In addition a good friend of mine, Sam Galbraith, who was a neurosurgeon and ended up as a minister in the Scottish Executive, and I were one day chatting about how to change society. Sam suggested I go into politics. Now I couldn’t think of anything worse but it was in the context of that discussion it made me think public health could be a viable option.
You have recently been discussing the concepts of wellness and wellbeing. I would probably say being well is not being ill but what do you see as central to an individual’s being well and what value do you place on a secure and stable home as part of this?
Wellbeing is complex, but I would see it as more than being ill. It is about being in control of one’s life, one’s own decision making. It means you have a purpose in life, you have an optimistic outlook. You are adaptable and resilient and feel safe and secure.
When you look at society today with increasing numbers of people accessing food banks, welfare sanctions and children in care it is no wonder people don’t feel in control of their lives
I want to move onto politics and public policy - how do we challenge the assertion that it costs too much to provide good housing, a decent income and improve public health? We as an organisation will call for more money for housing but sometimes I don’t think we make the connection as to why a home is not just a good in itself but that it will address child poverty, health inequalities and a range of other outcomes. How do we make the case that by helping people we will actually reduce costs to the government as well as putting people first?
The literature is clear; poor wellbeing is expensive for the state. Children who are neglected cost the government millions every year. And yet the problem of inaction is not entirely the fault of politicians. Officials are struggling to balance the finances and tackle whatever problem is causing the headlines each day. We need a new and different approach to change. But if it was easy we would be doing it already.
A positive development in recent years has been the increasing understanding between the housing sector and public health in Scotland. However there is not, as yet, the recognition across the entire health sector about what housing can contribute. I would reflect on the limited impact Housing Contribution Statements have made in leveraging new commissioning priorities from IJBs. How do we make policy makers connect the dots between different areas of public policy?
It beggars belief that the case for decent houses for all needs to be made and that policy makers don’t see the need for housing as a core need for everyone. I do believe the housing first approach is the answer. The use of hostels and temporary accommodation is almost Victorian and we are compounding the difficulties people face.
One challenge is that we do tend to oversimplify what are complex issues. What we need is for multiple agencies to work together. We need vision and leadership to achieve real change
To finish on a positive note, where do you see progress being made improving public health in Scotland? Where are we getting it right and sustaining a programme of intervention that is addressing health inequalities and creating wellbeing?
Public sector bodies often have bureaucratic protocols that undermine opportunities for change; performance indicators and processes become ends in themselves. It is the third sector in Scotland that leads the way in transforming lives. It has both flexibility and transparency in its approach and is able to work through issues that in turn create greater levels of trust, self esteem and self efficacy in people living difficult lives. Two examples are Centre Stage in Ayrshire and Galgael based in Govan. These are typical of organisations that build self esteem and give people a sense of control over their lives. The public sector needs to learn from the third sector.