Maria Gannon

Contribution of problem drug users' deaths to excess mortality in Scotland: secondary analysis of cohort study

Objectives To examine the “Scottish effect”—namely, the growing divergence between mortality in Scotland and England that is not explained by national differences in levels of deprivation—and, more specifically, to examine the extent to which the Scottish effect is explained by cross national differences in the prevalence of problem drug use. Design Secondary analysis of cohort study (the DORIS study). Participants 1033 Scottish drug users recruited to the cohort study in 33 drug treatment facilities across Scotland in 2001-2 and followed up 33 months later in 2004-5. Results 38 deaths occurred in the cohort, giving a standardised mortality ratio for the cohort of 1244 (95% credible interval 876 to 1678). Only 22 of the 38 deaths in drug users were classified as drug related deaths. From estimates of the size of the problem drug using populations in both England and Scotland, the contribution of deaths in drug users to national death rates can be estimated: the attributable risk fraction for Scotland is 17.3% (12.3% to 22.8%) and that for England is 11.1% (7.8% to 14.8%). Excluding estimated numbers of deaths in drug users would bring down age standardised mortality at ages 15-54 years from 196 to 162 per 100 000 in Scotland and from 138 to 122 per 100 000 in England; 32.0% (22.3% to 43.0%) of the excess mortality in Scotland is due to drug use. Conclusion Although problem drug use is a low prevalence risk behaviour, it carries a high mortality; the standardised mortality ratio for Scottish drug users is 12 times as high as for the general population. The higher prevalence of problem drug use in Scotland than in England accounts for a third of Scotland’s excess mortality over England. Successful public health efforts to reduce the prevalence of problem drug use in Scotland or deaths in Scottish drug users would have a dramatic impact on overall mortality in Scotland.

Coping with the Cuts? The Management of the Worst Financial Settlement in Living Memory

Abstract The scale of the cuts to local government finance, coupled with increasing demand for services, has led to unprecedented ‘budget gaps’ in council budgets. Arguably, two competing narratives of the trajectory of local government have emerged in which contrasting futures are imagined for the sector – a positive story of adaptation and survival and more negative one of residualisation and marginalisation. Drawing on case study evidence from three English local authorities, the paper distinguishes and provides examples of three strategic approaches to managing austerity – efficiency, retrenchment and investment. It demonstrates how and why the balance of these strategies has shifted between the early and later phases of austerity and considers the extent to which the evidence of the case studies provide support for either the survival or marginalisation narrative. The paper concludes by arguing that a third narrative – responsibilisation – captures more fully the trajectory of local government in England.

Capture—recapture and anchored prevalence estimation of injecting drug users in England: national and regional estimates

Capture—recapture (C—RC) using four data sources, one of which accounted for 81% of captured injectors, and multiple indicator methods (MIM) were used to obtain national, regional and local estimates of the prevalence of injecting drug use among opiate and/or crack cocaine users in England. Persons aged 15 to 64 years, in contact with health and/or criminal justice services during 2005/2006, and known to be using opiates and/or crack cocaine and injecting drugs were included in the C—RC analysis. The MIM analysis included indicators relating to drug treatment, drug-related deaths, population density and drug offences. There were an estimated 130,000 opiate and/or crack cocaine users who injected drugs in 2005/06 (95% confidence interval 125,800 to 137,000), corresponding to 3.9 per thousand of the population aged 15 to 64 years (95% confidence interval 3.8—4.1). Regional variation in the prevalence of injecting was evident, ranging from 6.1 per thousand of the population aged 15 to 64 years in Yorkshire and the Humber (95% confidence interval 5.6 to 6.6) to 2.3 per thousand in the East of England (95% confidence interval 1.8 to 2.9). Application of gender and age-group distributions for treated injecting drug users (IDUs) to the prevalence estimates suggested that there were 97,200 male injectors (95% confidence interval 94,000 to 102,500) and 63,600 female injectors aged 25 to 34 years (95% confidence interval 61,500 to 67,000). The prevalence estimates provide a basis from which numbers of current IDUs infected with hepatitis C virus (HCV) can be approximated.

Living apart, losing sympathy? How neighbourhood context affects attitudes to redistribution and to welfare recipients

Rising levels of income inequality have been directly linked to rising levels of spatial segregation. In this paper we explore whether rising segregation may in turn erode support for the redistributive policies of the welfare state, further increasing levels of inequality—a form of positive feedback. The role of the neighbourhood has been neglected in attitudes research but, building on both political geography and ‘neighbourhood effects’ literatures, we theorise that neighbourhood context may shape attitudes through the transmission of attitudes directly and through the accumulation of relevant knowledge. We test this through multilevel modelling of data from England on individual attitudes to redistribution in general and to welfare benefit recipients in particular. We show that the individual factors shaping these attitudes are quite different and that the influence of neighbourhood context also varies as a result. The findings support the idea that neighbourhood context shapes attitudes, with the knowledge accumulation mechanism likely to be the more important. Rising spatial segregation would appear to erode support for redistribution but to increase support for welfare recipients—at least in a context where the dominant media discourse presents such a stigmatising image of those on welfare benefits. Keywords: attitudes, inequality, redistribution, neighbourhood effects, spatial segregation

Preteen children and illegal drugs

In this paper we report the results of research on the nature and extent of legal and illegal drug use among preteens and those factors associated with illegal drug use at this young age. The paper is based upon a survey of 2318 ten to twelve year olds in Glasgow and Newcastle. Overall around 30% of children reported having been exposed to illegal drugs and 3.9% had started to use illegal drugs. There was a significant difference in the level of illegal drug use between our two cities. In most cases the illegal drug use identified on the part of preteens related to cannabis although in a small number of instances children were using heroin, cocaine and LSD. On the basis of this research we estimate that around 60 children in the ten to twelve age range will have used heroin in Glasgow and around 34 pupils will have used the drug in Newcastle. Preteen drug use was significantly associated with frequent smoking and alcohol consumption, with preteens’ involvement in a range of problem behaviours, and with family difficulties including the presence of someone else within the family using illegal drugs. The paper concludes by noting some of the challenges that are likely to be faced by services seeking to support children who are using illegal drugs by their preteens.

‘All in it Together’? Social Cohesion in a Divided Society: Attitudes to Income Inequality and Redistribution in a Residential Context

This paper asks whether where someone lives bears any association with their attitudes to inequality and income redistribution, focusing on the relative contribution of neighbourhood income, density and ethnic composition. People on higher incomes showed higher support for redistribution when living in more deprived neighbourhoods. People with lower levels of altruism had higher levels of support for redistribution in neighbourhoods of higher density. People living in more ethnically mixed neighbourhoods had higher levels of support for redistribution on average, but this support declined for Whites with low levels of altruism as the deprivation of the neighbourhood increased. Current trends which sustain or extend income and wealth inequalities, reflected in patterns of residence, may undermine social cohesion in the medium- to long-term. This may be offset to some extent by trends of rising residential ethnic diversity.

Opiate and crack cocaine use: A new understanding of prevalence

Aims: The aim of this study was to establish prevalence estimates of problem drug use, defined as opiate and/or crack cocaine use by persons aged 15 to 64 years, for England and for each of the 149 administrative areas responsible for commissioning drug interventions. Methods: Indirect estimation techniques, the capture–recapture and multiple indicator methods, were used to obtain estimates. Information on problem drug users presenting to healthcare settings and/or recorded by the criminal justice system, and drug-related indicator data were used in the analyses. Findings: There were an estimated 332,090 problem drug users in England during 2005/06 (95% CI 324,546 to 346,345), equivalent to 9.97 (95% CI 9.74 to 10.40) problem drug users per thousand population aged 15 to 64 years. Prevalence varied by geographic region and age group: the highest rates were observed in London and for those aged 25 to 34 years. Conclusions: This study has produced estimates of the prevalence of problem drug use in England that are more robust, more precise, and suggest a higher prevalence than previous studies. The estimates provide a basis on which to formulate policy, plan services, and measure service performance.

Austerity urbanism in England: the 'regressive redistribution' of local government services and the impact on the poor and marginalised

That contemporary austerity is being realised to a large extent in and through cities is a growing theme in urban scholarship. Similarly, the concern that the economically marginalised are disproportionately impacted as ‘austerity urbanism’ takes hold drives a significant body of research. While it is clear that substantial austerity cuts are being downloaded onto cities and their governments, the evidence on whether it is the most disadvantaged fractions of the urban population which suffer as a consequence remains thin. Moreover, the mechanisms by which the downloading to the poor occurs are unclear. This paper identifies how austerity cuts are transmitted to the poor and marginalised in the context of severe cuts to the spending power of English local government. It identifies three transmission mechanisms and shows how these operate and with what outcomes, drawing on empirical evidence at the English national and local city levels. The paper provides robust evidence from national data sources and from in-depth, mixed-method case studies to show that the effects of austerity urbanism are borne most heavily by those who are already disadvantaged. It also demonstrates the importance of identifying the specific mechanisms by which downloading on to the poor occurs in particular national contexts, and how this contributes to understanding, and potentially resisting, the regressive logic of austerity urbanism.

Attitudes to the ‘Necessities of Life’: Would an Independent Scotland Set a Different Poverty Standard to the Rest of the UK?

This article examines whether the population of Scotland would set a different poverty standard compared with the rest of the UK. It is based on research on a consensual or democratic poverty measure, defined by majority views of the items or activities which should be considered the ‘necessities of life’. The article explores whether majority opinions are the same in Scotland as in the rest of the UK. More generally, it explores how attitudes differ north and south of the border, and possible reasons for this. Data on attitudes were collected through three closely related surveys in 2011 and 2012. The analysis suggests that, in the early years at least, a more independent Scotland would be unlikely to set a different social minimum. On this topic, as on many others, attitudes in Scotland are very similar to those in the rest of the UK.