If there is a quotation in life that I over-use it is from Milan Kundera; “the struggle of man against power is the struggle of memory against forgetting”. I over-use it because it is a wonderfully literate encapsulation of why so much we swear we want to see being fixed goes unfixed. It is particularly relevant to a story that was under-reported this week.
The story was the release of data from the National Records of Scotland on ‘avoidable deaths’, defined as deaths that could have been prevented by public health and health service interventions. These are ‘public failure deaths’.
And the picture in Scotland is pretty awful. There has been a nine per cent rise in avoidable deaths in the last year, a number that had been declining for 15 years from about 2001. And while NRS puts this down to Covid, it is more complicated than that – the majority of avoidable deaths are cancer and circulatory and roughly one in six of them are alcohol or drug related.
What gives the game away on the meaning of these statistics is the income-related differential – these deaths are four times more likely to occur in the poorest communities in comparison with the wealthiest. An enormous amount of these are effectively ‘poverty-related diseases’ – and those are the ones that seem to be rising.
And this is not an issue where you can shrug and say ‘hey, what can you do?’. The comparators are stark – out of 100,000 people 257 people in England will suffer an ‘avoidable death’, in Wales 287 will but in Scotland 336 people will. This is not ‘in the margin of error’.
The Covid framing is true but also disguises the trend. Take out the Covid deaths and the trend would still have been upwards (though less dramatically so). And look at what has been happening and the ‘broadly steadily declining’ picture looks quite different. Avoidable deaths did indeed decrease until seven or eight years ago when it actually started to increase and then basically levelled out.
We have not returned to the level of avoidable deaths we had achieved nearly ten years ago even before this current upturn. Scotland (particularly poorer Scotland) was dying unnecessarily more than it did when this current government took power, before Covid happened.
And let’s get the scale right here. There are about 11,000 people who have died of Covid in Scotland since the pandemic began (nearly a third of those in care homes). Last year alone 63,000 people died from avoidable deaths, many of them deaths of poverty and neglect.
Something like 15,000 more people died from avoidable causes in Scotland than if they had been in England based on English death rates – which is more than was killed by Covid
There is another comparator worth making – something like 15,000 more people died from avoidable causes in Scotland than if they had been in England based on English death rates. So let’s be blunt about this; Scotland’s poor public health record killed more people than Covid in 2020.
This pattern pops up into public consciousness once a year, if that. Then it leaves the public consciousness again until the next year. This year the coverage was so fleeting and given so little prominence that most people would be lucky for it to come anywhere near their consciousness at all.
That isn’t accidental; Scotland’s public agencies have been contorted in recent years and now act almost explicitly as ‘reputation managers’ for government. These statistics should be causing real alarm but were dropped in the middle of the Ukraine crisis and on the day that a critical Audit Scotland report on drug and alcohol deaths came out which superseded it in the news. Its launch was designed to be buried rather than create the kind of pressure that leads to change.
This is where the memory-hole problem comes in; when it ’emerged’ that Scotland was the drug-death capital of Europe this appears to have taken the media and political classes largely by surprise. The First Minister herself made great play of regret over ‘having taken their eye of the ball’.
But their eye was never on the ball and in this both the media and the commentator class seem too quick to assume that poor people dying ‘is just what happens’. They forgot.
But in Scotland the problem is bigger than that; the poorly-resourced state of our media means that thing after thing seems to escape the memory of journalists (and indeed politicians) who are covering far too wide a brief to develop proper expertise and knowledge.
The middle classes keep stories which affect them in the public eye; the poor just die quietly
Let me give you a case study which really twists my head when I see it repeated over and over. As everyone knows the Scottish Government discharged people into care homes without having tested them for Covid. The opposition parties flirt with the idea that this might represent criminal negligence.
But that’s not what happened at all and it takes ten seconds on an internet search engine to confirm that. The Scottish Government tested people for Covid, found that they were positive but sent them into care homes anyway. That is way worse than what Boris Johnson’s administration did.
And yet both the media and the opposition seem to have forgotten this, information which was openly in the public domain and even discussed at length for a number of days at the time. Yes Public Health Scotland has been desperately manipulating the data to try and hide the impact of these decisions, but to forget what happened completely?
Scotland should have woken up to its public health problems at the time the so-called ‘Glasgow Effect’ was debated ad nauseam over 15 years ago. That debate should have been happening for the last five or six years at least when it became clear progress on reducing avoidable deaths had stalled and even reversed.
If this kind of information simply disappears down the memory-hole in Scotland, what chance do we have of addressing the problem? That it slides down that memory hole so fast in large part because it is ‘just the poor, the jakeys and the junkies’ just makes it all more tragic. The middle classes keep stories which affect them in the public eye; the poor just die quietly.