Depression, substance abuse, and suicide have long been associated with homosexuality. In the decades preceding the gay liberation movement, the most common explanation for this association was that homosexuality itself is a mental illness. Much of the work of gay liberation consisted of dismantling the pathological understanding of homosexuality among mental health professionals.
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The research literature on health inequalities (health differences between different social groups) is growing almost every day. Within this burgeoning literature, it is generally agreed that the UK’s health inequalities (like those in many other advanced, capitalist economies) are substantial.
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When making decisions about health interventions in whole populations, many people believe that the best evidence comes from analysis of the results of randomized control trials (RCTs). This belief is reinforced by the notion of a hierarchy of evidence in which the RCT is close to the pinnacle of evidence. It has that position because the RCT is a powerful tool for eliminating bias.
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By Eugene Milne
My card-carrying North London media brother, Ben, describes himself on his Twitter feed as a ‘recovering Northerner’.
In my case the disease is almost certainly incurable. Despite spending a good deal of last year in cosmopolitan London — beautiful, exciting and diverse as it is — I found myself on occasions near tears of joy as my feet hit the platform at King’s Cross.
“I need to know I can be at the coast or in miles of open countryside within 20 minutes,” I told Ben.
“I need to know I can get Vietnamese food at 3.00 a.m.,” he replied.
While mine is clearly the healthier individual craving, the gulf in population health outcomes between the North and South of England, or, perhaps more accurately, between the provinces and the capital and its South Eastern sprawl, remains as wide as ever.
On examining the distribution of age-standardised mortality for Nomenclature of Territorial Units for Statistics regions, the United Kingdom remains the most starkly unequal of European nations. This is starkly illustrated in our new analyses of the North South divide in England, when compared with the experience of East and West Germany following the fall of the Berlin Wall. After that great political upheaval, notably for women, life expectancy in East Germany began to climb rapidly. Twenty years on, it is indistinguishable from that of the former West Germany.
In contrast, the gap between the North East of England and London, which in 1990 was similar to that between East and West Germany, remains just as wide in the most recent figures. Of course, life expectancy has risen markedly in both countries and their regions; modern North East English life expectancy is significantly higher than that which obtained in 1990 for West Germany. But the English failure to narrow its inequality gap despite overt national efforts signals that those efforts are simply too light-touch to be effective.
As Johan Mackenbach has commented, in reflecting on the English strategy from 1997-2010:
“it did not address the most relevant entry-points, did not use effective policies and was not delivered at a large enough scale for achieving population-wide impacts. Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the overall targets.”
Of course, fundamental to this problem is economics. The wealth of London and the South East in comparison to, well just about anywhere else in the UK, is now extraordinarily stark. London now feels more alien to my Northern sensibilities than much of Europe, and the reason is not people but cash.
The difference is illustrated rather well by the contrasting artistic expectations of the South Bank Centre — close by the Waterloo offices of Public Health England, for whom I worked last year — and the Culture budget of the City of Newcastle — for whom I now work as Director of Public Health.
On consecutive days in 2013, the Guardian and BBC reported the Southbank Centre’s unveiling of its £100m redevelopment plans (6 March), having made a successful first stage bid for £20m from the Arts Council, and Newcastle City Council was reported (7 March) as having cut its £2.5m culture budget by 50%. This comparison could equally be drawn in many other ways: for transport and infrastructure, investment in business, development of academic institutions (why did the Crick Institute need to be in King’s Cross?). And it all matters because, despite the cleaner air and wide open spaces, the English provinces and in particular the North, are losing out — on culture, mobility, urban environment, jobs, and crucially on health.
The English North has many charms, both for its natives and many who come upon its joys by accident (see this delightful, recent New York Times piece). For too many, however, it remains a place of shorter and poorer lives. The German experience suggests that it need not be so.
Prof. Eugene Milne became Director of Public Health for Newcastle upon Tyne earlier this year, after working nationally for Public Health England as Director for Adult Health and Wellbeing. He is an Honorary Professor in Medicine and Health at the University of Durham, and joint-editor, with his colleague Prof. Ted Schrecker, of the Journal of Public Health. He has research interests in health improvement, inequalities and ageing.
The Journal of Public Health invites submission of papers on any aspect of public health research and practice. We welcome papers on the theory and practice of the whole spectrum of public health across the domains of health improvement, health protection and service improvement, with a particular focus on the translation of science into action. Papers on the role of public health ethics and law are welcome.
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Image credit: Angel of the North, Gateshead, by NickyHall5. CC-BY-SA-3.0 via Wikimedia Commons.The post Is the past a foreign country? appeared first on OUPblog.
By Simone Frizell Reiter
According to Statistics Norway, around 10,000 children under the age of 18 in Norway experience divorce every year. These numbers do not take into account non-married couples that split up. Therefore, in reality far more children experience parental separation.
Status of knowledge
Focus has been on the adversity of parental divorce, emphasising the support and safety an intact family gives. The child may experience conflict, neglect or parental alienation, and insecurity about who belongs to the family. Not only the separation itself but also the period preceding and following the divorce may disturb the child’s well-being. Several studies show that parental conflict, that may be harmful to the child, is perpetuated even after the divorce. However, other studies show that when the parents are able to reduce the level of conflict after the divorce, the divorce is not exclusively negative if the child is moved from a family situation with conflicts to a more harmonious one. Society’s attitude toward divorce has changed as divorce has become more common. Prejudice and stigma are less pronounced. A natural assumption is therefore that mental problems related to divorce are also reduced. However, more recent studies conclude that adults, who experienced divorce in childhood, have more mental health problems than adults from intact families.
Divorce and reduced parental contact are closely linked. Children with loss of parental contact after divorce report more mental health complaints compared to children with preserved contact. Lack of attention, support, and economic insecurity may explain some of the negative effects of a parent’s absence. However, even when provided with at step-parent after divorce, these children report a lower level of well-being than children with preserved parental contact. Biological parents therefore seem to be of particular importance. Regular and frequent contact with both parents after divorce may also reduce the potential harmful effects of parental absence as seen in sole-custody households. Parental support is an important, independent risk factor to children’s sense of achievement and well-being. It is shown that as children’s relationship with their fathers weakens after divorce, they also lose contact with paternal grandparents and stepfamily.
Studies show that when divorce is followed by strong conflict, children may be used as a weapon between the parents. In such conflicts contact with one of the parents may be limited or brought to an end. The child is forced to ally with one of the parents, and suffers from the psychological stress this causes.
What is the concern?
Family law in Western societies generally aims at preserving dual parental contact for the child after divorce. This is also the aim of the Norwegian legislation. The Norwegian Child Act states that the parents may come to an agreement on where the child should primarily reside. However, if the parents cannot agree on this, the court has to decide which one of the parents the child should stay with. In practical life this has, in most cases, been the mother, while the father has been reduced to a weekend parent. Due to this, the experience in Norway is that when it comes to loss of parental contact, children of divorce primarily lose contact with the father. This effect is in some cases strengthened by the primary caregiver intentionally sabotaging the other parent’s visitation rights. To prevent this, the Norwegian legislation has sanctions, but these are very rarely used. A suggestion has been to introduce shared residence as a preferred solution after parental divorce, and that parents who sabotage this agreement may get restrictions on their contact with the child.
Most parents choose to take an active role in their child’s upbringing, and only a small group is absent, either by choice or circumstances. Therefore, social benefit systems have built in mechanisms to compensate the lacking of the absent parent by high financial contributions to sole providers left alone in charge. The downside of these benefits is that one of the parents can gain financially on monopolising the contact with the child and in some cases the sole provider actively sabotages or reduces the other parent’s contact, only to gain financially. This mechanism is strengthened by the Norwegian child maintenance system, where the level of economic support is linked to the amount of time spent with the child. Parents who share the custody in equal parts do not pay any child maintenance to each other. The combination of the systems has turned many fathers in to “child maintenance machines” because the mother would lose so much financially, sharing the custody of the child with the father. The benefits therefore undermine the aim to gain shared custody, and deprive the father of the possibility to have a close relationship with his child.
The concept of “parental alienation syndrome” is used to describe the condition where the child is alienated against one of the parents. If the government wants the children’s voice to be heard in custody conflicts, they must take into account that the child is already involved in a process of demonization and slander of one of the parents. From the literature, we know the term folie à deux. The government should be careful not to act in a game that can be characterized as folie à troi (madness shared by three).
In practice, it is difficult to have an equal amount of contact with both parents unless the child lives in two places equally. What is important to consider is whether advantages of maintaining a close relationship with both parents outweigh the disadvantages of having to change residence, for instance every week or every second week. Equally shared legal custody is not the same as having the child living in two residences fifty-fifty.
The experience is that the Child Act’s intention of parental agreement on a solution of custody between equal parties does not work. This is because the court, when presented the case, is legally bound to choose a single residence and almost exclusively chooses the mother.
On the basis of this knowledge it is important that the government puts effort in protecting the child’s right to have contact with both parents. This work must be as unprejudiced as possible. It is not acceptable that we continue with a practice in which the legislation allows the systematic favoring of one part in conflicted divorces.
Simone Frizell Reiter is a PhD candidate in the Department of Clinical Medicine at the University of Bergen, Norway, and the author of the paper ‘Impact of divorce and loss of parental contact on health complaints among adolescents’, which appears in The Journal of Public Health.
The Journal of Public Health aims to promote the highest standards of public health practice internationally through the timely communication of current, best scientific evidence.
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