Phil Hanlon Emeritus Professor of Public Health University of Glasgow

 

This is an important book. It explores how Adverse Childhood Experiences (ACEs) could help to explain why a rich and progressive country like modern Scotland still suffers from such poor health. Carol Craig begins with her own lived experience and then moves to a multifaceted analysis. Her compelling conclusions about how and why we have created adverse environments for too many Scottish children are a challenge to us all.

 

In doing so, Carol has, I believed picked up an issue (ACEs) that is grabbing the attention of policy makers, academics, teachers and parents. This is not the first time she has demonstrated an ability to discern the zeitgeist within Scotland. In 2003, she published The Scots’ Crisis of Confidence. The analysis she presented resonated with so many that it led to the creation of the Centre for Confidence and Well-being which has influenced thinking and practice in Scotland through a long series of impressive publications and events. In 2010, The Tears that Made the Clyde employed her wide-ranging knowledge of Glasgow to provide an analysis of the city’s poor social and physical health. Again, many found her approach and findings compelling.

Carol returns in this book to the exploration of poor social and physical health – but this time for the whole of Scotland. She does so in a manner that is not conventional but that is its strength.

 

Throughout much of my professional life in public health I spent many years exploring the conundrum of why Scotland as a wealthy Western European country performs less well in terms of health outcomes than might be expected. The work I and many others carried out naturally centred on factors we could measure. We concluded that deprivation and post-industrial decline are undoubtedly central. However, I was always concerned that we might be missing evidence about the culture of Scotland which might also be important.

 

Culture is created in what might be called the inter- subjective space. We all have our own interior (subjective) world. However, when memories, understandings, beliefs and motivations are held in common with many others – they become part of our collective culture. Public health research uses epidemiology and other tools to understand the determinants of health but it is very difficult to use these methods to penetrate cultural influences. Yet, there is a real case to be made for integrating objective data with cultural insights. Carol Craig seeks to do just that. The data that already exists on ACEs is objective and compelling. Scotland, however, needs more empirical data to establish how we compare with other similar regions and countries and this book adds to the urgency of that call. The book then examines aspects of our culture in Scotland which may contribute to historical and current circumstances which make ACEs common. It goes further – it speculates on why an adverse culture for children may have developed in Scotland.

 

The findings presented and the discussion that follows deserve serious consideration and debate among all who care about the health of the people of Scotland.