The Politics of Health in Scotland, 1979-1992: ‘Personal responsibility’ and the ‘false dawn’ of social determination

West Central Scotland and Glasgow exhibit a range of unenviable health outcomes – including low life expectancy, pronounced health inequalities and substantial ‘excess mortality’. Previously, the authors have contributed to work highlighting the socio-historical and political processes shaping these health outcomes, and have demonstrated, based on research in government archives, the awareness amongst policy makers within Scotland in the 1970s of the underlying causal processes. This paper further develops the findings from new archival research covering the period 1979-1992, and shows how policy makers moved to embrace a view of social problems, including health, as reflective of a ‘dependency culture’ from which individuals and communities needed to be ‘liberated’- via housing tenure change, local government reform, community participation in ‘regeneration partnerships’ and the inculcation of ‘entrepreneurial spirit’. Ultimately, poor health outcomes were to be seen as reflective of the failure of individuals to respond appropriately. Notwithstanding the trenchant adherence to this view amongst leading politicians, some policy makers from the later 1980s, faced with a growing body of countervailing evidence from areas of multiple deprivation, sought to encourage a more ‘holistic’ approach along the lines of other European countries. The paper will show how this was to prove to be a ‘false dawn’ for the re-emergence of the view of health as ‘socially determined’, and will present a Simmellian/ Polanyian perspective on how the public policy of this period contributed to intensifying issues of both social deprivation and health in the region, and in the city of Glasgow in particular.