The Imagined Health Community: Narratives of Scottish Health and Independence

The goal of this paper is to situate Scotland’s on-going goals in health and health research, and the current Scottish movement for independence, within the conceptual framework of imagined communities as originally theorised by Anderson (1991). The rise of Scottish nationalism is closely linked to the view that Scotland holds more communitarian attitudes to social policy than England, and that Westminster does not understand the needs and expectations of the Scottish population. The paper asks the questions: “does Scottish health and healthcare form a part of Scottish identity vis a vis the rest of Britain?”, “how do Scots perceive health and healthcare?”, and “what implications might this have on health related research?” Answers to these questions are provided based on analysis of grey literature from before, and leading up to, the foundation of Scotland’s Parliament.

The imagined community of Scotland is expressed in a series of statements that indicate a “have not” status or a “have-but-denied” (i.e. not able to take advantage of) status (Beland and Lecours, 2008; Scott and Wright, 2012; Bond et al, 2013). For example, Scottish White Papers and strategic plans addressing health policy consistently indicate that Scottish health is below that of the rest of the UK, and that the challenges facing Scotland need to be addressed in a more direct manner. The health issues that have been outlined for Scotland over time have included cardiovascular and other diseases caused or exacerbated by lifestyle decisions, and research has increasingly been highlighted as part of the solution.

In government documents and White Papers regarding Scotland’s health policy, research has been framed as a contributor to increased health, with NHS Scotland being the object of restructuring plans that would better capture the benefits of new health innovations. The rhetoric in the documents, however, also calls for efforts to use epidemiological and population health research to provide better data and evidence- based policy making to improve healthcare in Scotland. The emphasis of this rhetoric has been to better tailor policy and practice to match the specific needs of the Scottish population (whether policies or changes did better match these needs is beyond the scope of this paper). The emphasis on Scottish health needs since the early 1990s (and earlier) raises the question of whether these view are much different than those being expressed currently in the run-up to the independence referendum.

The remainder of this paper is divided into 5 sections. Section 2 introduces the concept of imagined communities, and how it might apply to the case of Scotland. It discusses how health, health policy and health research has been a major component of the imagining of Scotland. Section 3 reviews the grey literature, evidence from public sector white papers and strategy documents, as well as the media. Section 4 briefly discusses the implications of the societal image of Scotland, its health system and goals, and how it may be impacted by separation from the rest of the United Kingdom. Section 5 summarises the discussion and the main points of the paper.

This Working Paper is one in a series as part of Innogen’s work with the ESRC Future of the UK and Scotland programme.