Health inequalities- what causes them? Why do people in some parts of the UK have an average lifespan of years and years longer than people who live in other parts?

Glasgow is a case in point. Life expectancy at birth in Glasgow is the lowest in the UK –over six years below the national average for Glaswegian men (71.6 years, compared with a UK average of 78.2 years), and over four years below average for Glasgow’s women (78 years, compared with the UK average of 82.3).

In previous discussions, we suggested that this difference was primarily caused by pockets of extreme deprivation in the inner cities- an underclass who die young through high risk lifestyles skewing the statistics. However this may well not be the case.

This from the Guardian;

 …the conventional wisdom that Glasgow’s ill health is all down to poverty, bad diet and bad behaviour is, at best, partial and, at worst, misleading. Despite years of research and decades of evidence that something has gone terribly wrong in the heart of Scotland’s largest city, the underlying causes of Glasgow’s fatally poor health remain something of a scientific mystery.

Poverty alone doesn’t account for Glasgow’s dismally low life expectancy. Other British cities – Liverpool and Manchester, for example – have rates of deprivation every bit as high as Glasgow, yet their life expectancies are substantially higher. What’s more, even Glasgow’s most affluent citizens, those in the top 10% of the income distribution, die significantly younger than their counterparts in other British cities. At best, according to the epidemiologists’ calculations, deprivation accounts for less than half (around 40%) of Glasgow’s “mortality gap” compared with the rest of the UK. The other causes are still unknown.

This is quite a statement. For many years research had pointed clearly to the fact that poverty is the single most likely indicator of life expectancy. What other options are there that might explain the Glasgow situation then?

With colleagues at NHS Scotland and the University of Glasgow, Walsh has devoted much of the past five years to uncovering what makes Glasgow so different, compared with other, similarly deprived British cities. If you think deep-fried Mars bars are to blame for Glasgow’s ill health (as many English commentators seem to), then think again: obesity rates in the city are actuallylower than in some English cities.

Nor can Glasgow’s infamous penchant for alcohol and cigarettes explain the puzzle. According to the largest health surveys in England and Scotland, Glaswegians neither binge-drink nor smoke more than their peers in Liverpool or Manchester. Drug abuse (particularly heroin), knife crime, murder and suicide are all significantly more prevalent in Glasgow than in other cities. But that only prompts the question – why is this the case? What is it about life in Glasgow that seems to predispose some of its citizens to such destructive behaviours?

“Lots of people have their own pet hypotheses about it,” Walsh says. In a recent research paper, Walsh, McCartney and their co-authors, Chik Collins and David Batty, assessed no fewer than 17 competing explanations for Glasgow’s ill health. There are theories that blame the weather (perhaps it is vitamin D deficiency or chilly winters?), those that blame the data (perhaps Glasgow is simply poorer than it looks?), plenty of theories that blame the Glaswegians (a culture of hedonism, sectarianism or alienation) and still others that point the finger at the Tories (a “political attack” on Glasgow, conducted by Margaret Thatcher’s government). Some have more supporting evidence than others, but all are unproven, says Walsh. “The main thing to say is that it’s not going to be one thing. It’s going to be a combination of different factors interacting,” he says.

Point of death may not be the best measure of a life, and population wide stats tell little about individual experience- but I believe that this gap in life expectancy is a terrible blight on our country which should really be much higher up the political agenda.