Why do Glaswegians die young?

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.

Poverty in the UK- Blog action day

In the dying days of the ill fated Labour government in the late 1970’s, a report was commissioned from Sir Douglas Black into the causes and potential solutions to the inequalities in the health of the people of Britain.

This report, known as the Black report has become infamous amongst political and social scientists.

By the time the report had been completed, Thatcher had been swept into power on a platform of promises to break the power of the Unions, and to cut and control public expenditure. The report must have landed on her desk like an old kipper The Government wanted to bury it, but eventually released it on a bank holiday Monday, with a minimum of publicity. The report was never published- instead 260 photocopies were made available.

What was so controversial?

Black provided convincing figures that showed what many suspected—that the poorest had the highest rates of ill health and death. He argued that these rates could not be explained solely by income, education, mobility, or lifestyle, but were also caused by a lack of a coordinated policy that would ensure uniform delivery of services. He recommended health goals, tax changes, benefit increases, and restrictions on the sale and advertising of tobacco. Patrick Jenkin, the social services secretary, estimated with a shudder that Black’s proposals, which he hinted were little short of outrageous, would cost an unthinkable £2bn a year.

Excerpt from Sir Douglas Black’s obituary in the BMJ- here.

Leaving aside the economic questions raised by the cost of Trident nuclear weapons systems, or a war in the Falklands, the real political dynamite of this report was simply this- poverty makes people ill, and many of them die young.

This report was not talking about people who living marginal existences in sub-Saharan Africa- it was describing families living in one of the richest countries in the world- the worlds first industrialised country- Great Britain.

The Black report was not alone in reaching this conclusion. 28 years later World Health Organisation figures record a gap of 10 years between affluent Kensington and Chelsea, and post industrial Glasgow. Check out this article from the BBC.

This hides the real issues though- the figures represent areas, not individuals at risk. For example, if you are a homeless rough sleeper, your life expectancy is 42 years.

There have been many discussions about how poverty leads to poor health in Britain. Poor diets, obesity, poor education, poor housing, unequal access to health services, stress- all these no doubt play a part- but the common issue that even the New Labour administration are not happy to dwell on is… poverty.

I do not intend to get into a discussion about how we define poverty- the whole relative or absolute thing. Poverty, once seen, is recognised by most of us. It is easy to blame. It is easy to be repelled and repulsed by squalid living.

Because poverty brutalises.

I have worked as a social worker for all my adult life. I have seen people living in conditions that are hard to believe. A man who lived in a house with a broken overflowing toilet for 15 years. A young woman whose body was broken by drug use and prostitution to the extent that she simply forgot to eat. A woman who was so caught up in her need to escape that she drinks the alcohol based handwashes in the hospital. And many many people who live in fear of a loss of benefit, because life is so marginal- with choices to be made over whether to feed the electricity meter, or the cat, or sometimes- the kids.

These people are not described as poor. We now talk about ‘social exclusion’. Almost as if we stopped inviting them to parties.

There are no easy answers. This, I think, is the reason that Jesus said the the poor would always be with us– and why the early church seemed to have at it’s very heart a desire to serve the poor. Strange then to hear these words of Jesus spoken as justification for inaction.

There are some national policy decisions that will always impact the poor. Progressive taxation, as opposed to the imposition of tax on food or fuel. Public transport, good social housing, employment opportunities and support, adequate benefits- particularly to single parents or vulnerable older people. These things are all good- and we might raise our collective voices in support… but for me there is also a personal dimension.

Because those of us who are paid to try to make a difference soon realise that all we do is administrate. We may have some small success- and this keeps us trying- but ultimately, we bring only sticking plaster to road traffic accidents.

But I believe in redemption and renewal, and lives transformed. And for this to happen- this brings humanity and hope to my own brokenness- and richness to my own poverty. As Jean Vanier put it

Jesus came to bring good news to the poor, not those who serve the poor! … The healing power in us will not come from our capacities and our riches, but in and through our poverty. We are called to discover that God can bring peace, compassion and love through our wounds.

Some more links to poverty issues in the UK

Child poverty

Save the Children

Health inequalities, Scotland