Why does Glasgow have the lowest life expectancy in the UK, and what can we do about it? The Health Foundation’s chief executive, Dr Jennifer Dixon, talked through the issues with Dr David Walsh, senior lecturer at the University of Glasgow and a senior academic at the Glasgow Centre for Population Health, and Sir Harry Burns, professor of Global Public Health at the University of Strathclyde and a former chief medical officer for Scotland, for the latest episode of our podcast. Here’s a summary of the main themes that emerged from their conversation.
How does health in Glasgow compare with other cities?
Jennifer: Even after adjusting for poverty and deprivation, Glaswegians have a higher risk of dying prematurely than anywhere else in the UK. What do we know about the reasons behind this?
David: Health in Glasgow is poor relative to other urban areas, both in the UK and across large parts of Europe, and there are significant health inequalities within the city. That's what brings down the overall level of health. Comparisons across cities in different countries are difficult, but from the data we've got, I'd be reasonably confident saying that health inequalities in Glasgow are wider than in any other European city.
What do we know about the reasons behind Glasgow’s health inequalities?
David: The evidence shows that the fundamental causes of health inequalities are socioeconomic. For Glasgow, it’s a complicated combination of factors which include poor housing conditions and bad political decision making at different levels of government over many years.
Historically, health inequalities have widened because although the health of the poorest was improving, it was improving more slowly than the health of the more affluent. But what's happened in the last decade is that for the 20% most deprived, mortality rates are actually going up. We are seeing this in all parts of the UK and it’s clearly linked to the UK government's austerity measures, which have impacted on the most vulnerable and poor in society.
Harry: Doctors are taught about disease and the causes of disease, but what I realised in my public health training was that it’s the causes of wellbeing that we need to focus on more. There used to be an assumption that poverty influences different populations in the same way, but that’s not the case.
In Glasgow, one factor that has had a significant impact is the changing social structure of the city, with the old traditional communities replaced with high-rise flats. So people who were previously able to look to their neighbours for support, were no longer able to do that.
Episode 10. In the UK, life expectancy is lowest in Glasgow. Why is this? And what can we all learn...
What should a new health inequalities strategy for Scotland focus on?
Jennifer: It looks like there’s going to be a refreshed health inequalities strategy for Scotland. What should it learn from the last 20 years to take us forwards?
Harry: Part of the problem in dealing with inequalities is an overly simplistic analysis of the causes. The outcome that any society delivers is based on a complex interaction of things – housing, jobs, support and so on. We need to improve the wellbeing of people by making sure they have enough money to live on. But we also need to make sure that we support people in achieving their aims and aspirations.
What I've been talking about over the past year or two is we should have an inequalities improvement collaborative and the answer to improving things is do it from the bottom up. Don't tell people who already feel hopeless and not in control of their lives what to do. Ask them what they need to live better lives. It’s about creating a wellbeing economy where people are more in control of their lives and want to achieve better things.
David: We know that the actions need to focus on narrowing income inequality and socioeconomic inequalities. There are a lot of things we can do, including work on more environmental things like alcohol and air pollution. But for Scotland, the big question is, do we in the current devolved situation, actually have the powers to effectively address health and socioeconomic inequalities?
If you look, for example, at the increase in-work poverty – with zero hour contracts and the gig economy – tackling that requires changes to employment law and that is reserved to the UK government. We need the Scottish government to do everything they can with the powers they have to try and help those people that have been affected by spending cuts.
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.