The Glasgow Effect

Possilpark is less than two miles from the affluent, fashionable area around the University of Glasgow, yet this neighbourhood has the worst life expectancy rates in the UK, and perhaps in western Europe. The Glasgow Centre for Population Health calculated that between the years 2008 and 2012 an average man in Ruchill and Possilpark – a neighbourhood of 10,700 people, would die aged just 66 – barely old enough to collect his state pension.

The latest data for 2014 shows men in the wider Scottish parliamentary constituency that is home to Possilpark – Glasgow Maryhill and Springburn – will die aged 72 on average, five years younger than across Scotland; for women life expectancy is 77, against a Scottish figure of 81. Other British cities have identical levels of poverty, yet their citizens live longer. Glasgow’s figures are a significant factor in Scotland’s poor overall life expectancy rates: Scots still die earlier than in any other west European country, at 79 against 81 in England and Wales, or 82 in Spain, Sweden and Italy. Once about average, Scottish life expectancy has been bottom of the European pack for the last 30 years.

Advances in modern healthcare, new and refurbished housing, and slow changes to lifestyle have improved life expectancy. While they may live longer than before they do so in poor health, with complex, chronic illnesses. Clinicians call it premature multi-morbidity: patients who may be life-long smokers living with obesity, lung disease or ailing hearts. “Our patients have multiple chronic diseases about 15 to 20 years earlier than in affluent areas. They are living longer in poorer health,” says Dr Lynsay Crawford, a GP at Balmore medical practice. “They’re living longer but not in good health, lots of them. They’ve had their triple bypasses which has kept them alive, but then we have them in their 70s with heart and lung disease, and heart failure. I think that health has improved, but not in the way we would see in wealthier areas,” added her practice partner, Dr Allison Reid.

Dr Crawford’s, Balmore surgery is a leading member in the Deep End, a network of the 100 practices with Scotland’s most deprived catchment areas that campaigns for higher spending and targeted policies. Balmore’s patients live with the third worst deprivation levels of all GP surgeries in Scotland. Four in 10 of Balmore’s 3,511 patients have chronic diseases. While rates are slowly improving, nearly 34% of patients smoke, against a Scottish average of 19.7% and double the UK’s 15.9%; it has 151 patients with chronic obstructive pulmonary disease, double the Scottish average; and almost 200 patients with coronary heart disease, at 5.7% against the Scottish rate of 4.2%. The clinic has made significant progress on high blood pressure rates. They have fallen to 13.6%, while Scotland’s average has risen steadily, and is now higher than Balmore’s. Still, 231 Balmore patients have diabetes, 6.7% versus 4.9% for Scotland; and 296 have asthma, a third more than the Scotland-wide rate. More than 300 have a history of depression, nearly 50% higher than the Scottish average. 

There are subtle differences in the strategies pursued by Crawford and Reid compared with GPs in more affluent and less troubled communities. At Balmore, a doctor’s dire ultimatums to quit smoking, or to cut down on fatty, sugary foods, will simply fail. Patients will stop turning up. The GPs believe their authority rests very heavily on trust, carefully calibrated negotiation and a lack of judgment about a patient’s lifestyle and history. Getting someone to cut down their smoking or change their diet is by coaxing, negotiation. There is a strong sense that smoking is a rare pleasure in a difficult world; beating addiction is harder with great routine stress in daily life. They have alcoholics with multiple illnesses directly linked to their alcohol abuse, poor diet and damp homes. Those men will often quite candidly describe how heavily they drank the night before. They still need and deserve treatment, respect rather than censure, says Crawford. “I have several patients who are significant alcoholics and know that they’re going to die from that. But they come to you because I don’t make judgments, and they don’t lie to me about how much they’re drinking.”