Sick Scotland

Scotland has had the worst mortality rates in Western European among working age men and women for more than three decades, a report revealed.

 The study, Still 'The Sick Man of Europe'? by the Glasgow Centre for Population Health (GCPH), stated: "Mortality in the working-age population remains comparatively high and mortality for circulatory diseases and many cancer-related diseases is higher than in most other Western European countries."

The Glasgow Effect

"It's a human tragedy on a massive scale," says Gerry McCartney, an epidemiologist at NHS Scotland.

David Walsh, a lead researcher at Glasgow Centre for Population Health adds: "You are talking about thousands of people dying before their time."

Whether it is deaths from cirrhosis, drug abuse, lung cancer, murder or suicide, Glasgow's mortality rates are easily the highest in Britain, and among the highest in Europe. Life expectancy at birth in Glasgow is the lowest in the UK – more than six years below the national average for Glaswegian men (71.6 years, compared with a UK average of 78.2 years), and more than four years below average for Glasgow's women (78 years, compared with the UK average of 82.3). And because Glasgow is home to more than 10% of Scotland's total population, with nearly 600,000 people in the city itself, and more than a million in the greater Glasgow area, Glasgow's problems are very much Scotland's problems.

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.  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.  There are no fewer than 17 competing explanations for Glasgow's ill health.

Glasgow's city boundaries contain some of Britain's most deprived neighbourhoods. Liverpool and Manchester, for example – have rates of deprivation every bit as high as Glasgow, yet their life expectancies are substantially higher. Glaswegians neither binge-drink nor smoke more than their peers in Liverpool or Manchester. 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.  Obesity rates in the city are actually lower than in some English cities.

Drug abuse (particularly heroin), knife crime, murder and suicide are all significantly more prevalent in Glasgow than in other cities. What is it about life in Glasgow that seems to predispose some of its citizens to such destructive behaviours?

Socialist Courier has documented the evidence that the type of society we live in - capitalism - and the suffering inflicted in the past, can be seen as a culprit for the Glasgow Effect

The poor health of Scotland

The gulf between the health of the affluent and the poor in Scotland is exposed in a new report which shows the divide is wider in Scotland than most other countries in Europe. Only Hungary and the Czech Republic report a deeper contrast between the death rates experienced by men who left school with no qualifications and those who graduated from college or university.

The gap between women from the different academic backgrounds is greater in Scotland than any of the other 20 countries included in the research.

 Dr Gerry McCartney, head of the Public Health Observatory Division for health improvement agency NHS Health Scotland, said: "It is a massive injustice. If you are a child born just a mile from where I live you have got a 50:50 chance of making it to your 65th birthday. That is an appalling record."

 There were 501 more deaths per 100,000 men per year among 30 to 59-year-old Scottish male manual workers, than among non-manual staff. This was a greater difference than in all the 13 other European countries included in this aspect of the research. In England and Wales the difference was 222 deaths, and in Switzerland it was 121.

health inequality

Statistics released by the Scottish Government show people from more deprived parts of Scotland are more likely to die from alcohol-related causes.

The largest rate of inequality was in alcohol-related deaths among those aged 45 – 74. The report says that while there have been improvements, death rates and levels of inequality were higher in 2010 than 1998.

Grin and bear it

WhatClinic.com surveyed more than 3000 private dentists in the UK, including 50 in Glasgow and 30 in Edinburgh. Overall, it found that the average cost of a standard check-up in private dental practices has risen by 22 per cent in just one year.

Private dental patients in Edinburgh are paying almost double the cost of treatment in Glasgow, it has been claimed. The average cost of a standard consultation in the city has risen to £74 – the second highest rate in Britain – compared with just £27 in Scotland’s second city. There is also a wide disparity in the cost of more complex procedures, with a bridge costing £443 in Edinburgh compared with £293 in Glasgow, dentures set patients back £473 compared with £260 while a dental implant costs an average of £2273 in the Capital – more than £800 more than in the west.

Overall, private healthcare comparison company WhatClinic.com said that patients in the Capital were having to fork out an average of 42 per cent more for treatment compared with their Glasgow  counterparts.

Heartless capitalism

Disability tests are  'sending sick and disabled back to work'. People deemed too sick or disabled to work are being refused their benefits because the current assessment is inadequate, according to the expert appointed to review it. Prof Malcolm Harrington, the government appointed adviser on testing welfare claimants, admitted the work fitness test was “patchy”. Professor Harrington said: "There are certainly areas where it's still not working."

It emerged dying patients are being forced to attend interviews to prove they are unfit for work. It is claimed that because regulations over who is assessed are discretionary, thousands of terminally ill patients are being forced to prove they are incapable of work or face losing their benefits

Dr Dean Marshall, chairman of the BMA's Scottish General Practitioners Committee, said "Evidence appears to suggest that people with serious health conditions are sometimes being declared fit for work."

Macmillan Cancer Support explained "Too many cancer patients are undergoing stressful assessments when they are awaiting, undergoing or recovering from debilitating treatment."

scotland's health shame

Scotland's suicide rate is almost 80% higher than England and Wales. More people die by suicide than from road accidents and drug deaths put together. It is the leading cause of death in young men. Over the past year, Tayside Police has collected information about every call where someone was at risk of suicide. It attended about 150 attempted or threatened suicides every month. On average, four suicide deaths a month in just Tayside.

 Detective Chief Inspector Gordon Milne said of the figures: "Extend that out across the whole of Scotland; there is a significant number of calls every day, every week, every month, every year, involving people who are in mental health crisis."

The mental health charity SAMH said even these latest figures from Tayside were still just the tip of the iceberg. Kirsty Keay, the charity's national programme manager for suicide prevention, said: "Suicide devastates Scotland's communities..."

A quarter of patients who end up in intensive care in Scotland have drink problems, most with chronic alcohol disease. The study of 771 patients across all 24 intensive care units published by the Anaesthesia medical journal, said many young and less well off people were affected.

Dr Timothy Geary, an anaesthetic registrar at Glasgow's Victoria Infirmary and report co-author, said: "Alcohol disease adversely affects the outcome of critically ill patients and the burden of this in Scotland is higher than elsewhere in the UK." He added: "In Scotland, the frequency and volume of alcohol consumed is significantly higher than in the rest of the UK, as is the proportion of people with hazardous drinking habits. This corresponds to higher death rates, particularly for Scottish men, but only indicates a fraction of the deaths attributed to alcohol."

Why are you fat?

Nearly 14 percent of women in the world are considered obese, up from 7.9 percent in 1980. Among men, 10 percent are obese, up from 5 percent in 1980.

Marion Nestle, a professor of nutrition, food studies and public policy at New York University, one of the leading nutritional experts who has written many books on the food industry, explains obesity rates started to rise in the 1980s, she says largely because of demands Wall Street placed on food makers.

Wall Street "forced food companies to try and sell food in an extremely competitive environment," she says. Food manufacturers "had to look for ways to get people to buy more food. And they were really good at it. I blame Wall Street for insisting that corporations have to grow their profits every 90 days."

 Large government subsidizes given to the corn, wheat, soybean and sugar industries allowed farmers to reap high returns on their crops. Farmers could grow these commodities cheaply and were encouraged by the food industry "to plant as much as they could. Food production increased, and so did calories in the food supply," Nestle writes. Inexpensive food encouraged more eating, and more eating led to bigger waistlines. "Today, in contrast to the early 1980s, it is socially acceptable to eat in more places, more frequently and in larger amounts, and for children to regularly consume fast foods, snacks and sodas" Since 1980 the index cost of fruits and vegetables has gone up by 40 percent. Whereas the index price of sodas and snack foods have gone down by 20 to 30 percent.

Hospital bed-boarding

Patients are being put at risk in Scotland by a lack of consultants and a shortage of acute hospital beds the Royal College of Physicians of Edinburgh (RCPE) has highlighted. A growing number of patients are being forced to stay in wards not designed to cater for their illness in a practice known as “bed-boarding”. Doctors say this delays treatment and increases the time patients stay in hospital, making them more likely to contract a superbug, like MRSA, or suffer from blood clots.

Eight out of ten physicians questioned for the survey say bed-boarding takes place year-round, and every expert said the practice had a negative impact on the quality of care patients receive. Seven out of ten RCPE members say putting patients in inappropriate wards has a negative impact on death rates and that it increases the chances of a patient being readmitted to hospital due to them not getting the correct care during their initial stay.

The cause of the causes

Life expectancy in Scotland is markedly lower compared to other European nations and the UK as a whole. But what are the reasons for this higher mortality? Higher mortality in Scotland is often attributed to higher rates of deprivation, smoking, alcohol consumption and poor diet. However such explanations are not sufficient to understand why Scotland is so very different compared to other areas.

In synthesising the evidence a group of researchers identified candidate hypotheses. The results showed that between 1950 and 1980 Scotland started to diverge from elsewhere in Europe and this may be linked to higher deprivation associated with particular industrial employment patterns, housing and urban environments, particular community and family dynamics, and negative health behaviour cultures.

The authors suggest that from 1980 onwards the higher mortality can be best explained by considering the political direction taken by the government of the day, and the consequent hopelessness and community disruption that may have been experienced. Other factors, such as alcohol, smoking, unemployment, housing and inequality are all important, but require an explanation as to why Scotland was disproportionately affected. From 1980 onwards, the higher mortality has been driven by unfavourable health behaviours, and it seems quite likely that these are linked to an intensifying climate of conflict, injustice and disempowerment. This is best explained by developing a synthesis beginning from the political attack hypothesis, which suggests that the neoliberal policies implemented from 1979 onwards across the UK disproportionately affected the Scottish population.

"It is increasingly recognised that it is insufficient to try to explain health trends by simply looking at the proximal causes such as smoking or alcohol. Income inequality, welfare policy and unemployment do not occur by accident, but as a product of the politics pursued by the government of the day. In this study we looked at the 'causes of the causes' of Scotland's health problems,"  said Dr Gerry McCartney, lead author of the study and consultant in public health at NHS Health Scotland.

its an emergency

Major trauma, the commonest killer of children and adults under 45, accounts for 1,300 deaths every year in Scotland. Major trauma often involves patients arriving at hospital with multiple, complex injuries which could result in death or permanent disability, usually sustained in an accident such as a car crash or gas explosion, or from a violent situation such as a shooting or stabbing. More than half of all trauma patients have major head injuries.

Scotland is lagging behind other developed countries in its provision of care for victims of major trauma and needs to radically overhaul its approach. A report by the Royal College of Surgeons of Edinburgh said death rates for severely injured patients who are alive when reaching hospital is 40 per cent higher in the UK than in North America. But while England has reformed its healthcare policy to improve survival rates, the situation in Scotland has not yet been addressed.


Margaret Watt, chair of the Scotland Patients’ Association, said: “This is nothing short of scandalous. We have known for some time the health service in Scotland is lacking in specialist care. Trauma patients should have access to the best qualified, best doctors for the job. The report comes from specialists who work in the frontline and know what they are talking about. They can not be ignored. It will be no good politicians coming back and saying they will look into it. These recommendations are already long overdue. They should already be in place. They need to act now to ensure Scotland’s patients get the life-saving care they expect and deserve. Scotland used to be the world leader in health care – to lag behind the rest of the world is just not an option.”

Drugging our old folk

Elderly patients in care homes across Scotland are being prescribed powerful drugs for long periods of time without proper checks on whether the medication is needed. In some cases, frail patients are being kept on multiple and potentially harmful doses for up to two decades without doctors or staff questioning whether they are necessary. Patients are often kept on a mix of drugs for health problems that may have resolved over time.

The Royal Pharmaceutical Society in Scotland (RPSS) in a report calls for more powers for pharmacists to review patients’ medical records. Pharmacists say they are becoming “increasingly concerned” about patients’ safety.

 Drugs regularly handed out to elderly patients include anti-psychotic medicines for dementia. These are classed as high-risk because of their links to heart problems and strokes, yet some patients remain on these far longer than is required. Other drugs could be causing drowsiness and dizziness, leading to falls and loss of appetite.

 Henry Simmons, chief executive of Alzheimer Scotland, said: “The dangers of inappropriate or long-term prescribing without regular review are clear: an increase in falls due to dizziness and unsteadiness, an almost doubling of mortality rates and double the risk of stroke in people with dementia.”

A sick country

A team of researchers analysing 1.75 million people in Scotland found that nearly a quarter had two or more chronic diseases.

Rising numbers of people are living with more than two long-term disorders, called "multimorbidity", which could include coronary heart disease, diabetes, cancer, stroke and depression. In general, people with multimorbidity are more likely to live in deprived areas and have a poorer quality of life. Their care is fragmented because they see a number of different specialists. "Existing approaches need to be complemented by support for the work of generalists, providing continuity, co-ordination, and above all a personal approach for people with multimorbidity." explained the report

The study of nearly two million patients registered with 314 medical practices in Scotland showed that people living in the most deprived areas were particularly affected by long-term physical and mental disorders. These disorders were more common among poorer communities and occurred 10-to-15 years earlier than among those living in affluent areas.

Dr Chris Salisbury, from the School of Social and Community Medicine at the University of Bristol, said GPs in more deprived areas should have lower caseloads to account for higher levels of multiple morbidity.

A sharing, caring Scotland

A total of 2,025,400 people had put their names forward for the NHS Organ Donor Register as of 31 March - almost 40% of the population. Across the UK, the number of people on the organ donation register stands at 30%.

Three people in the UK die every day because of a lack of access to organs. The Scottish government also said the number of people who died while waiting for organs fell from 38 in 2010-11 to 36 in 2011-12. The tragic fact is that more than 600 people in Scotland are still waiting for a life-saving transplant.

Life begins before conception!

Arizona lawmakers gave final passage to an anti-abortion bill that declares life begins two weeks before conception. A sentence in the bill defines gestational age as "calculated from the first day of the last menstrual period of the pregnant woman," which would move the beginning of a pregnancy up two weeks prior to conception.

Representatives passed a bill to prohibit abortions after the 18th week of pregnancy. Arizona the earliest definition of late-term abortion in the country; most states use 20 weeks as a definition. Nationally, 1.5 percent of abortions in the U.S. occur after the 21st week and 3.8 percent occur between the 16th and 20th weeks.

Heart care 'more likely for rich'

An estimated 182,000 people in Scotland have coronary heart disease (CHD), around 3.3% of the population. Rates of heart disease in Scotland remain the highest in Western Europe, despite new cases falling by nearly a third in the last 10 years.

There is evidence that rich people are more likely to receive NHS treatment for heart disease than poor people, according to the public spending watchdog.

In some more deprived areas around 25% of men over 75 have CHD but, according to Audit Scotland, people in deprived communities "are not always getting the same level of treatment as the rest of the population"

Treatments such as angioplasty, which widens the arteries, or heart bypass surgery, are over 20% less than expected in deprived areas. The least deprived areas saw over 60% more than expected. Audit Scotland said this "implies a lower level of access to these treatments for people in more deprived areas".

Is it accidental?

Adults and children from the most deprived areas of Scotland are twice as likely to die from an accidental injury than those from the most affluent postcodes, new figures show.

Some 1,364 deaths were recorded in 2010 in an Office of National Statistics as due to “unintentional injuries” , “Unintentional injury” is the NHS classification used where the victim has not deliberately inflicted injury on him or herself, but is admitted to hospital or dies as a result, such as road accidents, poisoning, and violent crimes like stabbings and shootings. However, the vast majority were from falls. Of these deaths, the bottom fifth of the population in terms of deprivation was listed as having a Standard Mortality Ratio for children of 119.3, compared with just 54.7 in the top fifth. Figures for adults were similar with an SMR of 125.2 for the bottom 20 per cent and 65.1 for the top 20 per cent.

It is thought that sub-standard housing, poor health and more crime in deprived areas (as well as greater "middle class" awareness about child safety) were relevant. The highest recorded number of accidents was in the west of Scotland – Glasgow City local authority is home to 31 per cent of the most deprived areas in Scotland.

Elizabeth Lumsden, community safety manager at the Royal Scoiety for the Prevention of Accidents (RoSPA) Scotland, said:“Those who are more income-deprived suffer poorer health and we know this is a major factor in falls which is one of the biggest causes of death and injury – especially in older people.”

dying early in Scotland

More men and women die before retirement age in Scotland than in any other part of the UK.,

The premature death rate – where people die before 65 – is 50 per cent higher north of the Border than in the east and south-east of England, where it is lowest, the Joseph Rowntree Foundation reported.

Experts warn the high numbers of early deaths are driven by violence, drug and alcohol problems, and unhealthy lifestyles, particularly in deprived areas. The report the UK government was failing to tackle poverty and warned cuts to social security could see inequalities rise rather than fall in future.

Cancer of Capitalism

Professor David Cameron, an expert in breast cancer from Edinburgh University, said new treatments were increasingly being developed which targeted specific subtypes of cancer, helping make them more effective.

"These drugs are expensive. Some of that is the real cost of developing them and some of that is if you are only going for a subset of cancer then your total predicted sales will be less," Prof Cameron told The Scotsman. "The business model of the company will be that in order to develop the money to develop the drug your subsequent sales in the patent lifetime have to be sufficient to cover all your costs. So actually, the cost for rarer cancer is likely to be higher and not lower."

Spare parts for sale

People should be allowed to sell their kidneys for £28,000 in an NHS-regulated organ market Dr Sue Rabbitt Roff, of Dundee University said in an article published online today by the British Medical Journal. She called on the health service to offer financial rewards to individuals willing to give up a kidney as a means of speeding up the rate of transplants and reducing the cost of treatments and dialysis to the NHS.

Dr Roff, a senior research fellow at Dundee’s department of medical sociology explained “We already allow strangers to donate kidneys out of the goodness of their hearts. They get their costs covered, they don’t know who the recipient is, there’s no publicity, no public acknowledgement of what they do. We’ve moved away from the notion it has to be a family member or a close associate who can give you a kidney. We’ve already moved into the zone of allowing the general public to make good-hearted donations. What I’m suggesting is, why don’t we add money to this equation in order to increase the amount of provision which is there...I came to this figure of £28,000 because that’s the average national income in Britain at the moment, so it seems a fair price across all the social strata..."

The British Medical Association said it would not support money being offered in exchange for kidneys.

Dr Calum McKellar, director of the Scottish Council on Human Bioethics said: “A legal, regulated market in human body parts would end up exploiting those who have very restrictive financial means, such as many students and foreigners.”

There are currently 725 people in Scotland waiting for a new kidney but the number coming up for transplant has plateaued at around 200 in recent years. How much smaller would be the number if those in various industries (chemicals, oil, tobacco, pharmaceuticals etc) had not poisoned and polluted our bodies for profit for decades?

Everything inside capitalism takes the form of a commodity, everything has its price, so it doesn't come as a surprise to Socialist Courier to read Dr. Roff's proposal.