Glasgow wellbeing: why we need to tackle its inequalities

The Covid pandemic has affected us all. However, those at the lower end of the socioeconomic scale have been more likely to contract the virus, more likely to die of it and, if they survive, are more likely to experience the long-term effects of “long Covid”. When this infection is finally controlled – and that may be some time yet – we will see the true extent to which health and life expectancy in Glasgow has been affected.

The health of the people of Glasgow has been studied for many years. One of the earliest documents to describe the relationship between poverty and health was published in Glasgow. In 1861, John Strang, the Glasgow City Chamberlain, compared death rates of babies in their first year of life in affluent and deprived wards in the city. In the west end of the city, where rich people lived, 18 babies out of every thousand born would die before their first birthday. In the dark, dirty closes of the Calton, 260 of every thousand born would die. In 1872, Glasgow appointed Dr J B Russell as its first Medical Officer of Health. He set about improving sanitation, controlling pollution and started a programme of slum clearance. Glasgow was, he said, a "semi-asphyxiated city.”

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150 years on, Glasgow still has problems with health inequality. In 2010, the Glasgow Centre for Population Health published a comparison of premature mortality in Glasgow, Liverpool and Manchester. Deprivation levels in the three cities were almost identical but premature deaths were more than 30 per cent higher in Glasgow. This was a surprising finding, given that these three cities, and particularly Liverpool and Glasgow, seemed to share many similar problems of social and economic inequality. I asked a colleague who worked in public health in Liverpool about the study. Her explanation was that the Toxteth riots in 1981 awakened the city to the problems of alienation and poverty in poor areas. Efforts were made in Liverpool to ask communities what they needed and the support and regeneration process which was started then continues to this day. Community action seems to have been effective in this case.

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Poverty and alienation emerge in a community as the outcome of a complex series of influences. Changing a complex system needs an initiating event that demonstrates that the status quo is no longer acceptable. The riots in Toxteth made it clear in Liverpool that radical change was necessary. The current pandemic and the damage it has caused to the wellbeing of the population should be seen as a call to action. What can Glasgow do to help support radical changes to the lives of those most damaged by it. How do we make that change happen? The lessons from various successful projects suggest some methods.

Firstly, we need to recognise the importance of complexity. Too often, we assume that health inequalities can be solved by single, simple solutions. They have many interacting causes, and we need to recognise that people may need support in many different ways to feel in control of their lives.

Secondly, telling people what’s wrong with them and what they need to do to live better lives, is unlikely to work if they are struggling. Being told that their eating habits are killing them will only make them feel more helpless and hopeless. The mistake we make is to focus on people's problems rather than on the skills and interests they already have that they can use to improve their lives.

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Asking them what they think they need to live a better life and helping them achieve that sense of control is a method which has been successful in many different projects.

Too often, we focus our attentions on people's problems rather than on the abilities they might possess to fix their problems. We focus on their deficits rather than on their assets. The asset approach has been described as one which values the capacity, skills, knowledge, connections and potential in a community. It doesn’t just see the problems that need fixing and the gaps that need filling. In an asset approach, the glass is half-full rather than half empty

Kelvingrove Art Gallery and Museum is operated by Glasgow Life

The more familiar ‘deficit’ approach focuses on the problems, needs and deficiencies in a community such as deprivation, illness and health-damaging behaviours. It designs services to fill the gaps and fix the problems. As a result, individuals in those communities can feel disempowered and dependent. People can become passive recipients of services rather than active agents in their own and their families’ lives. If we are to transform health in our socially and economically deprived communities, we must support them to discover and develop those assets which enhance people's capacity for wellbeing. Where can we start?

Glasgow is a city full of assets. It has world-class art, music and architecture. It has great schools, colleges and universities. Its infrastructure is sound. Most importantly, it has good, well intentioned people. As a consultant surgeon at Glasgow Royal Infirmary, then as Director of Public Health at the Health Board, I have worked with a great many public officials in Glasgow. They have been, without exception, highly motivated to improve the lives of their fellow citizens. What can they learn from the efforts made elsewhere that have made a difference to the wellbeing of struggling individuals?

In 1995, the Beacon and Old Hill estate in Falmouth, Cornwall, was so violent, it was known locally as "Beirut". There were drug wars, violence between mothers at the school gates, primary school children were drunk in the streets and pets were thrown on bonfires. Two health visitors fed up with the despair they encountered decided to ask the residents what mattered to them. What they wanted to do to improve their conditions. Having got answers to these questions, they then set about working with the community to make the changes happen. Five years later, crime had halved, employment had increased dramatically, and the health of the community had improved across several measures.

In Stoke on Trent, a similar approach was taken with around 1,000 residents identified as living difficult lives. One of the measures used to demonstrate the effectiveness of their approach was how it impacted on the cost of public services. The average cost of providing services to struggling individuals was £106,000 a year. After adopting an approach based on asking what the person needed rather than telling them what was good for them, the annual cost fell to £2,200.

There is hard science underlying the success of these projects. The late Professor Bruce McEwen, of Rockefeller University in New York, was a leading authority on the effects of social deprivation on the brain. I spoke to him a few months before he died in 2020. He was excited about his latest study in which he had managed to reverse some of the brain effects of deprivation. How, I asked him, had he done this? “Three things work”, he said, “mindfulness, exercise and mentoring!”

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This combination seems to point to the importance of the approach outlined recently by Glasgow Life in its ‘Coach Core’ programme. Glasgow Life doesn’t only run gyms. Its mentoring activities change young people's lives and improves their wellbeing. It supports those who have left school, often without qualifications, to get jobs and, in the process, they acquire a sense of achievement, self-respect and they see for themselves the possibility of a healthy future life.

Those who question the costs of such programmes should realise that, ultimately, it reduces illnesses and social problems and enhances employment. People are less likely to get into trouble and are more likely to get jobs and pay taxes.

The leadership of Glasgow Life understands the importance of supporting people to discover their assets rather than telling them about their deficits. Whether it’s getting them involved in art, music, drama or sport, providing them with mentoring support helps them acquire a sense of self-esteem and purpose.

There are many other organisations in Glasgow working to support poor individuals and families. By working together, sharing ideas and measuring impact regularly, we can change Scotland’s largest city from one noted for its inequalities to a world leader in creating wellbeing.

Glasgow, it seems, has assets which can even attract Indiana Jones. There is little excuse for not supporting active communities. It could save the public purse a lot of money.

Sir Harry Burns is Professor of Global Public Health at the University of Strathclyde and the former Chief Medical Officer for Scotland