Job loss and social breakdown, not smoking and bad diet, lie at the roots of Scotland's infamously high rate of premature death, says a public health expert

(Image: Andrzej Krauze)

LAST year, just before the Commonwealth Games, figures came out showing that the host city, Glasgow, has the lowest average life expectancy of any UK city. A boy born there between 2010 and 2012 can expect to live just 72.6 years, against a national average of nearly 79.

This was hardly news. For many years, parts of Glasgow have had the UK’s highest premature mortality rate. The popular belief is that this is because of diet, smoking and drinking. Only one of these factors is genuine: Glaswegians drink too much.

In fact, most preconceived notions about the bad health of Scots are wrong. Research into its real causes has implications for health policy internationally.


There is nothing inherently unhealthy about the Scots. The Glasgow Centre for Population Health has charted life expectancy in several Western European countries for the past 160 years. For most of that time, Scotland’s was about average. Only in recent decades have other countries overtaken it. This slowing of the rise in Scotland’s life expectancy has been most marked in the poorest 20 per cent of the population, mainly because of increases in deaths due to drugs, violence, alcohol and suicide. From 1950 to 1970, Scotland had one of the lowest rates of death from alcoholic liver disease, for example. By 2005, it had the highest.

Put simply, widening health inequality in Glasgow is due to the recent emergence of socially determined causes of early death. What happened to cause this?

During most of the 20th century traditional industries, such as shipbuilding and steel, provided secure, meaningful employment for Glasgow. These industries declined in the 1970s as companies shifted production abroad. Skilled people left and those who remained struggled to find jobs. At the same time, communities changed as inner-city tenements were replaced by peripheral housing estates which lacked the same social cohesion. From this emerged a society with a deep sense of alienation.

However, research tells us that this is not something we have to accept. It is clear societies have the capacity to create well-being. We have become used to relying on healthcare to prevent and treat illness. Perhaps it’s time we asked: how do we create wellness?

There are many theories of well-being, but they share common features. Healthy, successful lives tend to be lived by people with a sense of purpose and meaning. They feel that they are masters of their own fate rather than being at the mercy of events, have a positive outlook and see problems as challenges to be overcome. It turns out that individuals who lack these attributes experience significant consequences.

Healthy, successful lives tend to be lived by people with a sense of purpose and meaning

People who don’t feel in control of their life are stressed by it. Many studies have shown that the lower down a social hierarchy an individual is, the higher the levels of stress hormones in their blood.

It appears that early childhood experiences can also produce lifelong abnormalities in the stress response. Young animals exposed to chaotic, inconsistent parenting have high levels of stress hormones.

Stress is also associated with abnormal patterns of brain development in key areas, including the prefrontal cortex, hippocampus and amygdala. These are important for learning, decision-making, memory, stress regulation and emotional arousal.

These developmental patterns are also seen in humans. So young animals – and young humans – who grow up in dangerous, chaotic environments are likely to be less able to suppress inappropriate behaviour, less able to learn and more likely to be anxious and aggressive.

These observations are not specific to Scotland. Studies elsewhere find the same relationship between turbulent early years and adult outcomes. The California Adverse Childhood Event study, for example, looked at nine types of childhood event and how they related to problems in adulthood such as alcoholism, drug abuse and domestic violence. None of these events were particularly damaging on their own, but the more of them an individual experienced, the more damaged their adult life was likely to be and the more likely they were to experience addiction, violence and mental health problems.

It may be that what we are seeing in Scotland is the consequence of austerity in the 1970s and 80s, when social change and joblessness led to a breakdown in family life and a cycle of alienation. Young people with no meaning and purpose tend to sit at home, watch TV, drink and have a couple of kids – and the cycle continues.

Plenty of other societies are experiencing the same kind of problems. What we have seen in Glasgow may become evident in southern Europe over the next two decades.

Can we fix it? Yes, but it will take time. The importance of investment in early childhood cannot be overstated. Breaking the cycle of alienation in young families is a first step. But it won’t happen overnight.

We are fortunate in Scotland in having politicians who are guided by science. They back a radical approach and novel methods to make Scotland the best place in the world to grow up.

I’m not advocating a revolution in the normal sense of that word. However, we need a revolution of a sort. A more consistent application of science to policy can radically improve quality of life and the opportunities for young people to realise their potential for health, happiness and attainment in life. We are fortunate in Scotland to have such political support. There is no reason why, in a few decades, life expectancy in Glasgow should not match the best in the UK.

This article appeared in print under the headline “Health of nations”