1. Geographical inequalities in health across the UK L.I. to be able to understand the effect of geographical location on health outcomes Success Criteria: You should be able to n provide evidence for a “North-South divide” in health n Evaluate whether it is fair to deem Scotland the “Sick man of Europe” n Give explanations for the persistence of a North-South divide n By referring to the “Glasgow effect”, analyse the extent to which geographical differences in health are linked to purely socio-economic factors

2. Health: a ‘North-South divide’ n Ongoing pattern of lower life expectancy & higher death rates in the north of Britain compared to the South n Gap is the greatest it has been in 40 years and the dividing line seems to be moving further south A shifting divide

3. A North-South divide: the evidence n 14 of the 15 worst health areas in the UK were in the North (8 in Glasgow alone) n 14 of the 15 most healthy areas were in the South n The gap has actually worsened since, despite the government spending £20bn on initiatives to eliminate it n Today, premature deaths before the age of 75 are a fifth higher in the North The Widening Gap (1999): Old but relevant!

4. Scotland: Still the “sick man of Europe”? n Glasgow Centre for Population Health report (2012) n Compared Scottish mortality rates with 19 other countries, mainly in Western Europe (and a number of which have a lower per capita GDP) n Out of 20 countries Scotland has – Lowest life expectancy – Highest mortality rate for 15-44 age group – 4 th highest infant mortality – Highest rate of deaths from oesophageal cancer (men & women) – Highest rate of female deaths from lung cancer (men = 4 th highest) – Highest rate of heart disease deaths – men are 33% more likely and women are 63% more likely to die from the disease – Highest rate of female deaths from liver disease (men = 3 rd highest) – Highest rate of male suicide and 4 th highest female rate …or the sick woman?

5. Why do geographical inequalities in health persist? Government policy Diet Exercise Smoking/ Alchohol Poverty unemployment

6. The common denominator behind most (but not all) of these explanations is n Remember, Scotland, overall, is not a “poor” region when compared with elsewhere in the UK but it does contain many of the areas of most extreme poverty in the whole of the UK, and the majority of these are to be found in Glasgow n Glasgow is home to 10% of Scots, hence “Glasgow’s problems are Scotland’s problems”

7. Glasgow’s health disaster: n Consensus: Glasgow's citizens suffer more from – poor diet – smoking – alcohol abuse – drug abuse – low emotional self-esteem n 40% of Glasgow’s population is obese n 46% of children have tooth decay by age 5 n Impact is evident in health outcomes: rates of cancer, especially lung cancer, diabetes, obesity, chronic liver disease and depression are the highest in the UK and Glasgow’s life expectancy is 6 years below the Scottish Average n Astonishing differences between Glasgow’s most deprived neighbourhoods and more affluent areas close by Report: The Tears that made the Clyde

8. Two baby boys, born 8 miles apart n One in Calton, in the East End of Glasgow and the other in Lenzie, in East Dunbartonshire. The baby born in Calton: – is three times more likely to have a mother who smoked during pregnancy – is three times more likely to die of heart disease or bronchitis and twice as likely to die of lung cancer – is 21 times more likely to be admitted to hospital for drugs misuse – is four times more likely to suffer from a psychiatric disorder – and will die, on average, 28 years sooner, at the age of 54

9. The ‘Glasgow Effect’ n Many of Glasgow’s unique health problems are linked to socio-economic circumstances n But recent theory suggests that Glasgow’s poor health is over and above that can be explained by deprivation – Many other UK cities have comparable overall poverty rates but better health – Glasgow has similar rates of smoking and drinking than Liverpool or Manchester and obesity is actually lower – It doesn’t just affect the poor: even the wealthiest 10% in Glasgow die younger than counterparts in other cities n Dubbed ‘the Glasgow effect’ – cause inconclusive Report: Investigating a ‘Glasgow Effect’ (2010)

10. Possible hypotheses The weather? The data? The Glaswegians? Maggie?

11. For you to do: 1. Read the article “The Glasgow Effect and health inequalities” and complete the student activities that follow 2. Analysis question: to what extent is a person’s health determined by where they live?