Will Glasgow ever be able to shake off the dubious distinction of being Britain's unhealthiest place?
There is no sign of it yet. The latest report by the Office for National Statistics reveals, yet again, that Glasgow has the worst life expectancy in Britain. At 72.6 for boys and 78.5 for girls, it is eight to 10 years behind the best performing areas of the UK such as Dorset, though the gap has been narrowing.
The picture is far from brilliant for Scotland either. Life expectancy is lower than for England, Wales or Northern Ireland and 72% of Scottish communities are in the lowest fifth for longevity. Scotland has a worrying level of deaths among those aged 15 to 44. Still, Scotland as a whole fares a good deal better than Glasgow.
Glasgow's average life expectancy does not just reflect poor diet, lack of exercise and high levels of smoking and heavy drinking, though these are entrenched problems. The picture within the city is varied. High rates of drug-related deaths among younger people are found in some areas and a well-established life expectancy divide also exists between rich and poor areas of Glasgow.
So why does it persist despite years of initiatives aimed at tackling the problem? An Audit Scotland report 18 months ago found initiatives to improve health have often lacked a focus on outcomes. There have been some important successes: heart disease deaths have fallen by 42% in nine years, more than in Scotland as a whole, while cancer deaths in Glasgow have fallen significantly too. There is still a long way to go, however, and bringing about behaviour change at a population level is one of the toughest public policy challenges facing any government.
Where policy makers agree is that there is a very strong link between deprivation and poor health. Yet poverty does not on its own explain Glasgow's poor life expectancy. There are parts of Liverpool and Manchester with similar or worse levels of deprivation where life expectancy is better, so why not Glasgow?
Scotland's outgoing chief medical officer Sir Harry Burns, who has spent years studying the problem, believes it is rooted in the effects of a "social collapse" caused by the breakdown of communities and families following the decline of heavy industries over a 60-year period. This has created a psycho-social problem underpinning poor health. He advocates initiatives such as giving people help with parenting and better early-years education.
A number of Scottish Government projects are under way, including Equally Well, to address health inequalities, and the Early Years Framework, but budget constraints do not help.
Individuals who have had a secure upbringing, enjoy strong relationships and feel positive about the future will be more likely to be healthy than those who feel marginalised and powerless. The health board, council and Scottish Government cannot make Glaswegians happy and healthy overnight but, by focusing on what is proven to work, they can help Glasgow rid itself of its chronically unhealthy image.
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