Glasgow's 'sick man of Europe' tag could return

She said there was strong evidence that Westminster imposed austerity measures were to blame and said there was a real risk rising pressures on household incomes could reverse Glasgow's health gains.

Dr de Caestecker spoke to The Herald as she reflected on the end of her 16-year tenure as Director of Public Health for NHS Greater Glasgow and Clyde where she was tasked with reducing the city’s stark health inequalities.

Three years after she took on the role in 2009 her annual report noted that a 15-year-old boy in a deprived area of the city had only a 50% chance of reaching his 60th birthday, while for his counterpart in a more affluent area the chance was 90%.

“If you look at the statistics it’s not always accurate that we [Glasgow] are the ‘sick man of Europe’,” she said. “We were seeing improvements in health for many years.

“Unfortunately more recently we have seen that stalling of life expectancy but that’s throughout the UK. It’s not a Glasgow issue, it’s a poverty issue.

“Austerity gets blamed for some of that - reducing benefits and not enhancing housing and support for people in poverty - I think the evidence is strong on that.

“Unfortunately with the rising cost of living, there is a risk of things getting worse in Glasgow."

Describing herself as “definitely a socialist” she said she stood by comments made in 2009 when she suggested high-salaried medics were part of the problem.

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At the time the earning power of doctors became particularly controversial after new contracts boosted salaries while cutting working hours in 2004.

“I guess the way it was reported, it made it sound like I was saying ‘doctors you are the trouble’,” said Dr de Caestecker, who lives in Glasgow's south side.

“I know that junior doctors and senior clinicians are working extremely hard and they deserve to get good recompense. 

“What I was trying to say is that we need a more equal society if we are genuinely going to see health improved for all of us.

“And that means people like me in a privileged position earning a good salary would not always be fighting for more money.

"We would be fighting for more money into public services, into better social security benefits.

“I would still argue for that. And I know that’s easy for me to say. I’m in a very fortunate position but I think that is the only way things will really improve.”

She said she would never have presumed to know how best to advise someone experiencing extreme poverty.

“Part of the public health job is to analyse the data and describe the problem as well as lobbying for policy change but as for saying ‘this is what you have to do to manage on a budget’, you have to listen to what people who are experiencing that say.

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“It’s about national initiatives, both Scottish policy and particularly UK policy and it’s about benefits and affordable housing and how we ensure that we don’t have people who can’t afford to feed themselves or heat their homes. And that’s about policy on minimum wages, on benefits.”

Dr de Caestecker was due to retire before the pandemic but stayed in post to oversee the city’s response to the crisis and believes Covid may make the public more supportive of preventative health measures.

“I think in the longer term peoples’ appreciation of the importance of vaccination - we didn’t always get as high flu vaccination rates as we would have liked. even amongst our own staff -  I think that [the pandemic] will support that.

“I think people are also more appreciative of population health measures. So it might help support for measures such as fluoridation of the water or supplementation of flour with folic acid where it’s not all about individual responsibility, it’s about the whole community.”

Before her appointment as director of public health she was seconded to the Scottish Executive and was involved in a number of major policy changes including the ban on smoking in public places, which was passed on March 26, 2006.

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She believes Glasgow has the best smoking cessation services in the world, saying cash incentives given to pregnant women had doubled the quit rate.

She said she hopes to continue to have some involvement in public health in Glasgow as well as continuing her work with Community Justice Scotland and Glasgow City Mission.

None of her four children followed her into medicine, all pursuing careers in hospitality and the creative industries.  Her daughter is a fashion designer and son Iain is a successful actor, soon to be seen in BBC One ambulance control room thriller The Control Room.

Another of her sons runs a restaurant in Arran and perhaps with her influence it has a focus on healthy food. She is supportive of plans that will require restaurants to display the calorie content of meals on menus.

“It’s a small piece in the fight against obesity, it’s not the answer but I think it would at least draw attention to things you don’t realise are so high in calories such as the dressings on salads.”

She started her career in obstetrics and gynaecology but says a spell working in Africa sparked an interest in public health.

“I loved obstetrics, it’s a fantastic speciality but I went out to work in Ghana in the mid-1980s and it was a hard place to do obstetrics,” she said. “Very high maternal mortality and very high perinatal mortality. 

“Patients would come in from the bush and they would have walked for miles with low haemoglobins and at times they would end up very unwell and the baby might die or the mother’s live would be at risk.

“I thought, this isn’t prevention what I’m doing, this is more like a sticking plaster.”