So Scots have a death wish?

 We’re doomed. Doomed. Get out now while you still can. It’s a wonder there’s anyone left in Scotland so terrifying are the headlines about Scottish mortality.   97% of us are living dangerously unhealthy lives according to a report last week in BMC Public Health.  A boy born in Glasgow can expect to live thirteen years less than a boy born in Chelsea, according to the Office of National Statistics. Twice as many of us die from alcohol abuse than in England - that’s if we aren’t murdered first. Half a million of us have coronary heart disease, according to CHASS -  one of the highest rates in the world.  Diseases like multiple sclerosis are off the scale. Two thirds of us are overweight or obese.   



 What’s the point of spending £2,000 a year on the Scottish NHS, 16% more than in England, when Scots are popping their clogs so fast the undertakers have to wear running shoes? Researchers at the Centre for Public Policy in the Regions last week questioned the wisdom of throwing £10 billion a year at self-destructive Scots - a figure that has doubled in a decade. Scottish health is not improving in line with other countries.  Indeed, in ten years, our mortality from supposedly preventable diseases will be worse than the worst regions of Eastern Europe like Silesia, so fast are we slipping behind Europe in tackling the great killer diseases.

   Is it the weather? Genetics? Or do we just have a collective death wish? I must say that, as one of the 3% who actually did look after myself in all the ways the other 97% of Scots apparently do not, I have had particular cause to ask these questions.  I still developed coronary heart disease even though I didn’t smoke, took exercise, ate properly and drank in moderation.   Which was a bitch, and made me want my money back. But the worst of it is that one really seems to know why Scots are so prone to life threatening disease. 

   Dr David Conway, the author of last week’s “shock” BMC Public Health  report on our fondness for live-threatening behaviours asks whether there could indeed by a “Scottish effect” - a pyscho-cultural factor at work in Scottish communities.  Professor Phil Hanlon of Glasgow University thinks it’s more like a  “Glasgow effect”.   How else to explain why between 2004 and 2007, there were 60% more deaths in Glasgow than in comparably “deprived” cities like Liverpool and Manchester?   If you take the Strathclyde constituencies out of the picture, the rest of Scotland is very much like England in terms of life expectancy and heart disease.  Yet, in the worst areas of social deprivation like Glasgow Springburn life expectancy for men is 57 and for women, 61.  It’s a bitter paradox that Glasgow is also one of the most vibrant in Europe in terms of youth culture, the creative industries and even retail. 

   Prof Hanlon believes that rather than just spending more we might be better looking at ways of making Scots more positive and sociable in their outlook.   Anecdotally we know all the manifold ways in which  Scottish male culture is injurious to mental and physical well-being.   The way we attack alcohol certainly looks like a symptom of some deeper psychological disturbance.   It goes without saying that Scottish men - of my generation certainly - have great difficulty talking about their feelings and are pretty neglectful of their personal well-being.    When Scottish men get together in drink they generally start “flyting” or ritually abusing each other.  Behind the braggadocio, Scottish men are cripplingly insecure.  Our gift for wry cynicism makes it almost impossible to benefit from therapies like Cognitive Behaviour Therapy or positive thinking - positive drinking more like. 

   Maybe it’s history. Since the loss of political autonomy three hundred years ago, Scotland has exported many of its more optimistic citizens.  Highlanders were cleared from the land to make Scotland a Victorian theme park for the English aristocracy.  The lowlands became a source of cheap labour to fuel the industrial revolution.  But the flip-side is that neo-nationalist whinge is that Scotland was one of the leading countries in the European Enlightenment in the 18th Century with the best education system in the world.  During the industrial age we were the workshop of the world designing and manufacturing  the most advanced engineering in history.  Subordination to England isn’t any kind of explanation.

    But there are broader political considerations. It’s no accident that most of the dire statistics on health, heart disease and alcohol abuse really got underway in the 1980s when the great industrial recessions destroyed the manufacturing way of life. The collapse of the self-confident working class communities left a legacy of mental inactivity, hopelessness, ill health.   Families broke up as men became redundant. 200,000 people of working age left languishing on benefits. Drugs invaded these once resilient communities like dry rot.  Cheap alcohol provided an easy anaesthetic for generations of Scottish men who simply had no purpose in life. 

 

   Whose fault?  I don’t know.  Certainly Scotland has been criminally let down by its political leadership at local and national level. The Tories never understood Scotland and  Labour, dug into its bureaucratic one-party local states, seemed content to defend the benefits culture.   Devolution has made a difference, and the smoking ban was a huge step forward.  But even now brain dead oppositionism and factionalism has prevented action on minimum pricing of alcohol - a policy universally supported by the police, doctors, public health experts and churches. Incredibly, minimum pricing is now likely to happen in England first.  This is junk politics by MSPs who have no sense of moral priorities. 

   The reality is that most of Scotland’s health problems are not psychological but historial - a product of economic and social malaise.  They arise from poor education, bad housing, social and economic decay.  The good news is that Scotland's health problem can be solved, just as they have been solved in other Nordic countries.  Alcohol abuse could be eliminated in a decade, just asin Finland, Sweden where a pint costs eight quid.  Suitable tax powers and a smaller more dynamic state could generate economic activity and get the nation working again.  We know how to tackle the Scottish disease and the elements are there - all we need is the political will.

   And here’s a final thought:  that figure of 97% of Scots indulging in self-destructive behaviour is just the same in England.