sick at heart

In a report naming Britain's poorest and unhealthiest constituencies, six of the worst areas were in Glasgow. But is the city really such a terrible place to live?

Alex Hand is sitting in the Shettleston bar where he spends almost every day of his life, sipping a few pints and smoking cigars with his friends. A retired roofer, he knows only too well alcohol has all but destroyed his liver - but he's more worried about what the effects might be if he stopped.

"My father, he keeled over after he stopped drinking. And my brother, he died of a stroke last year after he stopped. So I'll not be stopping," he says, laughing. The afternoon drinkers in the Portland Arms aren't taking much heed of the latest in a long line of blows that make Glasgow into a sick-city cliche, despite repeated bids to reinvent itself.

There were few raised eyebrows in Glasgow last week when a Bristol University report showed that six of the city's parliamentary constituencies were among 15 of the unhealthiest in Britain. Of the six, Shettleston was the worst. People living there are three times more likely to die before the age of 65 than those in the healthiest parts of England. But the residents of Shettleston don't believe they could be bottom of the league.

"Castlemilk is worse than this, much worse," says John, a ventilation engineer in the Portland Arms for a Friday afternoon drink. "I lived there for 25 years. I know all about poverty. You mention drugs up there and someone slips something into your pocket. I suppose it's worse down here for the drink. There's more pubs here."

He sips from his pint and draws on his second Kensington. "I suppose you don't know if you're in bad health until it hits you," he says. "You can drink and smoke for 40 years and think you're healthy enough, until you fall over dead."

The Shettleston drinkers were not, of course, the only ones in denial last week. Local politicians pointed out that the statistics were drawn from 1995, that a change of government since then and a new focus have begun to tackle poverty.

If it all sounds familiar, it's because the same explanations, excuses and quibbles followed another doom-laden report the previous week that "revealed" that Glasgow was quite poor and Edinburgh quite rich and getting richer.

The response was a loop tape of politicians pointing out that Glasgow's unemployment has fallen, that new firms have been attracted to the city, that new money will be poured into the worst areas.

The latest reports on poverty have seriously dented Glasgow's image. Fortune Magazine recently ranked it as the third-best city in Europe in which to live and do business. Only London and Paris outranked it in the league, but that hardly matters now.

Glasgow may have spent most of the 1990s rebranding itself as the cultural city, the shopping city, the city of architecture and design, but the spectre of poverty and sickness and despair just won't go away.

The story of Shettleston sums up as well as any what has gone wrong with the city. It has had a long relationship with poverty. In the local library you can read an 1842 report on the sanitary condition of the labouring population of Great Britain. It concludes: "On the whole, it appeared to us that both the structural arrangements and the condition of the population of Glasgow was the worst of any we had seen in any part of Great Britain." The Bristol report of 1999 came to the same conclusion.

In the 1960s, Shettleston, like many areas in the city, saw its bright, ambitious families pack up and head off to the new towns of East Kilbride, Cumbernauld and Irvine in search of a new life. The resulting social imbalance was compounded in the 1990s when boundary changes simply shaved middle-class suburbia from Glasgow city limits.

It may be true that Glasgow has recently attracted thousands of new jobs in information technology and call centres, but most of these do not go to the people who live in the city, who worked in manufacturing and the steel and glass works that dominated the east end of Glasgow for most of the century.

Most of the people who benefit from the new jobs take their money out and pay their taxes to the local authorities, which have much more limited demands on social services. The funding trap in which this leaves Glasgow was summed up by Ian Davidson, Labour MP for Pollok. "The poor in Glasgow end up paying more to be poor because the city cannot afford to provide services such as home helps and old people's homes to the same extent as neighbouring authorities."

There is a difference between poverty and impoverishment, and the residents of Shettleston do not consider themselves poor. "Poverty? You don't see much poverty around here," says Sam Hulme, his white locks being clipped in the barber's shop on the corner. Hulme bought his semi on Ruchazie Road 15 years ago. "They're desirable houses. No damp. I was quite shocked to hear about this report. I can assure you there's not much poverty here."

Shettleston does have enclaves of genteel suburbia, bowling greens, a golf course and lines of grand Victorian villas. The tower blocks, surrounded by manicured lawns, are havens of calm and much of the council housing is now privately owned. There is a new development of Barratt homes, all of which sold for upward of #40,000 before they were even finished. "It's one of the best sites we have. There's plenty of demand and we would build more if we could," said Ian McGhee, Barratt's West of Scotland sales director. "There's absolutely nothing wrong with Shettleston as far as Barratt is concerned."

Of course, health isn't all about money and Barratt homes. Ironically, it was vandals who gave Shettleston its new health centre. Five years ago, local youths started a fire that burned down the old place. The phoenix that rose from its ashes would be the envy of patients elsewhere - purpose-built and cheery, it has 15 GPs and a clutch of health visitors, nurses and physiotherapists.

The health centre serves a population of 25,000 who are offered on- site access to sophisticated diagnosis, as well as specialist services such as well-elderly clinics, parenting classes and healthy- eating groups. "The public here know they have a good health service," said the centre's general manager, Robert Peat. "The last thing they wanted to hear is that they are seen to be at the bottom of the heap."

Health visitor Lang Macleod and her colleagues insist the area has undergone something of a renaissance since 1995, the year the data upon which the research was based was gathered.

They want to raise the community's battered self-esteem and, therefore, its health status. The GPs now prescribe exercise for patients and the new sports centre in nearby Tollcross is well used. Food co-operatives distribute affordable fresh fruit and vegetables. Local women have been recruited to act as breastfeeding counsellors, in an effort to raise the number of babies who receive the health- giving benefits of their mothers' milk from the current 30%. Parenting classes, antenatal courses and healthy-eating groups are in demand.

"We desperately need to break the old cycles," said Macleod. "If people can appreciate what it means to eat properly and live a more healthy lifestyle, they will have started to crack it. Sure, individuals have to take control and responsibility for their own health, but it is essential that the support is there."

The line dancing, tai chi and yoga at the Eastbank health- promotion centre are booked up well into next year. Oriental music is drifting from a top-floor room in the converted school building. Six people are moving in silent harmony to the music, forming patterns in the air with tai chi stances. Hugh Mackay, an 81-year-old from Summerhill, is one of the most enthusiastic members. "We have difficulty in making people move on after their 20 classes are over," says Ronnie Robertson, who is instructing the lunchtime class. "There's a real enthusiasm here."

More than 52,000 people have been through the door since the centre, funded by Glasgow Health Board, opened four years ago. It has a crche, a health-information library and free tea and biscuits for everyone. Stephen Rycroft, the centre manager, feels they are making a difference, if not winning the war. "We're right in the middle of things here. Everything is free but we can only help the people who come to us."

The first real evidence of the impact of the government's new policies - negative or positive - will come this Wednesday with the publication of a Joseph Rowntree Foundation report, Monitoring Poverty and Social Exclusion 1999. Billed as the first independent test of Labour's record on tackling poverty, it will present a stark snapshot of what is really happening to communities such as Shettleston.

The Bristol report of 1999 concludes: "There is a self- reinforcing cycle of wealth accumulating wealth and poverty begetting poverty. This operates across space - through migration - and over time - through the advantages rich children gain from growing up in rich areas and the disadvantages poor children suffer from living in poor areas."

The government's aim is to end the cycle of poverty so children born today do not end up being the parents of poor children in 20 years. If it does that, it will have achieved what no other social- intervention policy has since the 1842 report on sanitary conditions in Shettleston library.

catch up A report on health in the UK shows Glasgow to be the sickest city in the country, with some Glaswegians three times more likely to die before 65 than their counterparts in the healthiest areas. The report made the point that poverty begets poverty and asks if the cycle can be broken.

solutions David Marshall MP: "Too many of the jobs being created in Glasgow are going to people outside the city."

Andrew Fyfe, director, Glasgow Alliance: "We've got to make it easier for people in these areas to compete for jobs in the city by improving their skills and training. Restoring the social mix in these areas is an important target."

Damian Killeen, the Poverty Alliance: "A fundamental problem is one of uneven economic development in response to post-industrial decline. We need to look at sustainable economic activity for areas that are not benefiting from the technological, and high-end developments that are benefiting others."

Phil Hanlon, professor of public health, University of Glasgow: "No single factor will make Shettleston healthy: income, opportunity, expectation, social support - they all matter. People need to be involved in devising their own solutions, but they also need leadership and vision, and in many respects that has been lacking in Glasgow."

Liz Kendell, public health fellow, The King's Fund: "Communities need to have meaningful leadership at a local level. There's plenty of evidence that top-down instruction does nothing to motivate people. Identifying their own priorities and being encouraged to work together to act on them does."

Dr Jim McCormick, research director, The Scottish Council Foundation: "There is still a great reluctance among councillors and health boards to involve members of the public in decision-making. The authorities just have to be prepared to change the way they do things. People don't believe they are listened to when they are 'consulted', and it builds suspicion that eats away at wellbeing. We have to rebuild trust and start understanding what the real problems are, not what we think they are."

Wendy Alexander, Communities Minister: "We're reviewing budgets to make them reflect need. We've had increases in child benefit that work out at #5 per child per day but the effect of all that will take time. We're only an eighth of the way through this parliament and one- sixth of the way through the funding we want to allocate to solving poverty."

Lang Macleod, health visitor, Shettleston Health Centre: "There is a real need for government policies that will create real jobs for real people. A lot of the local mums would love to get out to work, but they can not afford it because of the cost of childcare."

Robert Peat, general manager, Shettleston Health Centre: "The determinants of ill-health are what we have to focus on - social deprivation and drug and alcohol abuse all play a part. Tackling them involves much closer work between education, police, social work, health and housing. Most of our problems have a common thread."

Dr Eric Brunner, epidemiologist, University College London: "The anti-education culture that exists among many working class people is terribly sad. They have to change their attitudes and not dismiss education and qualifications. They may say, 'Who needs learning?' but the point is it gives you power."

Copyright 1999
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