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Postcards from Scotland

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Carol Craig is the Centre's Chief Executive. She is author of The Scots' Crisis of Confidence, Creating Confidence: A Handbook for Professionals Working with Young People, The Tears that Made the Clyde: Well-being in Glasgow and The Great Takeover: How materialism, the media and markets now dominate our lives. She is Commissioning editor for the Postcards from Scotland series. Carol blogs on confidence, well-being, inequality, every day life and some of the great challenges of our time. The views she expresses are her own unless she specifically states that they reflect the Centre's thinking.

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Posted 02/05/2013

I had an interesting, if sad, meeting recently. I ordered a taxi to take me to the hospital (I’m part of a clinical trial and one of the perks is being able to get a taxi to attend the numerous appointments). The driver immediately knew who I was as my name hasn’t changed. He was in the class above me at school and lived over the back from us in the council estate in Milngavie where I grew up. I must admit that I would never have recognized him: he had aged tremendously and was massively overweight. I had forgotten that he had married a classmate of mine – a girl that I had been friendly with in primary school but we had grown apart  once we went to secondary.
  
During the twenty minute journey the driver treated me to a running commentary on folk he keeps in touch with as they still live in Milngavie or the surrounding area. My driver didn’t bother telling me what they had done with their lives as he was mainly interested in telling me about their ill health or how they had died. This was a catalogue of heart attacks, cancer and even death from blood poisoning.
 
His own wife had suffered a stroke aged 48 and now walked with a stick. She gave up smoking for six months, and he did too to support her, but she then went back to it and so did he. Indeed you could tell from his voice that he was a sixty a day man.  He knew that he wasn’t doing himself any favours, and he said that his family were continually putting him under pressure to give up, but somehow he couldn’t chuck it. He enjoyed smoking and drinking too much. He would have loved a party when he turned sixty, he told me, but too many of his friends had died for it to be ‘much of a celebration’.
 
I found it very sad to hear about folk I once knew when I was young who were tragic exemplars of the premature mortality which characterises the west of Scotland.  The story of my classmate, who since the age of 48 has walked with a stick and has been forced to live a limited life, also brought home that other poor Scottish statistic – healthy life expectancy.
 
This term refers to the age at which a person begins to suffer from chronic illness and is, to some degree, disabled by it.  The Office of National Statistics now refers to healthy life expectancy as the number of years a person can expect to spend in very good or good general health.
 
It’s an important measure as it shows that while life expectancy has increased substantially in recent years, partly as a result of improvements in modern medicine, these increased years are not always good. As Dr Hiroshi Nakajima, a former Director General of the World Health Organisation once put it: ‘Increased longevity without quality of life is an empty prize. Health expectancy is more important than life expectancy.’
 
The UK measures up poorly compared with other countries - it ranked 12 out of the 19 countries in a recent Lancet study. Britons have 68.6 years of healthy life, whereas people in Spain, which tops the league, have 70.9 years of healthy life on average.

But figures in Scotland are lower than the UK’s. The most recent estimates of healthy life expectancy for Scottish boys born in 2010 is 59.5 years and for girls 61.9 years. In the most affluent areas of Scotland healthy life expectancy for men is 68.5 but it’s only 50 in the most deprived areas. For women there’s also a difference of 18 years: 70.5 years for women in well-off areas of Scotland and 52.5 years in the poorest areas.

It is important to point out, however, that the ill health I was hearing of in my taxi journey did not concern one of Scotland's most deprived areas.  Smoking, alcohol, bad diet and lack of exercise, however, did all seem relevant.

But there are undoubtedly cultural factors at work as well. I’ve attempted to analyse what these may be in my book The Tears that Made the Clyde: Well-being in Glasgow but I’ve been most impressed by aspects of Phil Hanlon and Sandra Carlisle’s analysis in their short book AfterNow: What next for a healthy Scotland.

At one point they use the French intellectual Pierre Bourdieu’s concept of ‘habitus’ to help explain why people often do not put any value on looking after themselves. They tell us that ‘habitus can be crudely explained as the mental structure through which people deal with their day-to-day world: it can be thought of a set of internalised schemes through which the world is perceived and acted upon.’

A person’s habitus is influenced by their position in the social hierarchy and the world view they develop can help to keep this hierarchy in place. This is why it often appears as if people could do things to protect or value their health but in reality their habitus militates against taking these actions.

I think there is a very strong set of injunctions in west of Scotland culture against looking after yourself. As a result health is bound to suffer. So too are Scotland’s figures for healthy life expectancy, as my old neighbour and taxi driver knew only too well yet seemed powerless to do anything about it. 
 
For more information see:

http://www.bbc.co.uk/news/health-21654536
 
http://www.scotpho.org.uk/population-dynamics/healthy-life-expectancy/key-points

Phil Hanlon and Sandra Carlisle, AfterNow: What next for a healthy Scotland, Argyll Publishing, 2012.

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