We now have a twenty-year gap in male life expectancy across Glasgow; male life expectancy in Parkhead West and Barrowfields is 59.9 years, compared with 80.1 in Kelvinside and Jordanhill (ScotPHO Health & Wellbeing Profiles 2010). With such a dramatic difference in life expectancy shaped by where you live, it is difficult to see why this is not viewed as being just as important as other equality themes, such as tackling sex discrimination, racism or homophobia. 

Across Glasgow, thousands of daily opportunities to tackle the health inequalities that fuel this life expectancy gap occur in GP surgeries, local health centres, clinics and pharmacies. There are many good local examples of where these opportunities are effectively used to address the health gap but wider evidence suggests that practitioners often fail to consistently do so. 

Examples from east Glasgow 

In east Glasgow - which has sadly often become a byword for the city’s poor health - staff in the newly established Community Health and Care Partnership (CHCP) came together in 2007 to develop an inequalities strategy for local children’s services. Recognising the importance of social factors in shaping individual health (Whitehead and Dahlgren, 2006), and supported by the Glasgow Centre for Population Health, staff discussed and identified the important wider changes needed to improve children’s opportunities and health. 

Building on this work, staff in local mental health services then took part in a series of workshops that led to a range of ideas being put forward to improve services. These included ensuring local plans did not over look the importance of addressing inequalities across all health services; increasing staff awareness of how poverty, gender and ethnicity can shape health; ensuring that new staff remain open and sensitive to the various inequalities facing people using their services.

Despite these two examples, and earlier NHS work to maximise income among older people it became increasingly evident that there were huge differences in how local staff used nearby resources, such as money advice and social support services, which could shape individual health and address inequalities.  

Greater engagement of front line staff with partner organizations was achieved through a board-wide income maximisation programme (Healthier Wealthier Children), however local variations across services settings still remained. To understand the reasons behind these variations, in 2013 a practice inquiry was undertaken across NHS settings in North East Glasgow. 

Learning lessons 

Important lessons to emerge from this new research included the need to recognise the importance of relationships in supporting equality of care. In other words, how do midwives, doctors, psychiatric nurses and other staff relate not only to people using their services, but also with each other. Encouraging staff to become more involved in shaping how services are delivered, alongside other partners could be an important step forward. Equally, staff taking part in this practice inquiry valued having time to reflect on their work, share experiences and receive validation from other colleagues.

Valuing reflection 

In a so called time poor culture, it is vital that we value this reflective space, to ensure that routine thinking and practice (which has been successful in tackling other discrimination, such as racism) becomes so embedded that widespread poverty does not remain either ‘hidden’ or considered unremarkable.

The lessons from this local research have provided momentum to roll out further work to address inequalities across further service areas in North East Glasgow. It has generated wider interest within NHS Health Scotland, and NHS Greater Glasgow and Clyde’s strategic efforts to tackle health inequalities across the board.   

Like most journeys, the multitude of efforts to tackle the health inequalities that fuel the shocking life expectancy gap in parts of North East Glasgow has not been a straightforward path. At times, there have been detours, frustrating stops and perhaps a feeling that sometimes we have been heading in the wrong direction.  

The current coordinated efforts to tackle local inequalities will continue. In the meantime, here’s a naïve thought to ponder: can you imagine the day when mentioning areas like ‘Shettleston’ or ‘Calton’ and ‘poor health’ in the same sentence receives nothing but a puzzled look. If not, then why…?