When all hope is lost

Observations on Scottish health

We know Scots are unhealthy, but the latest figures are truly startling. Life expectancy is actually falling in some parts of the country - to 63.9 years for men in Shettleston, in Glasgow's East End. This is roughly the same as for Iraq. Even more remarkably, Shettleston women live 11.3 years longer on average than the men - a gender gap that is nearly twice the national average.

This may provide a clue to the real reasons for Scotland's chronic ill-health. Tom McCabe, the deputy health minister, emphasises smoking, alcohol consumption and bad diet. Others put the stress on socio-economic factors such as poverty, unemployment and poor housing. But Professor Phil Hanlon, former head of the Public Health Institute of Scotland and now at Glasgow University, highlights "the Scottish effect". In 1981, socio-economic factors accounted for more than 95 per cent of the health differences between Scotland and the rest of the UK. Today, they account for less than half.

Why? Nobody knows for sure, but the best guess is that Scotland's de-industrialisation after 1979 was so harsh, particularly in the west, that it had a dramatic effect on the population's outlook on life, particularly among men in deprived areas such as Shettleston. Many have lost all self-confidence and all hope for the future, and feel powerless to control their own lives. This fits with international research showing that optimism or pessimism has an effect on an individual's health.

The political implications are profound. Areas such as Shettleston, once Labour strongholds, are now wholly unchampioned. Their inhabitants are disconnected from the rest of the country and its politics. Electoral turnouts are among the lowest in the UK.

Scottish politicians may talk about "closing the gap", but they have little power to tackle the problem, and less ambition. Glasgow may be the poor-health capital of Europe, but it is also the UK's second retail centre: a city that likes to swagger and to shop. Dundee may have the fastest-declining population of any UK city, but it is also an international centre of excellence in biotechnology. Increasingly, the two Scotlands live side by side, ignorant of each other. While a third of Shettleston's working-age population is entirely dependent on benefits (unemployment or incapacity), Edinburgh, 50 minutes along the motorway, has an overheated housing boom, and labour shortages increasingly filled by temporary migrants from around the world.

The Scottish Executive tries to reconnect with traditional working-class communities through a crackdown on antisocial behaviour - similar in its populist old Labour style to what David Blunkett is doing south of the border, except that Margaret Curran, the minister for communities, takes a feminist approach, emphasising the need to make the streets safe for women to walk around at night.

This doesn't do much for social justice. Labour may find it has to pay a political price for its neglect of "the Scottish effect". With proportional representation, voters can turn to alternatives on Labour's left, from the Scottish Socialists through the Greens to the SNP.

Gerry Hassan is co-author of The Political Guide to Modern Scotland, published next month by Politico's (£20)