Let Glasgow Flourish

Home , Abronhill, Anderston, Anniesland, Balornock, Barlanark, Bellahouston

Hanlon,Hanlon, Walsh Walsh and and Whyte Whyte AprilFebruary 2006 2006

Acknowledgements

The information used to compile this report has come from a wide variety of national and local organisations. We are indebted to the many individuals in these organisations who have helped to compile the data and who in many instances have also provided their own advice and knowledge. The length of this list indicates the range of organisations who can provide public health relevant data and underlines the collaborative nature of this work. We hope that those who provided data will in turn derive useful information from the report for their own uses.

It is simply not possible to mention every individual who has assisted in the compilation of this report. Those not listed here, however, are acknowledged through the listing of their organisations from whom we have obtained information.

The authors are grateful to the following:

x ISD Scotland – and in particular Laura Kelso (one of the authors of the NHS Health Scotland Community Profiles on which a significant amount of the presented data is based, and who also helped in some of the initial analyses for this report); also, Julie Kidd, Richard Lawder, Kenny McIntyre, Nadiya Choudhry, Samantha Clarke and Joanne Hattie.

x Colleagues at the Glasgow Centre for Population Health – in particular Valerie Millar, Russell Jones and James Arnott.

x Glasgow City Council – in particular Neil Hunter (Addictions Services) and Iain Paterson (Social Work Services).

x NHS Greater Glasgow – in particular David McCall and Allan Boyd.

x University of Glasgow, especially Gordon Hay, Maria Gannon, Neil McKeganey of the Centre for Drugs Misuse Research.

x Graeme Busfield and Neil McKinnon of Communities Scotland.

x Fiona Marrison, MSc student in Geographical Information Systems, University of Edinburgh, Institute of Geosciences.

x Strathclyde Police – in particular Chris Mooney, Carol McLeod and Will Linden.

x Roger Houchin, Glasgow Caledonian University.

x Kate Lang, HESA.

x Edith Young, Glasgow and Clyde Valley Structure Plan Joint Committee.

x Health Protection Scotland – in particular Ian Henton.

3 x David Leon, London School of Hygiene and Tropical Medicine.

x Newhaven Research.

x Various departments and individuals within the Scottish Executive.

x Scottish Neighbourhood Statistics.

x General Register Office for Scotland – in particular Paula Lopez.

x Department of Work and Pensions.

x Glasgow Housing Association.

x Keep Scotland Beautiful.

x Office for National Statistics (ONS).

x Finally, we are grateful to colleagues at NHS Health Scotland, particularly those who commented on various drafts of the report.

4 Chapter 1: Introduction er created for Glasgow and West Central Scotland.” er created and West for Glasgow This is the description of health most and its determinants comprehensive An analysis of what is getting better in Glasgow is illuminating and chal- of what is getting better in Glasgow An analysis lenges a number of stereotypes.” “ “If fresh insights are to be generated need a health into we Glasgow’s health understanding is being pro-detailed of how and comprehensive moted in our city.” or harmed “ ev

Let Glasgow Flourish

A comprehensive report on health and its determinants in Glasgow and West Central Scotland

written by

Phil Hanlon1, David Walsh2 and Bruce Whyte3

for the

Glasgow Centre for Population Health

1 Professor Phil Hanlon, Professor of Public Health, University of Glasgow 2 David Walsh, Public Health Information Manager, NHS Health Scotland 3 Bruce Whyte, Public Health Information Manager, NHS Health Scotland

Published by the Glasgow Centre for Population Health Chapter 1: Introduction

1.1 The Glasgow Centre for Population Health

The Glasgow Centre for Population Health (GCPH) is a research and development facility that generates insights and evidence, provokes discussion and debate, and mobilises action to improve health and tackle inequality. It provides a setting where academics, policy-makers, practitioners and local people can come together to confront problems facing population health in Glasgow and beyond. The Glasgow Centre is a collaboration between NHS Greater Glasgow, Glasgow City Council and Glasgow University supported by the Scottish Executive. Other partners also play an important role. For example, NHS Health Scotland contributed the time of two of the authors of this report.

1.2 The ‘Observatory Function’ within the GCPH

If fresh insights are to be generated into Glasgow’s health problems we need a detailed and comprehensive understanding of how health is being promoted or harmed in our city. To achieve this aim an interdisciplinary group has been assembled from a variety of organisations. This group will create and maintain a detailed description of health and its determinants in Glasgow, conduct detailed analyses of major determinants of health and develop new techniques to enhance our understanding of how routinely collected data can be used for planning and evaluation. This report is the first from the observatory group but more will follow.

1.3 Health and how it is created and destroyed

Health is a resource for living. It is not an end in itself but the lack of good health diminishes life for many. Health is multidimensional. We can recognise physical, mental, social and perhaps even spiritual dimensions to health. We are aware of poor health (concepts like disease or compromised function) as well as good health (well being and good function). It is also important to recognise subjective as well as objective measurements of health.

One way of thinking about the factors that determine health in a population is the phrase ‘it all matters’. What this means is that health in populations emerges from a complex interplay between the physical environment, social environment, individual response and behaviour, genetic endowment and the provision of services interacting with economic and other influences from which the health status of a city emerges.

These factors interact and combine over the human life-span to create or destroy health. These influences also give rise to the patterns of inequality that are now observed. They also provide the intellectual framework that should allow us to devise strategies to improve health. It is clear, therefore, that health is a complex construct and that the determinants of health are multiple, interactive and complex, but we understand enough of this complexity to devise detailed strategies to confront the system as a whole and to target specific determinants of health.

8 1.4 How we use data – the strength of holistic data

A full description of how we developed our approach to public health data is provided elsewhere1. The key idea is to reflect the description of health and how it is created and destroyed (set out briefly above) in the way data are analysed and presented. Consequently, we have tried in this report to provide data on many aspects of health and its determinants so that, taken together, they paint a picture of what is happening. Although it is possible to highlight weaknesses in each individual source of data, these individual weaknesses are rendered less important by the strength and consistency of patterns that emerge throughout this report.

For example, our understanding of the determinants of health in communities highlights the difficulty of focusing on only a small number of indicators. Community health profiles2 have demonstrated that the least healthy communities fare less well on a whole spectrum of indicators. These factors are mutually reinforcing, meaning that improvement in one small area is unlikely to bring about transformative improvement in others. In fact, it appears that a significant number of determinants of health have to change in a community for the health of that community to improve significantly. The comparison, shown in Figure 1.1 overleaf, between the two postcode sectors covering Newton Mearns and Dalmarnock demonstrates this clearly. The key point is that the least healthy communities in Glasgow have concentrations of problems, not only less good health outcomes, and many (if not all) of these other factors will need to change before health outcomes significantly improve.

The example shown in Figure 1.1 has been created from data for two defined areas - in this case postcodes that overlap fairly well with Newton Mearns and Dalmarnock. In other parts of the report data will be presented for different geographies. Often this will be for local authority areas – for example, Glasgow City compared with other West of Scotland local authorities. Sometimes data will be presented for NHS Board areas or parliamentary constituenciesi. Overall, a picture will emerge of the health of people in the whole of the West of Scotland but with a central focus on Glasgow. Each Figure and Table is carefully labelled to indicate the geographic area being considered and the source of the data.

1.5 The purpose of this report

This is the most comprehensive description of health and its determinants ever created for Glasgow and the West of Scotland. Our aim is to increase understanding, provoke debate and stimulate action. The intended audience is ‘anyone in a position to influence health in Glasgow and the West of Scotland’. In a very real sense that means everyone so the report will be widely circulated and also published on the GCPH web site – www.gcph.co.uk. Copies of the report will also be disseminated to key policy makers and practitioners who work in sectors highlighted by the report. We expect that the press will cover the issues it raises too. It is vital that this report generates public debate. The result we are seeking is a ‘civic conversation’ that leads to a new consensus about what needs to be done to transform the overall health of Glasgow’s population and to effectively address existing health inequalities. i The range of large and small scale geographies that have been used in the report are explained in more detail in the ‘Preface to Chapters 2-12’. 9 Figure 1.1 A comparison of health outcomes and determinants of health in two Glasgow communities showing the degree to which this sample of indices is better or worse than the Scottish averageii. Note that the profile for Newton Mearns is different in almost every way from that for Dalmarnock.

Newton Mearns – G77 5

-70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70

Dalmarnock – G40 4

-70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70

ii Each bar on these charts represents that community’s position on a specific indicator, with bars to the to left indicating a position better than the Scottish average, and those to the right indicating a worse position. The indicators include both measures of health and measures of the determinants of health. 10 1.6 Summary of main themes

Glasgow is changing but health status and inequalities in health lag behind

Glasgow has been undergoing profound change in recent times. It is true that all cities have changed in the last 25 years, but Glasgow is not only typical of these changes, it has experienced the most rapid change in Scotland and has been at the forefront of change in the UK. In addition to the obvious physical improvements in the city, there has been a significant amount of social change. Since the 1980s, the following social, demographic and housing trends have been influential:

x Population decline since the 1950s - driven particularly by the drop in Glasgow’s birth rate which fell beneath the death rate for the first time in the mid 1970s. x Population loss, especially evident in the peripheral estates and in the most deprived parts of the city. x The number and proportion of residents aged between 25 and 44 has increased, even with overall population levels in decline. x Increasing numbers of households overall and, within this, a growth in single adult households, a drop in two parent family households and a rise in lone parent households. x Growth of a service sector based economy - comprising finance, business, the public sector, retail and hospitality - compensating for the collapse of manufacturing industry. x Doubling of jobs in occupations considered as middle class employment, reflecting the growth in the service sector. x Increasing involvement of women in employment and the growth of part-time work. x Increased general levels of prosperity and a generalised reduction in indices of overall deprivation - as measured, for instance, by increased car ownership and reduced levels overcrowding. x Rising income levels for those in employment. x Significant falls in unemployment rates. x Doubling in size of owner-occupation, with growth both in the city centre and in the peripheral estates. x Transformations to the quality and condition of housing in the city.

In short, much of Glasgow has become a more affluent and ‘middle class’ city with a profile that is currently similar to most UK cities. Yet, Glasgow’s overall health status does not fully reflect the changes described above. There is a ‘Glasgow effect’3, iii – that is, an excess of mortality beyond that which can be explained by current indexes of deprivation. The result is that Glasgow’s health status remains worse than that of comparable English cities like Liverpool. This ‘Glasgow effect’ is currently being investigated by a member of the Centre’s Observatory Group.

Thus, while there have been many positive changes in Glasgow over the last twenty years there remain notable causes for concern.

iii The supplied reference relates to the existence of a ‘Scottish effect’. However, that research has shown that the areas most affected are in Glasgow and the West of Scotland. 11 Socio-economic, health and environmental differences between affluent and deprived communities are still clearly evident. The income gap between the well-paid and those on the lowest incomes has widened. Official unemployment levels have reduced but increases in economic activity have not been realised because a significant proportion (15%+) of the working age population is too ill or disabled to work. The proportion of families in Glasgow dependent on income related benefits is relatively high and has been so for many years, and a third of children live in households where neither parent is in work. Although overall crime levels have reduced there have been worrying rises in violent crime, drug related crime and vandalism.

An example of the persistence of inequalities, despite decades of interventions to reverse these trends, can be seen in Castlemilk. This area of Glasgow still features prominently in the 10% most deprived datazones in Scotland and its health outcomes remain poor in spite of the high levels of investment in the area over the last 20 years. Despite enhancements to the physical environment and to the facilities in Castlemilk, commensurate social and health improvements have not followed.

What is getting better? An analysis of what is getting better in Glasgow is illuminating and challenges a number of stereotypes. Life expectancy continues to increase overall and there are encouraging trends in smoking, unemployment, teenage pregnancies, some crimes, and some specific causes of death (e.g. heart disease, stroke, some cancers, accidents, infant mortality).

Two of these trends are worth particular comment. First, smoking has shown a steady decline for two decades. This is part of a national trend but reflects a multiplicity of national and local interventions (tax, health warnings on packets, workplace smoking policies, smoking cessation initiatives, advertising campaigns, schools programmes and much more) that, over time, have made a difference. Is this a model for what needs to be done for problems that are currently getting worse? Second, deaths from heart disease continue to show a marked decline to the extent that, although it was true that at one time Glasgow was the ‘coronary capital of the world’ this is no longer the case.

What is proving resistant to change? The answer to this question is: some aspects of health related behaviour (e.g. the dental health of children and breastfeeding) and many of the circumstances in which some people live (e.g. some indices of poverty and low income), and indices that reflect disability or chronic disease (e.g. adults unable to work for reasons of health and ‘healthy life expectancy’).

What is getting worse? Inequalities in health are widening, and we know from numerous studies - many of them recent - that the health of Glasgow's population, as measured by a variety of indicators, is still amongst the worst in Scotland, and indeed in the UK, and that position does not appear to be improving4,5. There is also evidence that Glasgow's health position (for example, as measured by rates in all-cause mortality) has worsened relatively over the last 25 years (see Chapter 3: Population and life expectancy).

12 However, some of the more specific problems that are worsening are interesting because they, arguably, have a relationship to each other. Obesity is showing a worrying rise. We are part of a global epidemic of obesity but our levels are among the highest in the world and show no sign of slowing. More obesity has already brought rising rates of diabetes and might put into reverse our improving heart disease trends. Alcohol related harm also shows a dramatic increase and concern has been raised that we are ‘in denial’ about the size and nature of this problem. The size of our ‘drugs’ problem is harder to measure but data in this report suggest that, at best, it is not improving. Notifications of sexually transmitted infections are rising, some aspects of mental health seem to be worsening and inequalities between the most and least deprived communities are increasingiv. It is also notable that traffic volumes continue to rise and that vandalism, fire-raising and violent crime are rising.

How do we make sense of these trends? The historian, Professor Tom Devine, in a lecture hosted by the Glasgow Centre for Population Healthv argued two main points. First that Scotland has, historically, experienced a series of social and economic changes more profoundly than any other part of the industrialised world and, second, the past twenty years has seen a marked improvement. His arguments refer to the whole of Scotland but Glasgow’s experience exemplifies his analysis more than any other part of country.

Devine’s argument is that when the industrial revolution started, Scotland experienced a more rapid and profound industrialisation, with higher migration from the land and a greater intensity of urbanisation, than most regions of Europe. Next, Scotland experienced the highest per capita death rate on the battlefields of World War I and a deep economic slump during the great depression. Scotland, and in particular West Central Scotland, continued to rely on heavy industry much longer than most other European regions. Consequently, when the collapse of heavy industry occurred in the 1960s, 70s and 80s, the effect was more profound. This analysis provides a convincing narrative to explain the relatively poor heath of Glasgow around the time of the 1981 census. Unlike cities such as Birmingham, London and Manchester, Glasgow maintained its dependence on heavy industry (despite policy initiatives to diversify into light industry) right up to the early 1970s. Therefore, when the ‘shock’ came in the form of the OPEC oil embargo and the three day week, followed by an economic slump, Glasgow suffered greatly from de-industrialisation, and unemployment then decimated its traditional working class communities.

iv Inequalities in life expectancy between the most affluent and least affluent parliamentary constituencies have increased although the populations of these areas have changed over time and more sophisticated analysis is required to make judgements about the overall changes in inequalities in the whole population. v Lecture on 6th December 2005 - available at www.gcph.co.uk/seminar2.htm. 13 The causes of inequalities in health at that time were clear. They resulted from income inequalities and the poorer life circumstances of people in lower paid employment and unemployment. However, in the past 20-25 years (since the 1981 census) Glasgow has experienced profound changes that have seen a significant improvement in, for example, housing stock, median wages, levels of employment, nature of employment, social class composition of the population and some manifestations of social mobility. We know, of course, that the polarization between the most affluent and least affluent communities has become worse - indeed there is evidence of significant sections of the population being left behind as others prosper further. However, the analysis is not a simple one because the sizes of Glasgow’s poorest communities have also decreased significantly since 1981 (see Chapter 3).

The old pathologies, arising from socio-economic inequalities of an industrial age, are now overlaid with a new set of problems that reflect the stresses, speed and levels of consumption of our modern society – obesity, alcohol related harm, mental health problems, traffic congestion and so on. So, despite our rising prosperity, economic gains remain unequally distributed and, while our new ‘epidemics’ affect the whole population, those who live in the least advantaged areas are suffering most.

Do we need a new strategy? Towards the end of this report, we ask the question whether Glasgow’s strategy for the 21st Century is too heavily influenced by an analysis that was formed in the early 1980s. That analysis focused on material manifestations of deprivation as the primary causes of ill health. Thus, for example, improved housing and employment were seen as two key improvements needed to generate health. This is a sound argument and remains true. Yet, it is equally true that many improvements in material circumstances have occurred. Our inequalities are not confined to material capital but extend into social and cultural capital. Other research now provides interesting clues about the biological pathways between inequality and ill health. For these reasons the Glasgow Centre for Population Health believes we need ‘fresh thinking’, and a new strategy, if we are genuinely to address our current problems: after all, our current strategy has yielded the results set out in this report. This is discussed further in the final chapter of this report. The reader must make up his or her own mind about the most appropriate way forward.

1.6 Predicting the future?

Our level of satisfaction with our current circumstances will, in part, depend on where we believe our future lies.

The optimistic scenario is that we are experiencing the birth pangs of a historical transformation into a post-industrial society. Glasgow’s economy is now dominated by services and consumerism within a much wider (UK, European and global) context. Although we do not understand fully why Glasgow as a whole has less good health than comparable cities, the explanation probably has its roots in the history outlined above and will improve over time. Also, although inequalities between communities are getting bigger, social mobility is diminishing the size of our poorest communities and this will yield a more equal society in time.

14 How convinced are we of this ‘optimistic scenario’? If we take some of the more troubling trends set out in this report and extrapolate them, the projected future is more worrying. The population is ageing, economic inactivity remains high compared to other parts of the UK and the ratio of those in work to those who receive pensions, benefits or are in full time education will become progressively more unfavorable. While Glasgow’s population is predicted to reduce further in the next ten years, single adult households are predicted to rise to make up half of all households and lone parent families are set to become as common as two parent families in ten years time. Traffic volumes are forecasted to rise by 25% in the twenty years to 2021. In terms of health, two forecasts of what could happen are particularly worrying. If the current trends in alcohol related mortality continue, the number of deaths from this cause will double by 2027. Secondly, looking at life expectancy it is possible that the gap in male life expectancy between Glasgow City and its near neighbour East Dunbartonshire may have widened to ten years in approximately ten years time. Many of these trends are predicted for other parts of Scotland but the uniqueness of Glasgow’s position is in the scale of the changes and the fact that, within Scotland, Glasgow is already at the extreme for many of these indicators.

In short, trends that are currently well established threaten our future. We should also consider threats that have not yet fully engaged public concern. We have moved, over 20 or 30 years, from an economy dominated by manufacturing to one that makes very little. Yet, a long recognized phenomenon, known as ‘peak oil’, is set to bring the age of cheap oil to an end in the near future. This will occur not when oil runs out, but after only half of the oil reserves have been used – the production peak6. This is likely to have a large negative and sustained impact on Western economies in the future, as multiple facets of our societies are built upon the cheap availability of oil. Through the impact on economic circumstances, the dwindling availability of energy resources may be the biggest challenge to public health in the foreseeable future. The timing of the oil production peak is hotly debated but we should at least consider the possibility that, just as Glasgow came to rely too much and for too long on heavy industry, we have overshot too far in the direction of consumption and may be ill prepared for future challenges.

1.7 Structure of this report

The whole document is designed to be a comprehensive review of health and its determinants in Glasgow and the West of Scotland. Although the report is an integrated whole, each chapter can be read on its own and individual graphs and figures stand on their own. Chapter 2 provides a historical perspective on Glasgow’s population; Chapter 3 looks at issues concerning population and life expectancy; Chapter 4 considers economic factors; Chapter 5 presents data relevant to the so- called ‘social environment’ in which people live (and so includes topics such as education, crime, and social capital); Chapter 6 examines the physical environment; Chapter 7 reviews health related behaviour; Chapter 8 describes data related to pregnancy, childbirth and early years; Chapter 9 includes data relevant to the health and well-being of children and adolescents; Chapter 10 looks at indicators of the health and function of the population; Chapter 11 examines the topic of illness and disease; Chapter 12 looks at past and future trends; and finally Chapter 13 provides a summary and discusses possible new approaches.

15 1.8 A ‘civic conversation’

Our proposition is that we need a ‘conversation’ about these issues – a civic conversation. Government, at all levels, will play its part in any solution but it is up to the people of Glasgow, ourselves, to discuss the findings of this report and to come up with the fresh thinking needed to confront some old intractable problems and to rise to a variety of new challenges.

Visit the website – www.gcph.co.uk – to find out about events or add your comment.

16 References

1 Hanlon P, Walsh D, Whyte B. Meeting the information needs of the ‘Health for all’ challenge – lessons from Scotland. Public Health 2005; 119(12): 1088-1096

2 NHS Health Scotland. Community Health and Well-being Profiles, 2004. http://www.scotpho.org.uk/communityprofiles

3 Hanlon P et al. Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a ‘Scottish Effect’. Journal of Public Health 2005; 27(2): 199-204

4 Palmer G, Carr J, Kenway P. Monitoring poverty and social exclusion in Scotland 2004. Joseph Rowntree Foundation, 2004.

5 Shaw M, Dorling D, Gordon D, Davey-Smith, G. The Widening Gap: health inequalities and policy in Britain. 2nd ed. Bristol: The Policy Press, Bristol, 1999

6 Kunstler J H. The Long Emergency. London: Atlantic Books, 2005

Preface

Preface to Chapters 2-12

Please note that the data presented in the following chapters relate to a number of different geographical areas: x West of Scotland. This is defined as covering 11 local authority areas in West Central Scotland, namely East Ayrshire, East Dunbartonshire, East Renfrewshire, Glasgow City, Inverclyde, North Ayrshire, North Lanarkshire, Renfrewshire, South Ayrshire, South Lanarkshire, and West Dunbartonshire (Map 1 overleaf). However, we have also defined the West of Scotland as covering a number of so-called ‘communities’. This is discussed further below. x Greater Glasgow. This relates to the boundaries of NHS Greater Glasgow. x Glasgow City. Data presented at this level relate to the City Council boundaries. Note also that, generally, references to ‘Glasgow’ mean Glasgow City.

However, a considerable amount of information has been taken from the 2004 Community Health and Well-being Profiles produced by NHS Health Scotland1. These data are presented at two further geographies: x Community. These are primary care-based localities (mainly the old Local Healthcare Cooperative (LHCC) areas or, in some cases, the new Community Health (Care) Partnerships (CH(C)Ps)) with populations ranging from 20,000-140,000 people. Map 2 overleaf illustrates the broad geographical spread of the West of Scotland and Greater Glasgow communities. x Postcode sector. These are small areas with populations of around 3,000-5,000 on average.

Note that all the charts which present data at a ‘community’ or postcode sector level, employ the following colour scheme. Communities/sectors within Greater Glasgow are shaded dark red; other West of Scotland areas are shaded light blue. This is illustrated in the example below.

Dependent children living in households where no-one is in employment, 2001 Where possible, the same West of Scotland and Glasgow communities Source: NHSHS Community Profiles (from 2001 Census data) colour scheme has been

60 incorporated into other 50 50 47 charts employing different

40 37 geographical breakdowns 33 33 33 29 30 28 (e.g. in charts by council 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 14 area, Glasgow City is 12 ntage of all dependent children 11 10 6 7 shaded dark red; the other Perce 0 West of Scotland council d d e n e e e n e l n o d ire ire ld e ire g w w un lvi al u lton yd well pe o o avi bri a rgl rid sgo a g ke l wsh sd rn mi e b st End a asg ist ln th e h Wishaw t l l Scotla a fre yde Ayrsh Lomond Ha vercl t Ayrsh a G nn Eastwo /Mi l h In h e n n C t Mother rn rumch D areas are coloured light Str u umb rt D East Ki Re C East Ayrshire & Ru e So No st rsde st ng rie & Co h West G n& e a lasgow Weeater Shawlands Ea nk & to W rd G Gr outh East Glasgowa usl Ai S ge d/Bea ley and Levern Valley eb Sout oodside &d N Glasgow n w & mb yd blue). la Bri s fre Pais Cl ie n Ca Re Ann Maryhill/W Community

1 See www.scotpho.org.uk/communityprofiles.

21 Note also that the postcode sectors are presented by means of a descriptive name rather than their official postcode name (e.g. ‘Hillhead’ rather than ‘G12 8’). With some minor adaptations, these are the names that were used in the Community Profiles. We believe that presenting the information in this way is more meaningful to the reader. However, it should be borne in mind that all these descriptive names are very approximate, and the boundaries of postcode sectors will seldom match natural communities. A full list of all the West of Scotland postcode sectors used in this report, along with their descriptive names, is included in Appendix 2.

It should be noted that most of the data presented at a community and postcode sector level covers the years 2001 to 2002. It is possible, therefore, that areas (particularly small areas) may have undergone change in the past three or four years which could impact on the figures presented.

Note finally that in a few cases, other geographies (e.g. parliamentary constituency, data zone) have also been used. However, these are fairly small in number.

Map 1: ‘West of Scotland’ council areas (Glasgow City shaded dark red)

22 Map 2: ‘West of Scotland’ communities (Greater Glasgow communities shaded dark red).

Chapter 2: Historical perspective tility rate or significant inward migration to Glasgow, the city’s population is likely to the is likely population city’s migration to Glasgow, tility rate or significant inward the startthe of health 20th compared favourably with century, Glasgow’s the large ability… although further reductions are predicted.” r The population [of Glasgow] in recent years has reached relative in recent years The population [of Glasgow] 50 years. 50 years. emain unchanged from a hundred years ago.” emain unchanged from a hundred years “In the past quarter century has been part Glasgow of a rapid change that has affected North Europe America, and parts of Asia.” of the healthiest“…many within communities and least the healthy city r “ st Summary extraordinary seen have The last change 200 years in the of the size population of decline. growth recent to initial rapid more from Glasgow, The birth century. and death since the been in decline rates have of the middle 19th the the birth deathexceeds rate now rate and, without in theresurgence a However, fe throughoutInequalities the in health Glasgow in period. been present entire have At English cities such Manchester as Liverpool, and Birmingham. This is no longer the case. years, the life last for expectancy 100 both has doubled over Overall men and women since the respectively late 19th and 39 years years 34 approximately by increasing century. drop further. drop in infant trend mortality underlinesThe downward in public the huge improvements thehealth, lasthospital sanitation treatment, and housing that over achieved been have 1 Guide to data presented in this chapter % of dependent children living in households where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 2: A historical perspective on Glasgow’s population

In the past quarter century Glasgow has been part of a rapid change that has affected North America, Europe and parts of Asia. Glasgow has undergone a transition to become a post-industrial society. Service industries have replaced manufacturing and a new knowledge economy is emerging. Consumer choice has exploded, fertility rates have fallen, divorce has soared, and out of marriage child bearing has increased. Perhaps most important of all, trust and confidence in institutions have declined. Within local communities, mutual ties between people have tended to become weaker and less permanent. We have to look to a set of demographic, economic and cultural trends to account for these changes. The nature of work and the respective roles of men and women have changed, as have many fundamentals of life including the family, leisure, beliefs, values and norms. For example, increased life expectancy and greater control of fertility made it both inevitable and desirable that women should seek a wider range of activities beyond the traditional child rearing and home making roles. Simultaneously, the knowledge economy had less use for the physical strengths of young men. The result in some communities is a large cohort of younger men who find themselves without a meaningful role at home or in work, and many of them lack the education or social skills to remedy the situation. Could this be the explanation for the fact that younger men have seen an absolute increase in their death rates in recent years, mostly through accidents, suicide, drug related deaths and violence?

Great disruptions of this nature are not new. At the beginning of the industrial revolution, alcohol consumption, crime and illegitimacy (to quote just three indices) were substantially higher than they are today. What emerged in that period was a reaction to the social disorder that accompanied the upheavals brought about by the industrial revolution. Victorian society deliberately sought to create institutions and instil values that would create order out of what seemed like chaos. Thus, in time, emerged co-operative societies, modern police forces, health visitors, universal education, orphanages and much else. These were supported by grass roots efforts to create and sustain a whole series of informal norms and behaviours that, in their time, were important for social order. The fact that these eventually became outmoded and now often seem illiberal to modern eyes does not mean that they were not radical in their time. Human societies have been very inventive and successful in their response to change. Can we be as successful in our responses to our post-industrial society?

The lesson of history is that we should be optimistic. Therefore, we begin this report with a brief review of Glasgow’s history, noting how successful we have been at improving health in the past.

In the following sections of this chapter some of the major demographic trends that have affected Glasgow over the last century and a half are summarised with the focus on three topics: population, births and deaths. A brief description of inequalities in the city around the start of the 20th century is also given to, first, emphasise that the issue of inequalities in living conditions and in health outcomes is not new; and, second, to show that Glasgow’s health position in comparison to other major UK cities has not always been as relatively poor as it is currently. Finally, the great improvement in life expectancy in the city over the last 150 years is illustrated.

27 2.1 Trends in population, births and deaths

Population The reports of Glasgow’s Medical Officers of Health1, which extend back into the 19th century, provide an insight into the spectacular growth of Glasgow’s population. Figure 2.1, using data drawn from the aforementioned reports and from the annual reports of the General Registrar for Scotland2, illustrates Glasgow’s population trend over the last 200 years.

Figure 2.1

Glasgow's Population; 1801-2004 Source: Reports of Medical Officer of Health, Glasgow (1898, 1925,1926,1972); Registrar General of Scotland's Annual Reports (1973-2004)

1,200,000

1,000,000

800,000

600,000 Estimated Population Estimated 400,000 Local Gov Unitary Major city Districts Councils extensions 200,000 introduced introduced

0 1801 1811 1821 1831 1841 1851 1861 1871 1881 1891 1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001

In 1801 the population of Glasgow was estimated as 77,000. Within 20 years the population had almost doubled to 147,000 and a hundred years later, in 1901, the population was ten times as large, estimated at 762,000. During this period the boundaries of the city were extended on many occasions reflecting the expansion of the city population. Both reductions in mortality (particularly early in life, brought about by improved sanitation, nutrition and general life circumstances) and greater inward migration (as people were attracted to industrial jobs) contributed to the increased population of the city.

Glasgow’s population peaked in 1925 but then remained stable until the early 1950s when it began to drop. In the early 1960s Glasgow’s population started to fall steeply, by 1% or more per year, and by 2004 the population of the city (as defined by the Council boundaries) stood at just over 577,000.

28 Births Figure 2.2 presents Glasgow’s birth trends from 1855 to 2004 in terms of both actual births and birth rates. The numbers of births in the city rose steadily through the second half of the 19th century and peaked just after the end of the First World War, in 1920. Since then, despite a post-war rise in 1947 and again in the ‘baby-boomer’ years of the 1950s and early 1960s, the number of births (and the birth rates) has continued to fall. In 2004 there were 6,612 births in the city; less than a third of the figure of 22,415 recorded forty years previously.

The most striking pattern to note from the birth rate figures is that they have clearly been in long-term decline since the mid 19th century. In the 1860s the birth rate was above 40 per 1,000 but had dropped to half this rate by the 1930s. From 1964 to 1977 the birth rate dropped particularly steeply, but since then it has stabilised at around 11 per 1,000.

Figure 2.2

Trends in Births and Births per 1,000 population in Glasgow; 1855 - 2004 Source: Reports of Medical Officer of Health, Glasgow (1898, 1925,1926,1972) Registrar General of Scotland's Annual Reports (1973-2004)

35000 45 1920

1914 40 30000

1947 35 25000 1962 30

20000 25 Births 15000 20

10000 Births per 1,000 population Births 10 5000 Births per 1,000 population 5

0 0 1855 1865 1875 1885 1895 1905 1915 1925 1935 1945 1955 1965 1975 1985 1995

Deaths Figure 2.3 illustrates the trends in deaths and death rates for the city since 1855. As the graph illustrates, the number of deaths in Glasgow rose from the mid-1800s to the 1920s before dropping. Much of the rise in the number of deaths until 1920 can be attributed to the expanded population of the city because the crude death rate from the 1870s onward dropped, falling from around 30 per 1,000 population to below 15 per 1,000 by the mid 1940s. The crude death rate has fluctuated between 13 and 16 per 1,000 since the 1940s. This rate does not, however, take account of population ageing and, as Chapter 3 of this report shows, the age-standardised mortality rate in Glasgow has reduced steadily since the 1970s.

29 Figure 2.3

Trends in Deaths and Deaths per 1,000 population in Glasgow; 1855 - 2004 Source: Reports of Medical Officer of Health, Glasgow (1898, 1925,1926,1972); Registrar General of Scotland's Annual Reports (1973-2004) 25000 40.0

35.0 1915 20000 30.0 1940

25.0 15000

20.0 Deaths 10000 15.0 Deaths per 1,000 population 10.0 5000

Deaths 5.0 Deaths per 1,000 0 lti 0.0 1855 1865 1875 1885 1895 1905 1915 1925 1935 1945 1955 1965 1975 1985 1995

The great progress that has been made in improving the health of Glasgow’s citizens can perhaps be best illustrated by looking back to 1901, when the distribution of deaths by age and disease was markedly different to today. In 1901, deaths of children under five years of age accounted for 41% of all deaths and, of those dying in their first year of life, 33% of deaths were due to diarrhoeal and respiratory diseases (532 and 660 total deaths respectively).

Deaths from many infectious diseases, which have all but disappeared in the present day, were common. Out of an overall total of 15,715 deaths in the city in 1901, significant numbers of deaths were recorded for the following: smallpox (193 deaths), diphtheria (115), scarlet fever (131), typhus (10), enteric fever (210), measles (499), whooping cough (850), diarrhoeal diseases (861), and tubercular diseases (2101). In contrast, deaths from cancer (498) and circulatory diseases (1154) were far less prominent overall than now.

Infant deaths The falling death rates in the city reflect public health advances, better healthcare and improved life circumstances. The impact of these improvements is seen most vividly in the dramatic drop in the infant death rate from almost one in five babies dying in the city in their first year of life (in 1855) to one in forty by 1972 (Figure 2.4). Even since 1972, infant mortality has dropped significantly (although this is not clearly shown in the graph) to 7.1 deaths per 1,000 live births in 2004 – a rate which is less than a third of the rate in 1972.

30 Figure 2.4

Infant Deaths (under 1 year) per 1,000 live births in Glasgow; 1855 - 2004 Source: Reports of Medical Officer of Health, Glasgow (1898, 1925,1926,1972); Registrar General of Scotland's Annual Reports (1973-2004)

250

196 200

150

100 Infant Deaths per 1,000 births

7.1

1 9 5 3 1 3 5 5 99 51 59 03 855 863 907 927 935 979 987 1 1859 1 1867 187 1875 187 1883 1887 1891 1895 18 1903 1 1911 191 1919 192 1 193 1 1939 194 1947 19 1955 19 1963 1967 1971 197 1 1983 1 1991 199 1999 20

However, despite the much higher rates of mortality that were prevalent a hundred years ago, Glasgow’s comparative position was better in the past than it is today. As Table 2.1 shows, in 1901, Glasgow had lower infant mortality rates than several English cities and comparable overall death rates.

Table 2.1

City Infant mortality All cause mortality in 1901 (per 1,000 live births) (per 1,000 population) Glasgow 149 21.2 London 149 17.6 Liverpool 188 22.3 Manchester 199 22.1 Birmingham 187 20.5

Implications of birth and death trends Figure 2.5 below, showing the birth and death rates in the city between 1855 and 2004, demonstrates how the birth rate outstripped the death rate throughout this period until 1973. In contrast, for most of the period since, deaths have exceeded births. The implications of this are that, unless fertility rates rise or Glasgow gains population through net inward migration, the population of the city looks set to reduce further. Population projections produced by the General Register Office for Scotland, which are included in the Chapter 3: Population and life expectancy, confirm this.

31 Figure 2.5

Deaths and Births per 1,000 population in Glasgow; 1855 - 2004 Source: Reports of Medical Officer of Health, Glasgow (1898, 1925,1926,1972); Registrar General of Scotland's Annual Reports (1973-2004)

15 Deaths per 1,000 population

10 Births per 1,000 population 5 Deaths per 1,000 population

5 5 0 0 0 5 5 5 0 80 860 870 885 895 905 930 940 1855 1 186 1 187 1880 1 1890 1 190 1 191 1915 192 1925 1 193 1 194 1950 195 1960 1965 1970 1975 19 1985 199 1995 2000

2.2 Inequalities one hundred years ago

While health inequalities are a major concern today, there were clearly growing concerns about the effects of poverty and poor living conditions in late Victorian times3. The following graphs show patterns in population density, birth and death indicators for sanitary districtsi in 1901.

Population density Population density (see Figure 2.6) – a crude proxy for overcrowding – showed huge variations across the city from 4.5 persons per acre in Pollokshields West & Bellahouston and similarly low rates in Kelvinside, to extremely high figures for Brownfield (357 persons per acre) and St Rollox (354).

i In 1901, for the purposes of health administration, Glasgow was organised into sanitary districts. Their average population in 1901 was 23,000, but there was a wide range in their size from St Enoch Square, the smallest, with a population of 3,000 to Bellgrove and Dennistoun with a population of nearly 80,000.

32 Figure 2.6

Population Density in Glasgow's Sanitary Districts, 1901 Source: Report of the Medical Officer of Health, Glasgow

400 356.7 350

300

250

200

150 Persons per Acre

100 60.1 50 4.5 0 l l w e ill il il re a d o ill s s e e n e re st s s n ld o d h a g un h a on g ar o a n to llox e si sh ryh u n d st n East st u e l fi uston q lhead wood e d lasg ckvill isto un ng s ri odsid q d Ca lvin Barn Ma S n ovan Hil D i u o derston s We Gorbal G e d Cros Ro n G K dWynd xcha nSqu a w S n se St Ro rown f llaho K n d n E lose o L W e A wca B e och n De Blyths Barrowfield ty o n d Port Clo Co Monteith Row n d Ci t E rna a tches n S h and Sandyfor and C u t Andr a ilpark a bu S t g ve H n ro idgegate a h St S Poss ri llg Br g gh Sp lvinhaug e Hi e B Hi Langside and Mount Florida K llokshields and Strathbu Po Greenhead and London Road kshields West and B o Poll Sanitary District

Births Birth rates in 1901 showed a five-fold variation across the city from 10.5 per 1,000 in Hillhead and 13.6 per 1,000 in Kelvinside to 49.8 per 1,000 in Port Dundas (Figure 2.7).

Figure 2.7

Birth rates in Glasgow's Sanitary Districts, 1901 Source: Report of the Medical Officer of Health, Glasgow

49.8 50

40 31.8 30

Births per 1,000 population 10.5 10

d l e n ill ill ll s s go re rd on o ld on ds ad hi ea ton o ida ar ton ide als t ie villa n o y s un ua ange s b s rnh nh k gs h ie a erst dden unda hb Flor Squ Calt Wy a Glasgow Hillh Crosshil andyf Kin Gor ownf ov Mar lahou at hSq nt Exc Wood St Rollox G arrowfield don R tD of Kelvinside r S ew Laur Br And B or el Blythswood oc d and Ba P ty B n MonteithMou Rowndr heson Squaree and Cowc Ci d nd St tEn d ark tc at S h a tA and Closes East urn and Roc g an S ilp Hu b ds a St s e dgeg ad and Lon iel id gh os ri h s P pring B gh St heand Closes West s Hi ellgrove and DennistounS Hi ds Westk an elvinhau B K ang iel ollo L reen h P G ks llo Po Sanitary District

33 Infant deaths The Figure below (Figure 2.8) shows infant death rates for Glasgow’s Sanitary Districts. There was a five-fold variation between the rate of 50 per 1,000 in Pollokshields West & Bellahouston and that of 242 per 1,000 in Brownfield (part of the Broomielaw area).

Figure 2.8

Infant Death rates in Glasgow's Sanitary Districts, 1901 Source: Report of the Medical Officer of Health, Glasgow

300

242 250

200

149 150

100

50 50 Deaths in first year per 1,000 births

l w l ill e d e ill ill e n e st d s x ld o go a g ds h r u rd r e a ow lo e n nh n a a da l ens fi sg u a yn u yfo W Ro R n eston d n la oustonb illhe arn d th swood Ro ri Calton d w h th H B Maryh n n i Du Gorbalsu G a CrosshiGova elvinsid d wSq Kingston Rockvilla e t St a ca lla tr K Exch nd Wn Woodside do nt r L Anderston w Bro of a Dennisto Barrowfieldd n o o Blyth Be S dre d nd Sa eson Squ o P Co ity Mount Florida n a L M d Closes East C gate ark a A an ch d and e lp h and Closes urn ann St Enoch Square St g Hut b a ds ve u d l ssi ro a a h St an o g e g West and side and Bridg P ll gh St pring s g e Hi nh Hi kshie B elvinh S e llo K e o Lan r P G kshield lo Pol Sanitary District

Deaths The overall crude death rates per 1,000 followed a similar pattern (see Figure 2.9) with the lowest rates in Kelvinside (8.3) and the highest rates in Brownfield (40.4).

Figure 2.9

Death rates in Glasgow's Sanitary Districts, 1901 Source: Report of the Medical Officer of Health, Glasgow

45 40.4 40

25 20.6 20

15 8.3 10 Deaths per 1,000 population 5

l o n a d n s n s s da on g ill ill w un o ll o on ld ds o re n ow h h o llox t e n lt da ori Ro kvi uare s rst y rbal ua East l ust h ist c e o q dde lasg rosshil t changeingst Sq de Ca S a tF C Hillheadho ei oodsideMaryhillnn K on Roa n G ses Dun c fG la Govan t W Ex d w St Roauri nd W ses West w o Kelvinsideun d Ro L A Barrowfia lo o Brownfield o Strathbun Blythswood and Barn son Square och Port y nd Sandyford Mon n Co it d a rk nd De he ate E C h a tc Andre and C nd M and Belan g lpa t eg St t and Cl s si burn anHu S t de a est eld os rove ng ad and Lon h S i nhau P g e Bridg igh S g sh ngsi k vi Spri H Hi lds W Bell enh La e llo Kel e Po Gr llokshi o P Sanitary District

34 The 1901 Medical Officer of Health’s report noted that, during the preceding 30 years, most sanitary districts had shown a reduction in death rates. However, two were largely unchanged, Cowcaddens and Brownfield, and the report commented that in these districts “the mass of insanitary conditions affects so large a proportion of the inhabitants that the district death rates, as a whole, are influenced thereby”. The areas were compared unfavourably to Kelvinhaugh & Sandyford and Pollokshields West & Bellahouston, which apart from Kelvinside, had the lowest death rates in the city.

These comments and the preceding graphs illustrate the truth of the observation that “where you live, the class into which you were born, the size of your family, and your access to ‘improvements’ in housing, diet and medical care – were all critical influences upon life and death in Glasgow”4. In Glasgow at the beginning of the 21st century this comment still retains validity, as will be illustrated in subsequent chapters. It is also notable from these figures that many of the healthiest and least healthy communities within the city remain unchanged from a hundred years ago. The next chapter of this report returns to the theme of health inequalities and illustrates the persistence of mortality and life expectancy inequalities in Glasgow at the beginning of the 21st century.

Life expectancy and overcrowding In the 1925 Medical Officer of Health report for Glasgow, the difference in life expectancy by size of house (a proxy for overcrowding) was demonstrated. For girls aged ten, there was an estimated difference in future expected years of life of 12 years between those living in one apartment houses (46.9 years) and those living in housing of four apartments or more (58.8 years) (see Figure 2.10). For boys of the same age, the equivalent gap in expected future years of life was only three years.

Figure 2.10

Expected future years of life at 10 by size of house and by gender for Glasgow; (calculated on the basis of 1911 Census and deaths between Oct 1909 and Sept 1912) Source: Report of the Medical Officer of Health, Glasgow, 1925 (p34) 70

Males at age 10

60 Females at age 10 58.8 54.7 53.1 52.5 51.7 50.0 49.6 49.9 49.8 50 46.9

Expected future years of life at 10 20

0 1 Apartment 2 Apartments 3 Apartments 4 Apartments or more Whole City

35 Overcrowding, and poor living conditions in general, and their relationships to ill- health were already well-recognised concerns, which had prompted a range of measures aimed at improving living environments. These included slum clearances, improvements to sewage and water quality, redesign of tenements, tighter planning controls and housing developments aimed at spreading the population and re-housing people in less cramped circumstances. However, the issue of overcrowding was still a major concern in 1921 with over 270,000 people, 28% of the city’s population, living in accommodation where there were more than three occupants per room (Figure 2.11). A presentation and discussion of more recent trends and inequalities in overcrowding is contained within Chapter 6: Physical environment.

Figure 2.11

Overcrowding in Glasgow in 1921 - percentage of occupants living more than 3 per room of all occupants by size of house Source: Report of the Medical Officer of Health, Glasgow, 1925 (p190); original source 1921 Census

All houses 27.8%

4 rooms or more 0.5%

3 rooms 7.7% Number of rooms of Number

2 rooms 35.3%

1 room 59.6%

0% 10% 20% 30% 40% 50% 60% 70% %

36 2.3 Improvements in life expectancy

Life expectancy trends in Glasgow from the early 1820s onwards (see Figure 2.12) demonstrate the exceptionally low life expectancy of men and women in the city during the 19th century. It is only from around 1900 onwards that a notable rise in life expectancy in the city occurs. Life expectancy for men and women has approximately doubled over the last 100 years.

Figure 2.12

Expected future years of life at birth by gender for Glasgow; 1821-27 to 2001-03 Source: Report of the Medical Officer of Health, Glasgow, 1925; Office for National Statistics, 2004

80 76.4

70 69.1

60 52.2 50 48.4 37.7 40 36.6 32.6 34.1 35.2 30 30.9 Expected future years of life at birth

10 Males Females

0 1821-27 1870-72 1881-90 1920-22 2001-2003

The following chapter (Chapter 3: Population and life expectancy) provides further analysis of life expectancy trends, particularly in relation to deprivation.

37 Summary

This chapter has attempted to highlight some of the key health and demographic trends that have occurred in Glasgow in the last 150 or so years. x There was extraordinary population growth from the beginning of the 1800s into the 1920s, followed by a brief period of stability in the 1930s and 1940s, and then a decline, which became rapid from the 1960s until 2000. The population in recent years has reached relative stability at around 570-580,000, although further reductions are predicted. x There has been a steady reduction in the birth rate from the 1860s onwards with the birth rate in 2004 approximately one quarter of the rate in 1860. x Over the same period the death rate has dropped significantly. x The death rate now exceeds the birth rate; a reversal of the pattern prevalent from 1855 to the 1970s. Without a resurgence in the fertility rate or inward migration Glasgow’s population is likely to drop further. x The downward trend in infant mortality underlines the huge improvements in public health, hospital treatment, sanitation and housing that have been achieved over the last 150 years. Even in the last 40 years the infant mortality rate has dropped significantly from 22 per 1,000 live births in 1972 to 7.1 per 1,000 live births in 2004. x Inequalities in health have been present throughout the entire period. x Compared to other large cities, Glasgow’s health position has not always been as bad as it is now. In 1901 Glasgow’s infant mortality and overall mortality rates were lower or on a par with those in Liverpool, Manchester and Birmingham. x Despite the poor comparative position of Glasgow’s health currently in relation to other parts of Scotland and the UK, it is important to bear in mind that overall life expectancy for both men and women has doubled over the last 100 years, increasing by approximately 34 years and 39 years, respectively, since the late 19th century.

38 References

1 City of Glasgow Corporation. Reports of Medical Officer of Health, City of Glasgow. 1898, 1925, 1926, 1972

2 General Register Office for Scotland. The Registrar General for Scotland’s Annual Reports, 1973-2004. http://www.gro-scotland.gov.uk/statistics/library/annrep/index.html

3 Booth C. Inquiry into the Life and Labour of the People in London. various publications, 1889-1903

4 Fraser W H, Maver I, eds. Glasgow, Volume II: 1839-1912. 1996

Chapter 3: Population and life expectancy hin Greater Glasgow thehin Greater Glasgow polarity in life is clear: expectancy for instance, there is an es in Scotland, but also those mortality.” with the lowest ecasts that predict further the City will reduce of Glasgow population in the 20 next t t r ends in overall deaths are downward, but the mortality deaths downward, are gap the between ends in overall communities The 15 year gap in male life expectancy between Bridgeton & Dennistoun between gap in male life expectancy year The 15 xpectancy (69.1) and East Dunbartonshire (77.2) the highest. and East Dunbartonshire (77.2) xpectancy (69.1) ears, but Glasgow will retain a relatively stable, low dependency ratio in contrast stable, will retain ratio dependency to a relatively ears, but Glasgow low eople are living longer, but when the West of Scotland councils are compared there are of Scotland councils is but when the West living longer, eople are hildren in its population but the in its population hildren highest proportion age. of working of people emale life expectancy, while better than male life expectancy, also displays while better a variation than male lifeemale life expectancy, expectancy, egion between theegion between most and least years. affluent communities has widened to nearly 12 “Greater not only has the communities with Glasgow the highest mortality ra “ & Milngavie highlights the differencesand Anniesland, Bearsden in life circumstances, lifestyles and life chances in the that city.” exist “It is predicted that single will account for adult households 49% of all 2016.” by households in Glasgow It is notable how relatively young people are when they are first when they are people are young affected relatively It is notable how limiting by longstanding illness, as is the length of time people, particularly with live a women, limiting long-term illness. in mortality, huge reductions health inequalities and indeed suchDespite remain overall on the basis of a number of differentinequalities appear, mortality and life expectancy the last ten widened over to tomeasures, have 20 years. estimated 15 year gap Bridgeton in male life between year expectancy & Dennistoun and estimated 15 Anniesland, Bearsden & Milngavie. the life in theOver expectancy last years, 20% most twenty affluent and 20% least affluent markedly; the communities has diverged gap in male life in the expectancy r of around four and a half years across the West of Scotland councils. of Scotland the across four West of around and a half years Wi y will rise. dependency ratios where of Scotland councils, other West numbers of Despite the of falling of a continuation prediction overall, population size predicted tohouseholds are rise. single households will account for adult 49% of all It is predicted that 2016 by up almost and single one in two households will make parent households in Glasgow households with children. Tr with the mortality highest and lowest has widened noticeably. P gap in male life with havingan eight year the expectancy life Glasgow lowest e F Summary NHS Board, and Greater Glasgow with 577,000, a population of of Glasgow, The City in the are largest respectively, and NHS Board, council with of 867,000, a population Scotland. one of the City has proportions Glasgow of Scotland councils, lowest of Among West c the proportions age of pensionable strikingly are of men and women In Glasgow, different: men. of compared with of women 22% 12% Fo Guide to data presented in this chapter % of dependent children living in hous eholds where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 3: Population and life expectancy

The previous chapter described some of Glasgow’s historical demographic trends. In this chapter we look at recent demographic and health trends across Glasgow and the West of Scotland, and highlight health inequalities within the region. Specifically, we focus on a number of key themes: x population – including population density, population structure, dependency ratios, population change and future projections; x household structure and household projections; x vital statistics, in terms of births and deaths; x life expectancy, in terms of patterns of inequality, trends and healthy life expectancy.

3.1 Population size and density

Of the estimated 5,078,400 people living in Scotland1, just over 42% (2.1 million) live in the West of Scotland. The city of Glasgow with a population of 577,000 and Greater Glasgow NHS Board (population - 867,000) are the largest council and NHS Board, respectively, in Scotland.

Population densities in all the West of Scotland council areas are higher than the Scottish average, reflecting the urbanised nature of the region. However, within that, there is a wide spectrum of population densities across the West of Scotland councils (see Figure 3.1), ranging from Glasgow City with the highest concentration of people (3,292 persons per square kilometre or 33 per hectare) to South Ayrshire with the lowest population density (92 persons per square kilometre or 0.9 per hectare).

Figure 3.1

Population density (persons per sq. km), West of Scotland council areas, 2004 Source: General Register Office for Scotland 3,500 3,292

3,000

2,500

2,000

1,500 Persons per sq km 1,000 687 610 653 514 516 579 500 154 172 65 92 95 0

e e e e e D d ire r r r ire N hir y h hi A s s s h L r w wshi Ay ton tonshi fre arks Invercl asgow City bar bar en an SCOT Gl orth Lanarkshire R East Ayrshire N Renfre South Ayrshire uth st Dun Dun rth L o a t t o S E N Wes Eas Council

43 3.2 Population structure

Population age structure by council The age and sex population structures of West of Scotland council areas vary greatly. Currently, the average age for a man in Scotland is 38 years, while the average age for a woman is slightly older at 41 years. In many of the West of Scotland councils, the average age of the male population is younger than the Scottish average. In Glasgow City, the average age of males is 36 years, the youngest average age among the West of Scotland councils. The average age of a woman in the West of Scotland is close to the Scottish average, but it is slightly lower in Glasgow at 40 and higher in South Ayrshire at 44 years of age.

Figures 3.2 and 3.3 show the proportions of the male and female population, respectively, in three age groups – ‘under 16’, ‘working age’ and ‘pensionable age’i.

Figure 3.2

Male population age structure, 2004 West of Scotland council areas (Source: General Register Office for Scotland) 100% 12 13 12 14 17 14 14 13 14 15 15 14

80% % under 16 % working age % pensionable age

60% 67 69 67 66 66 65 67 64 64 67 63 64

40% % of population % of

20%

23 20 18 18 20 20 20 20 20 21 21 21

e e e r ir re ir hire i hire h rs rclyde rsh rshire s y e y y gow City A A ton s h Inv tA h ar la t as bartonsh t SCOTLAND G Renfrewshi ou th Lanarkshire E Nor Renfrews S Dun Dunb st t t Sou as North LanarkshireEa Wes E Council

i Working age: 16-64 years for men and 16-59 years for women. Pensionable age: 65 years and older for men and 60 years and older for women.

44 Figure 3.3

Female population age structure, 2004 West of Scotland council areas (Source: General Register Office for Scotland) 100%

90% 24 22 24 23 23 24 21 24 28 25 25 25 80%

70%

60% % under 16 % working age % pensionable age

50% 60 59 62 58 59 59 57 59 57 58 57 55 40% % of population 30%

20%

10% 17 16 16 17 17 17 18 18 18 18 19 19 0%

y e e e r d ire ire ire ire ire ir y h h h hire AND Cit l s sh s L w nsh n o o wshire rk wsh g e to Ayrs a s rt r t n a Inverc a a a SCOT rth Ayrs b Gl Renfr un Eas South Ayrshi No th Lanark rth L tRenfre u t D s st Dunb s e So No Ea W Ea Council

Glasgow City has one of the lowest proportions of ‘under 16s’ in its population, but also has the highest proportion of people of ‘working age’ compared to other West of Scotland councils. Conversely, nearby East Renfrewshire has a strikingly different population structure with a lower than average proportion of its population that is ‘working age’, but a higher than average proportion of ‘under 16s’.

There is almost double the proportion of Scottish women who are of ‘pensionable age’ compared to men (24% vs 14%). This is in part because the pensionable age for women (60 years of age) is five years younger than for men, but it also reflects the greater longevity of women. In Glasgow the proportions of men and women who are of ‘pensionable age’ are strikingly different: 22% of women compared to 12% of men.

Population age structure by community and postcode sector The population age structure within West of Scotland ‘communities’ii and postcode sectors can be summarised from Census data compiled in NHS Health Scotland’s Community Health and Well-being profiles2.

The percentage of the Scottish population who were children (‘under 16’) in 2001 was 19% and the proportion of children in most West of Scotland communities varied only slightly from this national figure (Figure 3.4). However, two communities did stand out as having low proportions of children, Bridgeton & Dennistoun and Glasgow West End (both 14%).

ii These are primary care-based localities (mainly the old Local Healthcare Cooperative (LHCC) areas or, in some cases, the new Community Health (Care) Partnerships (CH(C)Ps)) with populations ranging from 20,000-140,000 people. For further details see ‘Preface to Chapters 2-12’.

45 Figure 3.4

% of population who are children (under 16 years), 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data) 25

21 21 21 21 20 21 21 20 20 20 20 20 20 20 19 19 19 19 19 19 20 19 19 19 19 18

15 14 14 %

e n y w e e e ll e e ld nd nd r e al d ire re re d ow a E ll go ilton d ly h hi hi we au g shi a c s elvin n r as es ws ngavi k er y d Wishaw e l th er Scotl LomondHam y Ayr fr atbridg Glas h A ern V Inver t Ayrs /Mi Eastwood Cl rth n Mo Co ast Kilbri rn ev N Gl as Strath E out East Glasgow E No Cumb te S h e & ie & asgow West eater Shawlands nd L est Ren r Eas Gl a Gr W Aird outh West Glasgow bank & Drumchapel Sout ley S e idgeton & Dennistoun s Br i and/Bearsde Pa ill/Woodsid sl Clyd Cambuslang & Ruthergleh nfrew & e Re nni Mary A Community

At the postcode sector level, there is greater variation. Figure 3.5 compares the ten postcode sectors in the West of Scotland with the highest proportions of children in their populations with the ten sectors with the lowest proportions. Unsurprisingly, in the sectors covering Glasgow City Centre only 3% of the population are children, and there are a handful of other areas where the proportion of children in the population is 10% or lower. The ten areas with the highest proportion of children tend, with two exceptions (Cumbernauld Village & Dullatur; Perceton, Scourlie, Doura & Roddinghill) to be among the more deprived parts of the West of Scotland.

Figure 3.5

% of population who are children (under 16 years), 2001 Comparison of 10 small areas with highest rates and 10 with lowest West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data) 35

29 29 30 28 28 28 28 27 27 27 26 25

19 20 % 15 11 10 10 10 9 10 8 8 6 7 5 3

e d e ill r ill E k v a tr ds tu E r ntre n khill n h als SE h ark a head ro e r b k lla g eW n n g la tick use E s milk el N pel W P in illhe C Yo d r din p a ie w H n Du d ou arla le a h Scotland ity Ce lv Pa ;Gor o rh B h sl To w n terho e C Ke to reenoc R mc mc rgu To s G Cast u ru as; Woo e Eas r D Fe d ura; East D dW n o Greenock Central n u ld Village; D Trad u ra t ou erna rb Por b a ; Sourlie; D H Cum r- eton Ay Perc Postcode sector

46 There are relatively small variations in the proportion of the population in the 16-64 age group comparing across communities in the West of Scotland (Figure 3.6). The lowest proportion of 16-64 year olds were in Clydebank & Drumchapel, Eastwood and South West Glasgow (all 62%), while the highest concentrations of this age group were in Bridgeton & Dennistoun and Glasgow West End (71%).

Figure 3.6

% of population who are adults aged 16- 64 years, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data) 72 71 71

68 67

66 66 66 66 66 66 65 65 65 65 65 65 65 65 65 64 64 64 64 63

% 64 63 63 62 62 62 62

d l e e e ll n n e ir w ir d ire w le e ire o w ld a p ow h h len a w h nds tl s s ly g d ridge go au o r r isha s er b milt la rn lasg ngavie lasgo her e hkelvin w e mcha t W d th rews Lomond a Glas Sc u EastwoodG G u ly f Ha r st thAy /Mil hAy Inverc R C Mo D e u n rn evern Valley Strat Dennistoun e East Ayrsh East Kilbride L Cumb & So Nort g& e & N Glasgow gow West End k n d on & s East la si reater Shuth East t a an uth W s d irdrie & CoatWest Ren G Gl b A So ge e So & id d nd/Bearsde ly la ew Br C s Paisley andill/Woo fr Cambu h y ar Ren Annie M Community

At the postcode sector level, there is a wider variation in the proportions of population who are adults aged 16-64 (Figure 3.7). It is notable, however, that the ten areas with the highest rates of 16-64 year olds are all in parts of Glasgow that have either undergone recent regeneration (e.g. Tradeston & Gorbals; City Centre) or are part of the West End of Glasgow (e.g. Hyndland, Hillhead, Kelvingrove). These areas tend to have higher house prices, are favoured by younger adults, including students, and appear to attract fewer families with children.

47 Figure 3.7

% of population who are adults aged 16-64 years, 2001 Comparison of 10 small areas with highest rates and 10 with lowest West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data) 100 88 90 86 86 82 79 79 80 81 80 77 77

70 65 57 57 57 58 60 54 55 55 55 57 57

% 50

d l t e ra r nt ill ill ds r t ark use o ilee als h h n ove n p od S od N n in N rb n r Largs e o o lm o e lv a ickhill dens C Millpo w York dla illhead apel SE P Ke Go o cad o H Scotlan k tsw ; D Part o c Parkh n ; w o n; Moss to o W Kelving City Cent en o Ayr; Be nigh s nd C s; e t Knightsw K e la ; a r ig Drumch d d s d G a n Tr y Cra H Dun odland Port ; Wo s u c ir C

Park Postcode sector

There was relatively little variation in the proportion of older persons (aged 65 or over) in the population across the West of Scotland communities (Figure 3.8). The two extremes are Cumbernauld with the lowest percentage (12%) and South Ayrshire with the highest percentage (19%).

Figure 3.8

% of population who are adults aged 65 years and over, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data)

20 19

17 17 17 17 16 16 16 16 16 16 15 16 16 16 15 15 15 15 14 14 15 15 15 15 14 14

12 %

ll d ld e e e in y e n w n u g ir lv ide nd un lle ire od d le o ire la id sh rw e r o o h o apel ly g avie g h t na e k b tw h r g s s o r tbr w h h milton om asgow c e e t a L Wishaw nist desdale n Va s Ayr Sc H Glasgow n r Gla mb nfr Mo t Gl n e th Ayrs Ea Inverc th u Coa e Strat ast Kil s D Cly r Ruthe n/Miln u E o e o C t R ter Shawlands Leve East AyrshireN d ie & s n & e & N Glasgowd g& s S e th Ea o d r hWest dr lasgow West End Easter si an a t Grea G d e u Air Sou y bank & Drum uslan o & W dget e b d/B S w isle d n e Bri Woo ly la fr ill/ Pa C s n h Cam e y ie R ar M Ann Community

48 Across postcode sectors in the West of Scotland, much wider variations are apparent (Figure 3.9). Of the ten areas with the lowest proportions of elderly, none had more than 8% of elderly people in the population, while in the ten areas with the highest proportions, all ten had populations where more than 25% were 65 or over.

Figure 3.9

% of population who are adults aged 65 years or older, 2001 Comparison of 10 small areas with highest rates and 10 with lowest West of Scotland and Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data) 45

40 38

35 32 33 29 30 30 28 28 27 27 27 25 % 20 16 15

8 8 8 10 7 7 7 8 6 5 5 5

r e k s t t u v ill ill N ie r gs ral t o h h ills d S d use dr on r t lla r g Bay n h o o o a n g s ro n o o h id lm L e in illhead din lie Par e w k R Millpo C Scotland H s Ab e sw ;Du lv u Carntyne ts t ;Be e e g Gr h Par r ck K ;Rod r - ig igh o a Wemys Ay on; Mosspark n Fe eS Kn Kn ee d r ld Villag ndas; Woodland G u Bonhill; JamestownDour Craigt Kilbri rlie; t erna s a Port Du mb E u ; Sou C ton e rc Pe Postcode sector

Dependency ratios Dependency ratios – which can loosely be described as the young and old as a proportion of working age adults in a populationiii – can be calculated for Scotland and for each West of Scotland counciliv (Figure 3.10). For Scotland as a whole in 2004, the dependency ratio is 53%, but it varies greatly within the West of Scotland, from 60% in East Renfrewshire to 48% in Glasgow. A lower ratio in theory reflects lower economic dependency. However, the measure does not take into account those who are of working age but economically inactive due to illness, incapacity or other reasons.

iii In econometric terms, it is the ratio of the economically dependent part of the population, to the productive part, where the economically dependent part is recognised to be children, who are too young to work, and adults of pensionable age, while the productive part of the population are those of working age. In theory this gives a dependency ratio = 100 x (‘under 16’ + ‘pensionable’) / ‘working age’. iv As applied here, the dependency ratio = 100 x (‘population under 16 years’ + ‘population of 65 years or more’)/ ‘population aged 16-64’.

49 Figure 3.10

Population Dependency Ratios1, 2004 West of Scotland council areas Source: General Register Office for Scotland 70%

59% 60% 60% 57% 57% 55% 55% 53% 53% 53% 52% 53% 50% 48%

40% % 30%

20%

10%

e e e e e ir ir r ir City h h h AND s clyd rshi s shire rkshire yr n TL to nark frews t Ay r asgow a Inver s th A nfrewshire SCO l en a G R E or Re th L th Lana N South Ayrshire or u N So est Dunbartonshire East W Council East Dunba

1Dependency Ratio: 100 x (Population under 16 years + Population of 65 years or more) / Population aged 16-64

Dependency ratios at a community level (from the Community Profiles) varied from 41% and 42% respectively in Glasgow West End and Bridgeton & Dennistoun to 61% in Clydebank & Drumchapel (Figure 3.11).

Figure 3.11

Population Dependency Ratios1, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data) 70%

60% 60% 61% 59% 59% 60% 58% 56% 56% 56% 57% 54% 54% 54% 54% 55% 55% 52% 53% 53% 53% 51% 51% 51% 52% 48% 50%

41% 42% 40% % 30%

20%

10%

d s e e n e d l nd w in ir w o e uld o nd ond lv ale aw rid le h o o tla a g ridg e d h lyde s g avie gow ap o rn s la milton m b k ilb rc r s g w la w a t th lasgow herg e Sc G a Lo a G Wis t K v AyrshireGlas mch t H o ra s n t East mbe s MotherwellClydes vern Valley I th s u a C St e rth Ay e Dru C &N Ea &Rut East Ayrshire o tern Gla E ter Sh e g N s Sou & th a rie & h W re d sid Ea nk Glasgow Westeton & En Dennistoun G earsden/Miln a g Sou Air od B b o Sout Brid land/ lyde frew & West Renfrewshire Paisley and L Cambuslan C Ren Maryhill/W Community Annies

1 Dependency Ratio: 100 x (Population under 16 years + Population of 65 years or more)/ Population aged 16-64

50 At a postcode sector level, the differences between the areas with the highest and lowest proportions are large (Figure 3.12). The ten areas in the West of Scotland with the lowest dependency ratios were all in Glasgow and are areas with lower than average proportions of children and higher than average proportions of working age adults. The areas with the highest dependency ratios tend to also have higher than average elderly populations.

Figure 3.12

Population Dependency Ratio1, 2001 Comparison of 10 small areas with highest rates and 10 with lowest West of Scotland and Glasgow Source: NHS HS - Community Health Profiles (from 2001 Census data) 90% 84% 81% 82% 82% 80% 76% 76% 77% 73% 74% 75%

70%

60% 54%

50% % 40% 31% 31% 30% 27% 27% 24% 22% 24% 20% 16% 16% 14%

10%

e s ill ill ls E e rt k s tr d h S s r g land rove kh ba l lpo lhead lan rk ic od N spa Lar Cen o t or lvin N o pe s entral cot Y r G Penilee rkhou Mil C S y Hil od Ke a elving Pa n; cha P Cit K Wo d; Dowanhillo ightsw m n; Mo s; n n u Ayr; Belmont o K Knightswood S t da dest Dr ig ra Greenock T Hyndla Cra rtDun odlands; Cowcaddens o Po

Circus; W

Park Postcode sector

1 Dependency Ratio: (Population under 16 years + Population of 65 years or more)/ Population aged 16-64

Projections of future dependency ratios at a council level are included in the next section.

3.4 Population change and population projections

Population change The General Register Office for Scotland (GROS) has produced tables estimating population changes, and the sub-components of change such as migration, births and deaths, over the period 1994-20041 (Table 3.1). The analysis shows that over this ten- year period there was net migrationv into Scotland but that overall the population dropped by 0.5%. The pattern within the West of Scotland is quite mixed. In East Renfrewshire the population has increased by 3.4% as a result of inward migration and ‘natural growth’ (births exceeding deaths) over the period. Glasgow City shows the greatest overall drop in population (34,590), two thirds of which is accounted for by outward migration and a third by a death rate that has exceeded the birth rate. Inverclyde shows the largest overall population decline – 7.7%, over the period.

v Includes movements to/from armed forces and an adjustment for a recurring unattributable population change based on the 2001 Census, which is assumed to be unmeasured migration.

51 Table 3.1 Components of population change, West of Scotland council areas, 1994-2004 Source: General Register Office for Scotland Estimated Estimated Estimated Population change population Births Deaths Natural net civilian population 30 June 1994 change migration and 30 June 2004 Number %

other changes SCOTLAND 5,102,210 557,631 589,385 -31,754 7,944 5,078,400 -23,810 -0.5 Glasgow City 612,260 70,437 81,191 -10,754 -23,836 577,670 -34,590 -5.6

East Renfrewshire 86,660 9,713 8,567 1,146 1,804 89,610 2,950 3.4 South Lanarkshire 305,220 33,229 33,845 -616 806 305,410 190 0.1 North Lanarkshire 323,830 39,121 35,317 3,804 -4,844 322,790 -1,040 -0.3 North Ayrshire 137,550 14,881 16,405 -1,524 -6 136,020 -1,530 -1.1 South Ayrshire 113,550 10,697 14,830 -4,133 2,433 111,850 -1,700 -1.5 East Dunbartonshire 109,540 10,643 9,933 710 -3,700 106,550 -2,990 -2.7 Renfrewshire 175,460 19,717 20,557 -840 -4,010 170,610 -4,850 -2.8 East Ayrshire 123,250 13,068 14,869 -1,801 -1,729 119,720 -3,530 -2.9 West Dunbartonshire 96,780 10,717 11,801 -1,084 -3,726 91,970 -4,810 -5.0 Inverclyde 89,320 9,277 11,641 -2,364 -4,526 82,430 -6,890 -7.7

Population projections The 2004 based population projections from the General Register Office for Scotland3 forecast that Scotland’s population will rise by 0.8% between 2004 and 2024 (see Figure 3.13), resulting in a projected population of around 5,119,000 (40,000 more than at present). However, the actual period of population growth is between 2004 and 2014, after which the Scottish population is predicted to reduce. The majority of West of Scotland councils are predicted to lose population up to 2024 with the largest decreases in Inverclyde (-13.6%) and East Dunbartonshire (-10.5%). It is predicted Glasgow City will have lost 4.4% of its population by 2024, or around 25,000 people overall. Small population increases are predicted for South Lanarkshire (+4.1%), East Renfrewshire (+3%) and North Lanarkshire (+0.3%).

Figure 3.13

Projected Population Changes in Scotland, 2004-2024, West of Scotland council areas Source: based on 2004 based population projections, GROS

4.1% South Lanarkshire

3.0% East Renfrewshire

0.3% North Lanarkshire

-2.5% South Ayrshire

-2.9% East Ayrshire

-5.0% North Ayrshire

-8.6% Renfrewshire

-8.7% West Dunbartonshire

-10.5% East Dunbartonshire

-13.6% Inverclyde

-4.4% Glasgow City

0.8% SCOTLAND

-16% -14% -12% -10% -8% -6% -4% -2% 0% 2% 4% 6% % Change in overall population

52 Detailed projections by age and sex are available from GROS. The following graphs are derived from these projections. The Figure below shows projected changes across six age bands at a Scottish level between 2004 and 2024 (Figure 3.14). The predictions for Scotland confirm a number of now well-known patterns. x Our population is ageing and the number of older people will increase markedly (nearly 200,000 more in 75+ population and 130,000 more in 65-74 years age band). x Our ‘working age’ population will get older (140,000 more in 50-64 age group) but will also shrink (overall 171,000 less in 16-64 age group). x Overall the number of children under 16 in the population will shrink dramatically by 115,000 or by 12%.

Figure 3.14

Population projections by age band, Scotland, 2004 vs 2024 Source: based on 2004 based population projections, General Register Office for Scotland

1600 1502

1400 1263 2004 2024 1200 1075

1000 935 933 881 820 807 800

585 600 569

Population in thousands 455

400 371

200

0 0-15 16-29 30-49 50-64 65-74 75+ Age band

For Glasgow (see Figure 3.15), a slightly different set of population changes are predicted. The number of children under 16 is set to decrease by 13,000 or 13%. There are large drops predicted in the 16-49 age bands, representing a reduction of 33,000 people, but the population aged 50-64 is set to grow by 24%. Unlike the overall Scottish pattern, the population in older age groups (65 years and above) will remain relatively stable, rather than increasing as elsewhere, which in part may reflect the poorer life expectancy in areas of Glasgow.

53 Figure 3.15

Population projections by age band, Glasgow, 2004 vs 2024 Source: based on 2004 based population projections, General Register Office for Scotland

200 2004 2024 180 174 163 160

140 131

120 110 106 99 100 86 85 80 Population in thousands 60 47 49 40 38 40

0 0-15 16-29 30-49 50-64 65-74 75+ Age band

Projections of dependency ratios The population projections allow a calculation of changes in dependency ratiosvi over the same period (2004-2024). For Scotland (see Figure 3.16) the projections imply an increase in the dependency ratio for the country as a whole and this is mirrored in most of the West of Scotland councils with the exception of Glasgow, which maintains a virtually unchanged position of having a relatively low dependency ratio up to 2024.

Figure 3.16

Dependency Ratio Projections, West of Scotland council areas, 2004 and 2024 Source: based on 2004 based population projections, General Register Office for Scotland

80% 76% 2004 2024 72% 73% 69% 70% 66% 67% 65% 63% 61% 63% 63% 60% 59% 57% 60% 55% 55% 57% 53% 52% 53% 53% 53% 48% 50% 46%

40%

30% pendency Ratio (%) De 20%

10%

y e e D it re re ire r ire i yd C sh shi LAN w nsh T rk o a frew rt Invercl lasgo en rth Ayrshi SCO nbartonsh o G th Lanarkshire h Lan u Renfrewshire East Ayrshire unba t D N South Ayrshire Nor Sou East R West D East Council

vi As previously, the dependency ratio = 100 x (‘population under 16 years’ + ‘population of 65 years or more’)/ ‘population aged 16-64’.

54 3.5 Household projections

Across Scotland, the number of households is projected to increase by 7% over the period 2002-2016 according to recently published GROS forecasts4. Within the West of Scotland, the largest growth will be in East Renfrewshire (11%), while in Inverclyde the number of households is forecast to reduce by 1%. In Glasgow City a 6% increase in households is forecast, which equates to the number of households in Glasgow rising by 15,300 to a total of 290,030 (Figure 3.17)vii.

Figure 3.17

Projected change in numbers of households, West of Scotland council areas, 2002 vs 2016 Source: General Register Office for Scotland 300,000 290,030

250,000

2002 2016 200,000

145,500 150,000 138,150 Households

100,000 76,320 62,180 49,980 51,350 43,840 50,000 37,170 39,180 42,200

e e e e e re ire r ir yd i hir ir cl sh s rsh sh sh w y r rkshire k ver ton ar gow City fre r A t Ay na n In n ba th a e n as rth Ayrshi enfrewshire La Glas E o R h L h R Sou N t rt Dunbartonshire o ast st ou E ast Du S N We E Council

These projections also predict changes in the relative proportions of different types of households (see Figure 3.18). In Glasgow City, single adult households with no children will rise as a proportion of all households will rise from 42.4% in 2002 to 49% in 2016. The percentage of ‘households with two or more adults and children’ is projected to decrease from 16.1% in 2002 to 11.6% by 2016. Over the same period the percentage of lone parent households is projected to increase marginally from 9.4% to 10.5% of all households.

vii Please note that the household numbers displayed above each set of columns are for 2016.

55 Figure 3.18

Projected trend in % mix of households, Glasgow City, 2002 - 2016 Source: General Register Office for Scotland

100% 9.4% 10.5% 90%

16.1% 11.6% 80%

70%

60% 32.1% 28.9%

50%

of all households 40% %

30%

42.4% 49.0% 20%

10%

0% 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Households with 1 Adult Households with 2 or more Adults Housholds with 2 or more adults and one or more children Households with 1 Adult with Child(ren)

Single adult households with no children are predicted to increase significantly across the whole of Scotland. Over the period 2002 to 2016, the GROS forecasts that nationally the figure for single adult households with no children expressed as a percentage of all households will rise from 33% in 2002 to 39% in 2016 (see Figure 3.19). In Glasgow the predicted rise suggests that, in 2016, single adult households with no children will make up 142,000 out of the 290,000 households in the city.

Figure 3.19

Projected change in % of single adult households with no children West of Scotland council areas, 2002 vs 2016 Source: General Register Office for Scotland

60%

2002 2016 49% 50% 42% 42% 41% 42% 39% 39% 40% 37% 38% 38% 35% 33% 35% 34% 35% 31% 32% 31% 31% 32% 29% 30% 30% 26% 25%

20% % of all households all % of

10%

e e e e ire re ir hir h h yde s shir shir shi l w ns k k e ews Scotland rto ar ar fr nfr an Inverc e an en bartonshire Glasgow City East Ayrshire orth Ayr R n South Ayrshire N Du uth L orth L t East R So N East Dunba Wes Council

56 Nationally, lone parent householdsviii as a percentage of all households are projected to increase by 12%. The GROS’ household projections also allow a calculation of lone parent households expressed as a percentage of all households with children (see Figure 3.20). Based on these projections, the 2002 national figure of 23% is predicted to increase to 33% by 2016. For Glasgow, the equivalent figure for 2002 is 37% and this is forecast to rise to 48% by 2016. All the West of Scotland councils show similar rises. However, Glasgow has by far the largest proportion of current and projected lone parent households.

Figure 3.20

Projected change in lone parent households as a percentage of all households with children, West of Scotland council areas, 2002 vs. 2016 Source: General Register Office for Scotland

60% 2002 2016 50% 48%

41% 39% 40% 37% 36% 37% 33% 33% 33% 31% 29% 29% 30% 27% 27% ll households with children 24% 25% 23% 23% 22% 20% 21% 20% 20% 14% 14%

10%

Lone parents as % of a 0%

e e e r ire r r hi h hi kshire clyde ks cotland yrs r er r tonshire A a rews v onshi S r t n s th Ayrshire I nba a Lana Glasgow City u E Renf th D Sou Dunbart North Ayrshire t outh Lan t Nor East Renfrewshireas S es E W Council

3.6 Minority ethnic population

According to the 2001 Census, only 2% of the Scottish population are from a minority ethnic group. However, there are large variations across the West of Scotland and particular parts of Glasgow have much higher concentrations of ethnic minorities. In fact, most Glasgow communities have a larger proportion of persons from an ethnic minority group than the Scottish average. In South East Glasgow and Glasgow West End over 6% of the population are from an ethnic minority, while in Greater Shawlands the figure rises to nearly 17% (Figure 3.21).

viii Please note the definition of lone parent households used here differs from that used in Chapter 5: Social environment, which refers to data drawn from NHS Health Scotland’s Community Profiles.

57 Figure 3.21

% of population who are from an ethnic minority group, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data)

18 16.9

10 % 8 6.7 6.7

6 5.5 4.2 4.3 4.4 3.8 4 2.4 2.0 1.5 1.5 2 1.1 1.2 1.2 1.2 1.2 1.3 1.4 0.7 0.7 0.7 0.8 0.8 0.9 0.9 1.0

d e l e e ll n d d ir e nd w ir e w w ie o h p lley a h o o v o ow s lyde h rw g g tou g En r mo rc milton is e nauld s s is w s esdale o e a h r la la Scotlan mcha L v rn Va W ews t nn t Ay u n e H rathkelvin e Milnga East t G s th AyrshireClyd r I nfr Mo t NG / s D e S est Gla a r Shawlands Ea East Kilbride Cumbe ern Glasgow & D en North AyrshireSou & R & d E e k rie & Coatbridgnd Lev hW th eat a East t ton ars u r an West u dside e e Glasgow GWest b Aird y o /B So le So o idg d is w& lyde a e W Br C P Cambuslang & Rutherglen ill/ nfr h ieslan e y n R r Ma An Community

At a postcode sector level, the variation in the proportions of the population who are from minority ethnic groups in each area across the West of Scotland is large (Figure 3.22). In some postcode sectors, less than five people were recorded as coming from an ethnic minority, while in Glasgow minority ethnic groups are concentrated particularly in areas of the West End, Springburn and parts of the south side of Glasgow.

Figure 3.22

% of population who are from an ethnic minority group, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data)

40 37.6

30 28.1 26.4 24.4 23.3 25 22.2 20.4

% 20 17.7 14.9 15 13.2

5 2.0 <5<5 <5 0.1 0.1 0.2 0.3 0.3 0.3 0.3 0

n n th n rk ill s S to o o h n go land r ill N s ston rk n a nst h ark N s de w e hopt kwood wpa o d ou Pa bu ringside v ir enholm e an odlands r a h th Scot te e ie Sou Vi Cowlairs gP C a Howwood Sp S n Bis ov lla ing Dumbreck St d; K G e n n Cowc Str innin ; B Kilbir la Dalmellington..ills; Gre K as; Wo s Kin k d ds; n ld la ie Mon h Patna; Newm od s ld o k O Port Dun llo W o P rcus; Ci rk Pa Postcode sector

58 Glasgow’s asylum seeker and refugee population It is worth noting also that the number of asylum seekers and refugees living in Glasgow has risen rapidly in recent years with the total number standing at 12,500 in December 20045. Currently children from asylum seeking and refugee families make up approximately 6% of the city’s under-five population.

3.7 Births

The previous chapter commented on the long-term downward trend in the city’s birth rate. In this section we examine the variation in birth rates across West of Scotland communities (Figure 3.23). In Scotland over the period 2000-2002, the birth rate was 4.8 per 100 women aged 15-44, while across the West of Scotland communities the birth rate varied from 3.6% in Glasgow West End to 5.9% in Greater Shawlands.

Figure 3.23

Birth rates per 100 females aged 15-44 years, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from GROS data)

5.9 6 5.3 5.4 5.4 5.1 5.2 5.0 5.0 5.0 5.0 5.0 5.1 5.1 4.8 4.9 4.9 4.9 5.0 5 4.7 4.7 4.7 4.8 4.8 4.5 4.3 4.1 4 3.6

1 Birth rates per 100 females aged 15-44 years

d d e e e n l ir w w w e ds vie ir lley o o ire aw n land lyde sh h shir g ilto g h ap h rwell ga mon rc rs r s s h la o e esdale asgo w L v Ay nVa rews Wis atbridge Scot rathkelvinMiln n t Ham Gla f o bernauld I h Ayr s thAy m Mothe Eastwood wWestEn St n/ Clyd r ver st Gla N Gl st u e East Kilbride ern Glasgowo e & a Drumc r Sha o d Ea N L Ren & C te rs Sout a East nd th We th E nk rie & C ea eton & Dennistoune a u a r Glasg g West G /B So Sou & eb Aird nd d Brid la s Paisley frew Cly ie Cambuslang and Rutherglenyhill/Woodside r Ren Ann Ma

Community

At a postcode sector level, not surprisingly, the variation in birth rates is far greater (Figure 3.24). The lowest birth rates occur in parts of the West End and in the Townhead and City Centre areas.

59 Figure 3.24

Birth rates per 100 females aged 15-44 years, 2000-2002, Comparison of 10 small areas with highest rates and 10 with lowest rates West of Scotland and Greater Glasgow Source: NHS HS - Community Health Profiles (from GROS data)

7.8 8 7.7 7.0 7.2 6.8 6.8 6.8 6.8 7 6.6 6.7

6 4.8 5

4 2.9 2.6 2.6 2.8 2.8 3 2.4 2.5

2 1.5 1.7 1.2 1 Birth rates per 100 females aged 15-44 years 0

l d d l ll N n r and hi n N to l hea hea i ungo llatu ot l dside ork tickhi lv nlaw.. b c il o Y r ki emilk E head wwood ous S H Ke c l k Wo Pa st r ath Ho ; Fenwick lah Town City Centre r s Kelvingrove Bridgeton EPa DalmarnockSt ig el ge; Du s; WoodlandsMeadowside Kno Ca a a ll; ds; B Vill el d tonhi Dunda outhcr aul rt Al S shi n lok er Po ol b P Cum Postcode sector

The reasons for this require further study, but the affordability of housing for young families and the type of housing available in these areas – much of which is designed for, or at least more attractive to, single people or couples without children – is likely to be important. The areas with the highest birth rates are quite mixed, including parts of the East of Glasgow (Bridgeton E, Parkhead N, Dalmarnock), the Southside (Strathbungo, Pollokshields & Bellahouston) and areas outside Glasgow that are within easy commuting distance (Howwood, Cumbernauld Village).

3.8 Deaths

Infant deaths In the previous chapter the large fall in infant mortality rates over the last 150 years was noted. In this section we examine the variation in infant death rates across the West of Scotland. The rate of infant deaths across West of Scotland communities in the period 1999-2002 varied quite markedly from 3.5 (per 1,000 live births) in Motherwell to 10.1 in Bridgeton & Dennistoun (Figure 3.25). Although the actual numbers of deaths underlying these rates are low, because infant deaths are so relatively rare now, some of the differences between communities may be worthy of further investigation.

60 Figure 3.25

Infant deaths per 1000 live births, 1999-2002 West of Scotland and Greater Glasgow Communities Source: NHSHS Community profiles (from GROS data) 12.0

10.1 10.0 9.0 8.0 8.2 8.0 7.1 7.1 6.7 6.2 6.3 6.4 5.8 5.9 5.9 6.0 5.3 5.4 5.5 5.5 5.0 5.1 4.7 4.3 4.4 4.4 4.5 4.0 4.1 4.0 3.5 % of all household spaces 2.0

0.0

l n e n w le y d re e re ow od lle ire ul nd i nds avi g o dge a o End erwell la ri rsh t sgow h ng b wsh rna s a aw at Wisha re Lom Ayrshi Ay e nnistoun Scotland Hamilto h Mil CamglenEastw lydesda t W e Mot / Co C nf h Inverclyds rumchape st Glasgow N Gl Strathkelvi evern V D w er S en & East Kilbride Re Cumbe ort Ea & t d N & South Ayrshire h West Glasgowrs rie st k sgo th Ea de t rea Eastern Glas nd L e la u W G G /Bea Aird ya ban So odsi geton & D Sou e & o d and w yde /W Bri Paisl re Cl ill esl nf h e R ry Anni Ma Community

Deaths Across the West of Scotland there was a two-fold variation in death rates in 2000- 2002 (see Figure 3.26), ranging from 428 and 454 per 100,000 in Anniesland, Bearsden & Milngavie and Eastwood, respectively, to more than double these rates in Maryhill, Woodside & North Glasgow (897 per 100,000) and Bridgeton & Dennistoun (965 per 100,000). From this it is clear that Greater Glasgow not only has the communities with the highest mortality rates in Scotland, but also those with the lowest mortality.

Figure 3.26

Death rates per 100,000 population, directly age standardised, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from GROS data)

1200

1000 965

800

600

428 400

200 Age standardised death rate per 100,000

e e e e e e s n n w l e y w w vi re nd r e nd d le ow and ood hir hi hir lto E go wel y l go oun l brid s s and i t r apel l go g ot tw il h Va as ist c ilnga wl es las he erc las S as K Ayr bernauld Lomo Ayrshi Ham Wishaw mc v rn Glas E trathkelvin h t G u In e t G Clydesdalth nfrews t Ruthergl Mot rn Gl N en/M East S um ast Ayr w W C Re E d Lev te d Sou Nor go & Dr e & Coatbridge st ater Sha ri as e e las uth Eas nk nd E ears ng an G o ird a uth Wes W Gr la S A o d/B ley S w & us s lan e ai /WoodsideBridgeton & & Denn fr Clydeba P ies Camb ryhill nn Ren a A M Community

61 At a postcode sector level the differences are magnified further with three- to four- fold variations in mortality between the ten areas of lowest mortality and the ten of highest mortality. Of the twenty areas in this analysis of extremes, only three lie outside Greater Glasgow, emphasising the huge polarity in health that exists across the city and often between adjacent areas. In the five areas with the highest mortality rates, it is double the Scottish average.

Figure 3.27

Death rates per 100,000 population, directly age standardised, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from GROS data) 1600 1475

1400

1200

1000

800

600

350 400

Age standardised death rate per 100,000 200

k rt n h n k n k d ill n lm c a o r o a h o o ton o c t oc to am rox d N e c ock c s h rl s h Ib a h u rk S n nn t a e llart n r Calt a gals les h u lie Par w R Pa Scotland mu C u B Hou rk F g lma Kilma Clark r o us To a a D ie - Eag Pa g Hamiltonhillnin D C v er e; a F n ftfoot; Linn Pa Kin to ilng arsden - Kessington M Cro e B - Keys ie v a

Milng Postcode sector

Death trends Despite Glasgow’s well-recorded poor health status, the trend in mortality for those aged 15-74 is favourable for both males and females, as Figures 3.28 and 3.29 show. The key issue, however, is that Glasgow’s mortality rate is not reducing at the same rate as Scotland’s, and the excess mortality in Glasgow compared to Scotland has actually increased over the last 30 years among men and women.

62 Figure 3.28

Male death rates per 100,000 population, directly age standardised, aged 15-74 years, 1974-2003, NHS Greater Glasgow Source: calculated from GROS deaths data 1600

1400 Greater Glasgow Scotland

1200

1000

800 te per 100,00 population year Ra

600

400

1 3 4 6 9 74 76 77 78 79 80 8 82 8 8 85 8 87 8 90 92 95 97 00 02 03 9 9 9 9 0 19 1975 19 1 19 19 1 19 1 19 19 1 19 19 1988 19 19 1991 19 1993 1994 19 1996 19 1998 1999 20 2001 20 2

Figure 3.29

Female death rates per 100,000 population, directly age standardised, aged 15-74 years, 1974-2003, NHS Greater Glasgow Source: calculated from GROS deaths data

1000

900

Greater Glasgow Scotland 800

700

600

500

400 Rate per 100,00 population per year per population 100,00 per Rate 300

200

100

6 7 8 4 5 6 2 3 74 75 79 80 81 82 83 8 8 8 89 90 91 9 9 9 97 98 99 0 0 9 9 9 9 9 9 9 1 1 1976 1977 1978 19 19 19 1 1 1984 1985 19 19 19 19 1 1 1992 1993 19 19 19 19 19 1 2000 2001 20 20

63 Figure 3.30, which displays the mortality trend for communities within Greater Glasgow over the last ten years, highlights the varied health trends within the region over this period. Across Scotland there was a 15% reduction in mortality between 1991/93 and 2000/02. However, while the mortality reductions in some parts of Greater Glasgow exceed this (-21% in Anniesland, Bearsden & Milngavie), in other communities the reductions have been very modest (-4% in Maryhill, Woodside & North Glasgow; -1% in Bridgeton & Dennistoun). It is also clear from the graph that, because of these differential reductions in mortality, the mortality gap between the communities with the highest and lowest mortality has increased.ix

Figure 3.30

Death rates per 100,000 population, directly age standardised, 1991/93 - 2000/02 Greater Glasgow Communities Source: NHSHS Community Health Profiles (from GROS deaths data) 1,100

Bridgeton & Dennistoun 1,000 Maryhill/Woodside & N Glasgow

900 South West Glasgow

Eastern Glasgow

800 Clydebank & Drumchapel

South East Glasgow lity Rate per 100,000 population 700 Glasgow West End

Cambuslang and Rutherglen

600 Greater Shawlands

Scotland

500 Strathkelvin Age Standardised Morta Age Standardised

Eastwood

400 Anniesland/Bearsden/Milngavie 1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002

3.9 Life expectancy

In this section we examine recent trends and patterns in life expectancy in the West of Scotland (at a council, community and postcode sector level), trends in life expectancy by deprivation and patterns of healthy life expectancy.

Life expectancy at a council level Male life expectancy at birth in Glasgow was most recently calculated as 69.1 years6 (see Figure 3.31), four years less than the Scottish average and eight years short of the life expectancy in East Dunbartonshire (77.2 years).

ix Note that there are major differences in the definitions and calculation methods relating to the figures presented in Figures 3.28 and 3.29, and those in 3.30. Thus, the rates in the two sets of graphs are not directly comparable. All definitions are included in Appendix 1.

64 Figure 3.31

Male life expectancy at birth, 2001-2003, West of Scotland council areas Source: Office for National Statistics 78 77.2

76.0 76

74.0 74.0 74 73.5

72.5 72.7 71.9 71.9 72 70.8 70.2 70 69.1

68 Life Expectancy at birth (years)

e e e e e ty d ir ir ir ire ire h h h tland ly sh s sh s o wCi c rs k o er on y yr r w Sc g v rt A A a re s a h h f In b st Ayrshire t an la n a rt u G u Renfrewshire E o o D N S th L t u s o e North Lanarkshir S East Ren W East Dunbartonshire Council

Trends in male life expectancy for West of Scotland councils from 1991-93 onwards have been upward in every council, although the rise has been steeper in some areas than others (Figure 3.32). There was a rise of 3.2 years in male life expectancy in East Dunbartonshire compared to a more modest rise of 0.9 years in Glasgow and 0.6 years in Inverclyde over the ten years to 2001-03.

Figure 3.32

Male life expectancy at birth, 1991-1993 to 2001-2003, West of Scotland council areas Source: Office for National Statistics 78

East Dunbartonshire

76 East Renfrewshire South Lanarkshire South Ayrshire 74 Scotland North Ayrshire East Ayrshire 72 Renfrewshire North Lanarkshire

70 West Dunbartonshire Life Expectancy at birth (years) Life Expectancy Inverclyde Glasgow City 68

66 1991-1993 1992-1994 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003

65 Female life expectancy varies from 76.4 years in Glasgow (two and a half years less than for Scotland) to 81.1 years in East Renfrewshire (Figure 3.33). This represents a four and a half year gap but is much less than the eight year variation in male life expectancy that occurs across the West of Scotland at a council level.

Figure 3.33

Female Life Expectancy at Birth (years), 2001- 2003 West of Scotland council areas Source: Office for National Statistics 82.0

81.1 81.0 80.5

80.0 79.3

79.0 78.9 78.5 78.5

78.0 78.1 78.0 77.8 77.4 77.4

77.0 76.4

Life Expectancy at birth (years) 76.0

75.0

74.0

e e e e e ire r ire ire City hir lyde h hire hir hir s sh c rs s rk n ws to Ayrshi ton e Scotland na r t frewshir narksh r a a Inver thAy a h Ayrs nfr lasgow L nb as r L G h u E Ren h Re rt No t Sout t o tD s s N e Sou Ea W East Dunba Council

The trends in female life expectancy have been upward overall over the ten year period from 1991-93 to 2001-03 but, while there was a rise in life expectancy for women in Inverclyde of 2.3 years over the period, the rise in West Dunbartonshire was only 0.3 years (Figure 3.34).

Figure 3.34

Female life expectancy at birth, 1991-1993 to 2001-2003 West of Scotland council areas Source: Office for National Statistics 82

81 East Renfrewshire East Dunbartonshire

80 South Ayrshire Scotland North Ayrshire 79 South Lanarkshire Renfrewshire 78 East Ayrshire Inverclyde 77 North Lanarkshire West Dunbartonshire Life Expectancy at birth (years) Life Expectancy 76 Glasgow City

74 1991-1993 1992-1994 1993-1995 1994-1996 1995-1997 1996-1998 1997-1999 1998-2000 1999-2001 2000-2002 2001-2003

66 Male life expectancy at community and postcode sector level The life expectancy graphs to a great extent mirror the death rate patterns, but add extra information on gender related health inequalities. For men, the life expectancy differences at a community level across the West of Scotland are large (Figure 3.35). In Bridgeton & Dennistoun life expectancy for a man at birth was estimated to be less than 64 years (in 1998-2002). Glasgow communities occupy the first six positions in order of lowest male life expectancy across the West of Scotland. At the other end of the spectrum three communities in Greater Glasgow have the highest male life expectancy within the West of Scotland – Strathkelvin, Anniesland, Bearsden & Milngavie and Eastwood. The 15 year gap in male life expectancy between Bridgeton & Dennistoun and Anniesland, Bearsden & Milngavie highlights the differences in life circumstances, lifestyles and life chances that exist in the city.

Figure 3.35

Male life expectancy at birth, West of Scotland and Greater Glasgow communities, 1998-2002 Source: NHSHS Community Health Profiles 80 78.7

75 73.3

65 63.5

Estimated Life Expectancy at birth 60

n w l e d s d e d e u o d ell d n l g En dge w ood to s t i gavi s chape rcly s br er tw n e Wishaw Lomo Ayrshire s Scotland v oat oth Hamilton a um In hawlan mbernau E /Mil Denni C M S u Clydesdale Strathkelvin n & er East AyrshirC East Kilbride e & N Gla East Glasgow Levern gowValley We t North South Ayrshire d d rie & rsde th West EasternGlasgow Glasgowth las d a bank & Dr G Grea odsi Sou e Sou ey an Air o d y sl Bridgetonl/W ambuslang & Rutherglen Cl Pai C ryhil Renfrew & West Renfrewshire Anniesland/Be Ma Community

At a postcode sector level the differences in life expectancy widen further (see Figure 3.36), although it should be borne in mind that estimates for these areas, which have populations of 3,000-5,000 on average, have wide confidence limits. In three postcode sectors male life expectancy is actually estimated to be less than 60 years, while in the sectors with the highest life expectancy, it is estimated that men will live for 20 years longer.

67 Figure 3.36

Male life expectancy (LE) at birth, 1998-2002 Comparison of 10 small areas with highest LE and 10 with lowest LE West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles

90 81.7 82.6 79.3 79.4 79.6 79.7 79.9 79.9 80.9 81.1 80 73.3 70 61.4 61.9 62.2 62.5 62.9 63.1 58.0 59.9 60.2 60 53.9 50

Estimated Life Expectancy at birth 10

l l l s y rn y m n h ton al on l on o c and ead nhi l NE nn Ba st tl al h o uchil ad S e ho gt C lt R e orb T co i h G Yorkhill yss ou larkst enzie N S lmarnock m rk mardi H ilmaco L - Barlo Town l m K C Ha Bridgeton E Pa on; e e Da t hopbriggs W W - Kessin s is n Drumchap B ade en - Ki Tr Milngavi arsd Be Bearsde arsden - Castlehill; e B Postcode sector

From life expectancy data it is also possible to estimate the likelihood of a 15 year old boy reaching his 65th birthday. This is again an estimate with wide confidence intervals but re-emphasises the differences in health across Greater Glasgow (Figure 3.37). In Bridgeton & Dennistoun, it is estimated that just 53% of 15 year old boys will reach their 65th birthday, while in Eastwood and Anniesland, Bearsden & Milngavie the estimates are that at least 87% are likely to reach this age.

Figure 3.37

Percentage of 15 year old boys likely to reach their 65th birthday, 1998-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles 100%

88% 90% 87%

82% 82% 80% 81% 81% 81% 79% 78% 78% 78% 80% 77% 77% 74% 74% 74% 75%

% 72% 72% 70% 70% 70% 70% 69% 66%

60% 60%

53%

50%

y e e e e e in ie nd ow le ge ds ell nd al r v a g yde apel al End d w ilton d a tl s cl h t lan er mo rshir shir s rshir shi o a c s w e y lng n V atbri th Wishaw Lo Ay ew am d thkelv i Sc Gl m r o r H y Ayr a M n Inver e We h Eastwood N Glasgow v w Mo rt enf Cl Str Le o Cumbernauld East A East Kilbride & ter Sha N t R South de ng & Rutherglen s Easter asgo ea a dsi ank & Dru Gl Gr b South East Glasgow Airdrie & C usl We South West Glasgow ey and b & d/Bearsden/ isl n Bridgeton & Dennistoun am ew ll/Woo Clyde Pa C fr yhi en niesla ar R M An Community

68 Female life expectancy at community and postcode sector level While female life expectancy is higher than for men, the differences between communities are still marked, although with much less variation (Figure 3.38). The gap between the communities with the lowest female life expectancy (Maryhill, Woodside & North Glasgow and Bridgeton & Dennistoun) and those with the highest (Anniesland, Bearsden & Milngavie and Eastwood) is seven to eight years.

Figure 3.38

Female life expectancy at birth, 1998-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles 85

82.2 81.4 80.2 79.8 80 78.7 78.7 78.9 78.9 78.2 78.3 78.5 77.2 77.3 77.3 77.3 77.4 77.5 77.5 77.5 76.8 76.8 77.1 77.1 75.9 75.2 75 74.1 74.4

70 Estimated Life Expectancy at birth

ll n w w el w n e d w e d re le re n e d p lley e ds ire ul lvi id o ha w n idge hir h e stou is er s na shi k lbr i asgo asgo tbr lasgo r W n Va est En a Ayrs Lomond ewshi Ki Scotland Glasgow Gl Gl r Hamiltonoth G be fr ath t enn t n e W t Inverclyde th Ayr r s Eastwo N D s v M s ast Ayr um Clydesda St ter Drumcha ow E C Ren Ea s & g ter Shawla North t Sou n & h We k d Le s a rie & Co s Ea n an a uth Ea eto ut Gl o y Gre Aird S dg So & We w /WoodsideBri & ambuslang & Ruthergl Clydeba Paisle C fre Ren Maryhill Community Anniesland/Bearsden/Milngavie

At a postcode sector level, the gap between areas with the lowest and highest female life expectancy is wider, around 14 to 15 years (see Figure 3.39). The areas of highest female life expectancy are quite geographically spread and most are affluent. In contrast, the areas of low female life expectancy are all areas of long-standing deprivation and the majority are in Glasgow. However, it is worth noting that these estimates of life expectancy for small areas have wide confidence intervals.

69 Figure 3.39

Female life expectancy (LE) at birth, 1998-2002 Comparison of 10 small areas with highest LE and 10 with lowest LE West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles

90 83.2 83.3 83.6 83.9 83.9 84.0 84.1 84.2 84.3 84.4 78.7 80 71.7 71.7 71.7 68.8 69.2 69.9 70.5 70.5 70.7 71.0 70

Estimated Life Expectancy at birth at Expectancy Life Estimated 10

l k n n nd ox r ie ill an lm rt m a r to h a a ton ur tl nhil nock ouse c ston h g b o llarton to r uchill Ib h ass ing th k s l use W R lie Pa oys le Sc Fu mil s Bar of Arr Ca lar Ke a ho ; R e ; Balmore C alma er gu d Park Kilmaco e Eag ie; H D st ns; c irl Fer nga ra; Rodd ; Isl Ea Easterhouser E en - KessinFa nd d ; Ga ; Loa la d s Torran ide e; Dou I hea i ns ir Bears e u Holy Gl M n- roo T Perceton; Sourl Postcode sector

From the life expectancy calculation it is also possible to estimate the likelihood of a fifteen year old girl reaching her 65th birthday. This is an estimate with wide confidence intervals but again re-emphasises the differences in health across the city. In Bridgeton & Dennistoun, it is estimated that 79% of 15 year old girls will reach their 65th birthday, while in Eastwood and Anniesland, Bearsden & Milngavie the estimates are that at least 92% are likely to reach this age (Figure 3.40).

Figure 3.40

Percentage of 15 year old girls likely to reach their 65th birthday, 1998-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles 100%

92% 92% 90% 88% 88% 89% 89% 90% 87% 87% 87% 87% 84% 84% 84% 85% 85% 85% 85% 85% 85% 83% 84% 84% 81% 81% 79% 80% 79% %

70%

60%

50%

l ll w w e n e e e re d n le e d ie o ow lley e ton i ul lvi id v g haw g a nds w hir h ond a e oo s is s a t End ridg s rshire m lbr asgo a tb er mil rn k esda nga W a ews Lo e d Ki il Scotland Glasgow Gl oa oth H fr rath ly t t M Inverclyde s Eastw N s w Wes en St C tern Gla Ea en/M East Gl o & C East AyrNorth Ay R Cumb d n & Dennistoun We s & Drumchap ater Shawl ie t South Ayrshire k e s to Ea uth and Levern V uth Glasg rdr So y Gr Ai /Bears idge So e & We d w Br /Woodside & ambuslang & Ruthergl e lan Clydeban Paisl C fr s ie en n R Maryhill An Community

70 Life expectancy by deprivation As part of our analysis of life expectancy we examined trends in life expectancy in relation to deprivation. Two analyses were designed to examine the gap in life expectancy between the most and least deprived communities in Greater Glasgow (as measured by Carstairs deprivationx quintile) between 1981 and 2001.

The first analysis set out to measure differences in life expectancy by defining the postcode sectors in Greater Glasgow’s most and least deprived quintiles in 1981 and using the same sets of sectors to represent the most and least deprived quintiles from 1981 through to 2001. The second analysis assigned postcode sectors in Greater Glasgow to the most and least deprived quintiles as measured at each Census from 1981, 1991 and 2001. Thus, while in the first analysis areas (postcode sectors) in each quintile remained fixed, in the second new areas could appear in the most and least deprived quintiles. In fact the two analyses produced very similar results and for this reason the following description describes the results of only one of the approaches (the first analysis) in depth.

Two features of this analysis are important: the trends in life expectancy by deprivation quintile and sex, and the change in the gap in life expectancy between the most and least deprived quintiles. A third trend, which underlies the approach taken, is the change in population of each quintile over time, remembering that the same postcode sectors remain in each quintile between 1981 and 2001.

In summary the most notable trends for males (see Figure 3.41) are that: x Male life expectancy in the most affluent quintile in Greater Glasgow was nearly three years better than the Scottish figure in 1981 and has remained in this position over the last 20 years, having risen in parallel to the Scottish trend. x Males in the most affluent parts of Greater Glasgow can now expect to live to over 76 years, while in Scotland as a whole men can expect to live to just over 73 years. x By contrast, in the most deprived quintile, life expectancy is estimated to have dropped slightly in the last 20 years from 65.3 years to 64.4 years.

As a result of these opposing trends, the gap in life expectancy for men in Greater Glasgow has widened from 6.9 years to 11.8 years. In other words, the gap in male life expectancy between the most and least affluent parts of Greater Glasgow has widened by five years over a twenty year period.

x Carstairs deprivation scores were originally developed by Vera Carstairs and Russell Morris. See the MRC Social and Public Health Sciences Unit website for more details: http://www.msoc-mrc.gla.ac.uk/Publications/pub/Carstairs_MAIN.html.

71 Figure 3.41

Estimates of male life expectancy, least and most deprived Carstairs quintiles, 1981/85 - 1998/2002 (areas fixed to their deprivation quintile in 1981) Greater Glasgow Source: calculated from GROS death registrations and Census data (1981, 1991, 2001) 85 Males -Dep Quin 1 (least deprived) Males - Dep Quin 5 (most deprived) Scotland Males 80

76.2

75 73.9 73.3 72.2 71.2

69.4 70

Estimated life expectancy at birth 65.3 64.8 64.4 65

60 1981-1985 1988-1992 1998-2002

The trends in life expectancy for women are similar (see Figure 3.42) but not as pronounced. Life expectancy for women in the most affluent quintile has risen (by approximately three years) and remains higher than for Scotland as a whole, but the difference from the Scottish average has narrowed slightly. Life expectancy of women in the most deprived quintile has improved but only by one year over a twenty year period, and so the gap in life expectancy between women in the most and least deprived communities of Greater Glasgow has widened from 5.5 to 7.5 years.

Figure 3.42

Estimates of Female Life Expectancy, least and most deprived Carstairs quintiles, 1981/85 - 1998/2002 (areas fixed to their deprivation quintile in 1981) Greater Glasgow Source: calculated from GROS death registrations and Census data (1981, 1991, 2001) 85 Females - Dep Quin 1 (least deprived) Females - Dep Quin 5 (most deprived)

Scotland Females 79.6 80 77.8 76.5 78.7 77.0 75

ancy at birth 74.9 72.1 71.6 71.1

70 Estimated life expect

60 1981-1985 1988-1992 1998-2002

72 Over twenty years the change in the populations of each quintile – whose areas were fixed to their 1981 positions – is both dramatic and contrasting. The population of the most deprived quintile was 203,677 in 1981, dropped to 150,821 in 1991 and then reduced further to 120,240 in 2001. This represents an overall drop of over 83,000 or 41% in the 20 year period. In contrast, the population of the most affluent quintile increased slightly over the period from 194,239 to 207,571, a rise of over 13,000 or 7%. Another way of describing this change is to note that, while in 1981 the population of each quintile, by definition, accounted for 20% of the population of the region, by 2001 the population of the most deprived areas (as defined in 1981) represented only 14% of the Greater Glasgow population and the population of the most affluent areas had risen to 24% of the total.

These trends are open to a number of interpretations. However, it is safe to say that the population trends do reinforce the often-noted observation that the population of many of the deprived parts of Glasgow has dropped significantly. This pattern may also partly explain the worsening life expectancy trends of males in deprived areas if it is believed that those who left were generally in better health, with better education and better employment prospects.

Healthy life expectancy Healthy life expectancy is the best estimate of years of life without a limiting long- term illness. Figures recently published by ISD Scotland7 show that across the West of Scotland there is almost a twelve year gap in male healthy life expectancy between Glasgow (46.7 years) and East Renfrewshire (58.5 years) (see Figure 3.43)xi. The average number of years of life lived with a limiting long-term illness varies between 17 and 25 years among the West of Scotland councils.

Figure 3.43

Estimated healthy life expectancy at birth and years of life with a limiting long-term Illness Males, West of Scotland council areas Source: ISD Scotland (based on 1999 & 2000 Scottish Household Surveys data, population estimates & deaths)

90 Years of life with a limiting longterm illness 80 Healthy life expectancy at birth

70 19.7 17.6 20.8 19.2 20.2 17.8 19.2 60 25.8 24.9 22.5 19.6 21.8

Years 40

30 58.5 53.8 53.8 56.5 50.5 52.6 53.2 53.6 46.7 46.8 46.8 48.3 20

y e e e e e it ir ir ire ir ir ire C h lyde h h h h sh s c rshire s s w rk n y yr rkshire n to to Scotland na r A frews na r frews a a Inver h hA a a lasgo L b G nb East Ayrshir Nort Ren u rth Sout uth L o o D N S East Ren West Dun East Council

xi Note that the blue part of each column shows years of 'healthy life expectancy' (HLE), while the maroon section indicates the estimated number of years of life with a limiting long-term illness (LLI). The overall height of each column indicates overall life expectancy at birth.

73 For women in the West of Scotland, the gap in healthy life expectancy is equally pronounced (see Figure 3.44): there is an eleven year difference in healthy life expectancy between North Lanarkshire (50 years) and East Renfrewshire (61 years). The estimated number of years of life lived with a limiting long-term illness varies between 20 and 27 years among the West of Scotland councils.

Figure 3.44

Estimated healthy life expectancy at birth and years of life with a limiting long-term Illness Females, West of Scotland council areas Source: ISD Scotland (based on 1999 & 2000 Scottish Household Surveys data, population estimates & deaths) 100 Years of life with a limiting longterm illness 90 Healthy life expectancy at birth 80

19.7 70 22.1 21.5 21.6 22.2 22.8 21.6 20.7 24.3 27.5 24.3 24.2 60

50 Years 40

30 61.0 56.9 55.5 55.6 55.6 56.3 57.0 57.8 51.5 50.0 52.1 53.0 20

e e e e nd ty r ire ire r ire re r r a hi h hi hi s rsh clyde ns rsh ow Ci y er y ws Scotl g to e nark Inv ar fr las b nfrews bartonshi G La East A outh Ayrshire Re rth S North A Dun outh Lanarkshi t ast Ren No S as E West Dun E Council

The calculation of healthy life expectancy for regions of Scotland is a relatively recent innovation and reveals important information. First, it is striking how relatively young people in Scotland are when they are first affected by limiting long-term illness. Second, although the data are not shown here, there has been little growth in healthy life expectancy while life expectancy has been rising. The result is that the length of time that people are living with illness is rising; thus, contributing in turn to the increasing demands on health and social services.

74 Summary x The city of Glasgow, with a population of 577,000, and Greater Glasgow NHS Board area, with a population of 867,000, are the largest council and NHS Board, respectively, in Scotland. x Glasgow City, compared to other West of Scotland councils, has one of the lowest proportions of ‘under 16s’ in its population but the highest proportion of people of ‘working age’. x In Glasgow, the proportions of men and women of ‘pensionable age’ are strikingly different: 22% of women compared with 12% of men. x Glasgow has a low dependency ratio in comparison to other West of Scotland councils and to Scotland as a whole. Projections predict an increase in the dependency ratio for the country as a whole and this is mirrored in most of the West of Scotland councils with the exception of Glasgow, which is predicted to maintain an unchanged and relatively low dependency ratio up to 2024. However, this (theoretically) healthy economic profile does not take account of people of working age not working or unable to work due to incapacity, of which Glasgow has a high proportion currently (as outlined in Chapter 10: Health and function). x Looking ahead to 2024, many of the West of Scotland councils are expected to show population decreases. The greatest decreases are predicted for Inverclyde, which is expected to lose 13.6% of its population between 2004 and 2024, and for East Dunbartonshire (-10.5%). Glasgow City is set to lose 4.4% of its population, equating to a reduction of around 25,000 people. x In Glasgow, the number of children under 16 is set to reduce by 13,000 or 13% in the period 2004-2024. Over the same period it is predicted that the population in the 16-49 age range will reduce by 11% (a reduction of 33,000 people), whereas the population aged 50-64 is set to grow by 24%. However, unlike the overall Scottish pattern, the population in older age groups (65 years and above) is predicted to remain relatively stable, rather than increasing as elsewhere. This, in part, may reflect the relatively low life expectancy in parts of Glasgow. x Despite the prediction of a continuation of falling populations, household numbers are predicted to rise as single adult households increasingly dominate. It is predicted they will account for 49% of all households in Glasgow by 2016. Lone parent households are also predicted to increase and may soon make up almost one in two of households with children (48% in Glasgow by 2016). x Trends in overall death rates are downward, but the rate of this reduction has varied greatly across Glasgow in the last ten years such that the mortality gap between the communities with the highest and lowest mortality has widened noticeably. At a small area level, there are three- to four-fold variations in mortality between the areas with the lowest and highest mortality.

75 x Life expectancy trends and local variations mirror the mortality rate patterns: people are living longer, but across West of Scotland councils there is an eight year gap in male life expectancy with Glasgow having the lowest life expectancy (69.1) and East Dunbartonshire (77.2) the highest. Trends over the last ten years show that the gap in male life expectancy has widened. Female life expectancy, while better than male life expectancy, displays a gap of around four and a half years across the West of Scotland councils. x Within Greater Glasgow, the polarity in life expectancy is clear: for instance, there is an estimated 15 year gap in male life expectancy between Bridgeton & Dennistoun and Anniesland, Bearsden & Milngavie, highlighting the differences in life circumstances, lifestyles and life chances that exist. The likelihood of a boy of 15 in Bridgeton & Dennistoun reaching his 65th birthday is little better than one in two (53%), based on current mortality rates. x At a small area (postcode sector) level there is an estimated gap in male life expectancy of at least 20 years between those areas with highest and lowest life expectancy, and a 15 year gap for females. x Over the last twenty years, the life expectancy at birth of the 20% most affluent and 20% least affluent communities has diverged markedly, particularly for men. For example, male life expectancy in the most affluent parts of Greater Glasgow has risen to over 76 years, compared to just over 73 in Scotland as a whole; while in the most deprived quintile, life expectancy is estimated to have dropped slightly in the last 20 years from 65.3 years to 64.4 years. As a result of these opposing trends, the gap in male life expectancy between the most and least affluent has widened to nearly 12 years. x The trends in life expectancy for women, in relation to deprivation, are similar, but not as pronounced. The gap in life expectancy between women in the most and least deprived communities of Greater Glasgow has widened to 7.6 years. x There is an 11 to 12 year gap in years of healthy life expectancy across the West of Scotland, for men and women. It is notable how relatively young people are, on average, when first affected by limiting long-term illness and how long people live with a limiting long-term illness, particularly women – estimates vary between 20-27 years across West of Scotland councils.

In conclusion, it is clear that in comparison to Scotland and the rest of the West of Scotland, Glasgow is already quite distinct in terms of its population and household structure. Predictions suggest that these differences may be further accentuated in the future (e.g. percentages of lone parents, single adults, dependency ratios). It is also clear that, despite overall reductions in mortality, huge health inequalities remain and indeed such inequalities appear, on the basis of a number of different mortality and life expectancy measures, to have widened over the last ten to twenty years.

76 References

1 General Register Office for Scotland, Mid-2004 Population Estimates, Council and Health Board Areas. 2005 http://www.gro-scotland.gov.uk/statistics/library/mid-2004-population- estimates/index.html

2 NHS Health Scotland. Community Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/communityprofiles

3 General Register Office for Scotland. Projected Population of Scotland (2004 Based). 2005 http://www.gro-scotland.gov.uk/statistics/library/popproj/04population- projections/index.html

4 General Register Office for Scotland. 2002-based Household Projections. 2005 http://www.gro-scotland.gov.uk/statistics/library/household-estimates- projections/2002-based-household-projections.html

5 Personal communication from Ann MacDonald, NRCEMH (The National Resource Centre for Ethnic Minority Health) and Margaret Hanlon, Fernbank Medical Centre

6 Office for National Statistics. Life expectancy at birth by health and local authorities in the United Kingdom. http://www.statistics.gov.uk/STATBASE/Product.asp?vlnk=10860

7 Clark D, McKeon A, Sutton M, Wood R. Healthy life expectancy in Scotland. 2004 http://www.isdscotland.org/isd/info3.jsp?pContentID=2860&p_applic=CCC&p_

Chapter 4: Economic factors kless (54% of the Scottish total), City alone contributedkless (54% and Glasgow 85,000 r eatly over the lasteatly four over to five years. The gap in pay between the paid is widening highestThe gap in pay between and the lowest The proportion population in the social classes has top of Glasgow’s two enfrewshire to 28% in Glasgow City – over 160,000 of the population. city’s 160,000 City – over to 28% in Glasgow enfrewshire han 45,000 jobs in thehan 45,000 jobs period 1998-2004. “In 1993, for history, the first there time in Glasgow’s more women were “In 1993, in jobs than men.” “ nationally and in Glasgow.” “ four ten out of adults in so that in 2001 more than doubled since 1981 classified as either were Social Class I or II.” Glasgow people or 19% of the Scottish total. people or 19% Income for those both has risen work in years, nationally in recent and in Glasgow. income inequalities widening, with are those in the best-paidHowever occupations in terms and far of pay. absolutely, more, having gained relatively, more, of the estimated population are in ‘income to live of Scotland 19% theAcross West This figure greatly varies in East 8% from Dunbartonshiredeprivation’. and East R City has double theGlasgow rate national of pupils eligible for school free meals (42%). House prices risen have where hugely areas in the in many last and to ten a level years affordability become a very has issue, especially real incomes. for those on lower greater numbers of households with towards access to trend has been an overall There of Scotland and the across West but there large in access levels variations are a car, especially. Glasgow population in the thanThe proportion has more social classes top two of Glasgow’s population were four out of ten of Glasgow’s so that in 2001 doubled since 1981 classified as either Social Class I or II. and some partsWhile the middle class has grown city’s of the greater from city prosper in other and higher wages, employment parts seen little improvement have Glasgow of circumstances. It is estimated that there are 110,000 adults in Glasgow who are not economically not who are adults in Glasgow It is estimated that there 110,000 are equating toactive, 30% of the age working population. definedIn 2002, 235,000 adults in the or deprived’ were as ‘employment region wo The official rate and the both unemployment rate have claimant unemployment reduced gr Summary retained has withinposition a Glasgow the as a major UK and is rated business centre second only to as a retail London centre. economy, The service in Glasgow’s to of predominance a position sectorhas grown the bulk of the and employment. economic output providing city’s and part-time than in Glasgow women men in employment more work now are There than more to a quarter represent has grown of all jobs. more – by years in recent has grown in employment residents The number of Glasgow t Guide to data presented in this chapter % of dependent children living in hous eholds where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 4: Economic factors

The economy globally, nationally and locally has a major impact on people’s lives and so it is important to consider the role of economic factors in shaping health at a population level. Thus, patterns and trends in economic output, social class, unemployment and income are all relevant to understanding health in Glasgow and the West of Scotland.

To cover this large and important area we start with a brief overview of Glasgow’s current business and labour market. This is followed by a more detailed description of the economic position of Glasgow (and West of Scotland) residents in terms of unemployment, economic inactivity, income levels, income related benefits, house prices, some aspects of deprivation and social class.

4.1 Business and labour market overview

The Glasgow Economic Monitor for autumn 20051 provides an in-depth description of the business and economic health of the city. We have summarised a selection of important trends and indicators drawn from this publication.

Business x A ranking produced by Scottish Business Monitor (2005) assessed that 113 of Scotland’s top 500 companies (some 23%) are located in Glasgow. x A national retail ranking for 2004 produced by Experian confirmed Glasgow’s ranking as the most important retail centre in the UK outside London. x Glasgow is one of only three UK cities included in a ‘European Cities Monitor’2, which ranks the 30 top European cities by their attractiveness as a business location. While Glasgow has been in this top tier of cities over the past decade, its ranking as a business location has fallen from 10th in 1990 to 24th in 2004.

Economic output In 2002 Glasgow accounted for 16.1% of Scotland’s Gross Value Added (GVA), an indicator of economic output that measures the wealth produced in an area – an increase from 14.4% in 1995. However, in comparison to ten other UK cities Glasgow’s ranking in terms of output rate of growth has fallen in recent years.

Sector breakdowns of output highlight the growth of the service sector, which has grown to represent 82% of total GVA for Glasgow (2002) – a rise from the 1981 position, when services accounted for only 66% of GVA.

Employment From 1950 to 1991 overall employment fell from 559,000 to 370,000 with over 90% of the employment loss in manufacturing. However in the five year period to 2001 total employment rose again to a peak of 411,000.

81 Employee jobs (i.e. people who work for a company or organisation, excluding the self-employed) account for 92-95% of all jobs in Glasgow and grew by 11.7% between 1998 and 2001 – almost double the Scottish rise. The main sector that gained jobs was the service sector, which gained some 44,599 jobs and within this the main gains were in banking, finance and insurance and business services (up 23%), public administration, education and health (+12.2%) and distribution, hotels and restaurants (+13.8%).

There are wide variations in employment levels by sector within Glasgow. The graph below (Figure 4.1), limited to Greater Glasgow constituencies in 1999-20013, illustrates this. ‘Public administration, education and health’ is the largest employment sector nationally representing 27% of those in employment, but in a number of the Glasgow constituencies the percentage of employees working in this sector is much higher; in Maryhill, Springburn, Pollok and Anniesland the percentage of employees working in the sector ranges from 36% to 42%. There are also wide variations across Glasgow in the proportion of employees working in ‘distribution, hotels and catering’ and ‘banking, finance and insurance’ – the second and third largest employing sectors nationally. Manufacturing, which employed 14% of all employees nationally in 1999-2001, varies widely across Glasgow from being a minor employer in some parts, (Glasgow Kelvin (4%) and Maryhill (7%)), to being a major employer in other areas such as Rutherglen (33%) and Shettleston (21%).

Figure 4.1

% of Employees by Industry, Scotland and Greater Glasgow Constituencies, 1999-2001 Source: NHSHS Consitutency Profiles (original source: ABI)

Public administration,education & health Distribution, hotels and restaurants Banking, finance and insurance, etc Manufacturing Construction Transport and communications Other services Energy and water Agriculture and fishing

100%

90% 4% 80% 14% 9% 13% 12% 7% 9% 14% 17% 9% 70% 11% 14% 10% 13% 33% 21% 34% 13% 19% 60% 18% 15% 17% 9% 24% 23% 23% 20%

% 50% 12% 8% 26% 16% 40% 23% 27% 26% 27% 19% 20% 19% 30% 24% 20% 41% 42% 36% 39% 27% 26% 26% 28% 29% 21% 22% 23% 10% 16% 0%

d n n d n n le to o a o ston llok tl rg es w ova o o e l st llie Kelvin P esland c th a i G S u Cathcart Milngavie w w w hett w E Ba o R S o & go sg w g o s nk ow lasgo la g gow a Glas G gow Springburn G gow Anni s Gla lasg Glasgow Maryhill s Gla Glas G Glas Gla Clydeb Constituency

The latest figures (2001-2003) show a small net loss of jobs across the city. In this period further jobs were lost in manufacturing (4,600), along with smaller losses in ‘finance and business’, in ‘transport and communications’ and in the ‘distribution, hotels and restaurants’ sectors. Partially offsetting these losses was a large increase in public sector jobs (up by nearly 9,000 jobs) and a small rise in construction sector employment. In the future it is predicted that there will be further increases in employee jobs as well as in self-employment. The major rises are expected in business and finance

82 services (26,100 job gain, 2003-2013) and in public services/health/education (8,600 gain).

In 1993, for the first time in Glasgow’s history, there were more women in jobs than men. By 2003, 51.5% of all jobs in the city were held by women, in contrast to only 45.7% in 1981. Over the same period part-time working increased considerably, rising from 19.6% of jobs in 1981 to 28.8% in 2003. However, there is a wide variation between the different sectors in terms of the patterns and trends in part-time employment, and employment by gender.

The increase in service industries has been accompanied by changes in the occupational structure of the city (see Table 4.1). Since the 1980s, ‘professional’, ‘technical’ and ‘administrative’ occupations have all increased in contrast to decreases in ‘skilled trades’, ‘process, plant and machine operatives’ and ‘unskilled manual workers’.

Table 4.1 Employment in Glasgow by Occupation, 1981, 1991 and 2004 Employment by occupation 1981 1991 2004 Managers & senior officials 11% 13% 13% Professional 10% 11% 13% Associate professionals and technical 14% 16% 17% Administrative and secretarial 15% 16% 17% Skilled trades 13% 11% 8% Personal service 5% 5% 6% Sales and customer service 9% 9% 9% Process, plant & machine operatives 9% 7% 6% Unskilled manual 14% 12% 11% All Occupations 100% 100% 100% Source: SLIMS/RF

The number of Glasgow residents who are in employment, irrespective of whether they work within Glasgow or not, has risen in recent years. Compared to 1998, there were 45,000 more residents in work in 2004, 20,000 more men in work and 25,000 more women. This rise has, in turn, led to a rise in the employment rate (the proportion of the working age population in employment), which increased from 55.9% in 1998 to 66% in 2004. However, Glasgow’s rate is still considerably below the rate for Scotland (74.8%) and for Great Britain (74.9%) but the gap halved (approximately) in the period between 1998 and 2004.

83 4.2 Unemployment, economic inactivity and employment deprivation

Unemployment The Glasgow FQAi unemployment rate was 7.6% in the period June 2004 - May 2005, representing 20,000 people out of work. This rate is 35% higher than the Scottish average (5.8%) and 58% above the level for Great Britain (4.8%). However this position does represent a relative improvement from Glasgow’s position three years ago, in 2002.

The claimant unemployment rateii is not a proxy for total unemployment or for overall levels of worklessness because, in terms of unemployment, it represents only a subset of those who are officially unemployed and, in terms of worklessness, it takes no account of those too ill to work. However, it does provide a useful comparative indicator for measuring local trends and patterns in employment deprivation.

As Figure 4.2 demonstrates, the claimant unemployment rate fell by over half nationally between 1992 and 2004 and this was mirrored by a reduction across the West of Scotland. However it should be noted that the rate for Inverclyde has risen again in the most recent years.

Figure 4.2

Unemployment claimant count expressed as percentage of working age population, West of Scotland council areas, 1992-2004 Source: NOMIS

Glasgow City 14.0 West Dunbartonshire 12.0 Inverclyde

East Ayrshire 10.0 North Ayrshire

8.0 North Lanarkshire

Renfrewshire 6.0 Scotland % of working age population 4.0 South Lanarkshire

South Ayrshire 2.0 East Dunbartonshire 0.0 East Renfrewshire 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

More recent data from 2004 show that Inverclyde has the highest percentage of claimants of Job Seekers Allowance (4.8%) across the West of Scotland councils, followed by Glasgow (4.1%). The lowest rates of claimants are in East Renfrewshire and East Dunbartonshire.

i FQA – Four Quarter Average. ii Claimant unemployment rate is defined as the proportion of the working age population claiming job seekers allowance.

84 Data from NHS Health Scotland’s Community Health and Well-being profiles4 highlights the variation in claimant unemployment rates across the West of Scotland using the average claimant unemployment rate for 2003. Across the West of Scotland ‘communities’iii, claimant unemployment rates varied widely from 1.6% in Eastwood and Anniesland, Bearsden & Milngavie to 6.3% in Maryhill, Woodside & North Glasgow (Figure 4.3).

Figure 4.3

% of working age population claiming unemployment benefit (12 month average), 2003 West of Scotland and Greater Glasgow communities Source: NHSHS Communtiy Health Profiles (from NOMIS data) 7% 6.3%

6% 5.6% 5.7% 5.2% 5.2% 4.9% 5% 4.7% 4.3% 4.4% 4.0% 4.1% 4.1% 4.1% 3.9% 3.9% 4% 3.7% 3.7% 3.3% 3.3% % 2.9% 2.9% 3.0% 3% 2.6% 2.7% 2.2%

2% 1.6% 1.6%

l d ie e n d e s w w w od v ire len o n ir aw ge lley ow ire o o a rid auld h g h nd h id a g h g n mo rs la erwell r s s stw hkelvin esdale milt o w tb V lasgo la lasgo la Kilb d ther a L a Wis h a n Scotlan t frews u H o G G G Ea /Milng s mber n t t Inverclyde n Strat Cly Sh Mot C r s s rth Ayrs NG Ea u dR uth Ay r ever e a e o C Ren te L East Ayrshire N & So a gow West End ie & E W rsde r nd th h a re d a East u t West G Glas ir o ank & Drumchapedside /Be A S b geton & oDennistoun & Sou id o nd uslang an ew b lyde Br sla fr Paisley C ill/W ie h n Cam y n Ren r A Ma Community

At a postcode sector level, the variations between the extremes were even greater. In the ten areas with the lowest rates, the rate varied between 1.2% and 1.3% of the working age population, while in the ten areas with the highest claimant unemployment, rates were all above 8% (Figure 4.4). As with other indicators, the majority of areas at both extremes were in Greater Glasgow, emphasising the polarity in economic circumstances that exists in the city and surrounding area.

iii These are primary care-based localities (mainly the old Local Healthcare Cooperative (LHCC) areas or, in some cases, the new Community Health (Care) Partnerships (CH(C)Ps)) with populations ranging from 20,000-140,000 people. For further details see ‘Preface to Chapters 2-12’.

85 Figure 4.4

% of working age population claiming unemployment benefit (12 month average), 2003 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from NOMIS data) 14%

11.8% 12%

10% 9.2% 8.8% 8.8% 8.8% 8.5% 8.5% 8.7% 8.7% 8.1% 8% % 6%

4% 3.3%

2% 1.2% 1.2% 1.2% 1.2% 1.2% 1.3% 1.3% 1.3% 1.3% 1.3%

k k n h k ill c c r on c W ton als h .... o t s b n w van fno nloch arns gton se y r o if Th i esham e in o Calton G ou lie Par Go ilto apel NE Scotland G ll; h R ; kinla Dumbre hi Clarks us ; n c le s N; Cadder Auch Eagl ie - Barlo ter rg o Ham own Centre st g ; v rkhill; M s T a Fe ngad est nga Ea r d ll; Kno Drumch il Ga a hi n - C opbrig M rsden - Kess Tr e h Lenzie S a d s ur and W rs Bi Broom; Ki Be Alton o a rb e a B H r - y A Postcode sector

Economic inactivity Economic inactivity ratesiv across the West of Scotland, as measured at the 2001 Census, were above the Scottish average and particularly high in some Greater Glasgow communities – above 50% in Maryhill, Woodside & North Glasgow and in Bridgeton & Dennistoun (Figure 4.5).

Figure 4.5

% of people (aged 16-74) who are economically inactive, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data)

51 51 50 44 45 41 41 41 38 39 39 39 39 39 40 37 37 37 38 35 35 35 33 33 33 32 32 32 32

% 30

l d ld ie d in le e d e w w v n a ir ire ds aw o o ride lv h h well lyde n En h g g a shire e d s r c t ap s s ilb rnau w k s milton rshire erglen r la s cotland e h yr y h e w e Wis la nistoun S t K astwoo Lomo A Ha othe v a mch G Gla n s E lyde t h Ayrs In h W t e mb C s M rth A rn Glasgows D Ea u Strat evern Valley o r S Dru e e N C Ea N te ow & sden/Milngst Renfre dL Sout W e & e ea nk East th id r lasg a u s Bear W irdrie & CoatbridgeG G outh Eastb Glasgow d / A S e So o dgeton & d o mbuslang & Rut ly W Bri Paisley an a C ill/ C h niesland y n Renfrew & r A Ma Community

At a sector level this indicator highlights even more clearly the very high levels of economic inactivity, in particular in parts of the east and north of the city (Figure 4.6). iv Please refer to Appendix 1 for a definition of ‘economic inactivity’.

86 Figure 4.6

% of people (aged 16-74) who are economically inactive, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data)

70 66.0 64.2 61.5 61.6 59.1 59.7 60.3 60 56.9 57.5 57.6

40 35.0 % 30 26.4 24.8 25.0 25.0 25.1 25.3 22.8 23.0 23.4 19.4 20

l S l E hu E ick W ne ck and R ood ton eld lton k y w ne anhil tfi a onhil ton otl w ous w ss Bay C head lt H ski emil k Sc ; Dullatur Er Fenw tl Carnt arkhouse marno e Ho Do ; Oatlands P al Townhead gs; s as Par Hami D Bridge nsburgh; Old Kilpatrick Wemy C e loch; Wes crai al Hel ndland; B y outh H S

mbernauld Villag Cu utchesontown; Gorbal H Postcode sector

More recent data (restricted to working age adults i.e. males 16-64 and females 16-59 years) for 2003 and 2004 at a council level show that Glasgow City has the highest levels of economic inactivity in the West of Scotland but that there was a slight reduction in economic inactivity rates across all the councils between 2003 and 2004 (Figure 4.7). The figure of 30% for Glasgow equates to 110,000 people of working age.

Figure 4.7

Employment deprivation% of people economically inactive, West of Scotland council areas, 2003-2004 Source: Annual Scottish Labour Force Survey, SE

35%

2003 2004 30% 30% 30% 27% 27% 27% 25% 24% 25% 25% 25% 24% 24% 24% 22% 22% 22% 22% 21% 21% 21% 21% 20% 18% 18% 17% 17%

15%

% Economically Inactive 10%

d ity re ire re lan lyde rc ow C Scot Ayrshire arkshi ve arkshi n In n lasg enfrewshire G th La R East Ayrsh Dunbartonshire South North Ayrshire Dunbartonshire t East Renfrewshirest Sou s North La Ea We Council

An indicator of the number and percentage of working age adults who are ‘employment deprived’ – a measure of those not in work either due to unemployment,

87 illness or disability – was produced as a component of the Scottish Index of Multiple Deprivation5,v.

Across the West of Scotland councils, 235,000 adults were ‘employment deprived’ in 2002, a third of whom (85,000) lived in Glasgow City. Glasgow also had the highest percentage of the working age population who were employment deprived (23%), whereas the lowest percentages were in East Renfrewshire and East Dunbartonshire (both 9%) (Figure 4.8).

Figure 4.8 % of working age population who are 'Employment Deprived', West of Scotland council areas, 2002 Source: Scottish Neighbourhood Statistics (from SIMD)

25 23.1

20 19.0 18.6 18.8 17.9 17.4 16.1 15.5 15.7

15 13.8 13.7

10 8.8 9.1 % of Working Age Population % of Working Age

0 d e e e e e nd n ity ir ir ir ir ir h h h h h tla tla C s s s o o w rshire ks n c ow ews e y o Sc g fr ark ar rt s artonshire h Ayrshire n nfr t A h Ayrshire Inverclyde n la b t e s a ba G n th La R Ea Nort thL u Sou u r o t D West of S o N s East Ren S e East Dun W Council

At a data zonevi level across the West of Scotland, there is a massive variation in the proportion of working age adults who are employment deprived. In the ten data zones with the lowest rates, between 1.4% and 2.4% of adults were employment deprived; while in the ten areas with the highest rates, the figures were all above 50%. In one part of Calton the percentage was above 60% (Figure 4.9).

v A detailed definition of this measure is available in Appendix 1. vi Data zones are areas constructed from 2001 Census output areas and have populations of between 500 and 1,000 household residents.

88 Figure 4.9

% of working age population who are 'Employment Deprived', 2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: Scottish Neighbourhood Statistics (from SIMD)

70 64.7

58.8 58.9 60 53.2 53.4 53.6 50.7 51 51.7 51.9 50

20 13.8 % of working age population

10 1.4 1.5 1.6 1.7 1.7 2 2.1 2.2 2.3 2.4 0

r m n th d h e n le n n n r e r eld a fu c le irs o p o o o d ber o i k lo r la p ston lt lt nfa rs lo N nfarm o e w gst a a cotland e a C k e sshe ro th o ra Calton C C e c Bar e Ashfield th S re B o C Toryglen C Kin k nderst King G n Gre N w A nd Seaf y/Mo o t a G Giff o fra o f d f lja a an B r Doon r Ay Pathe Data Zone Name given is that of the ward within which the Datazone is contained

4.3 Income

Income levels Data on pay levels from the Annual Survey of Hours and Earnings6 show that mean gross weekly pay for Glasgow residents (see Figure 4.10) is slightly below the national average (-2.6%). Across the West of Scotland average weekly wage levels are highest for residents of East Dunbartonshire (21.5% higher than Scottish average) and lowest for residents of West Dunbartonshire (12.3% lower than the Scottish average).

Figure 4.10

Mean Gross Weekly Pay for all Employees, West of Scotland council areas, 2005 Source: Annual Survey of Hours and Earnings, Office for National Statistics £600

£500 £481 £456 £458 £424 £398 £396 £386 £394 £395 £400 £367 £372 £348

£ £300

£200

£100

£0

re ire re ire ire re City h yde shire rsh shi rks on Scotland a Ayrshire vercl arkshi Ayrshire frew rt In h h Ay lasgow bartonshi an enfrewsh rt en t Lan L o nba G un th East h R r t N Sou Du No Sou East R West D East Council

89 Gross weekly pay has been rising in recent years, by 30% nationally from 1998-2005 and by the same amount in Glasgow. However it is interesting to note that the gap in pay between the highest and lowest paid is widening, both nationally and in Glasgow. While pay in the lowest paid decile of employees rose by 24%, amongst the highest paid ten per cent of employees the increase in pay was 34%. In percentage terms these figures do not seem so far apart; however, the equivalent rises in actual weekly pay equate to just over £22 in the lowest paid decile and to £189 in the highest paid decile. In fact, the increase in the highest paid group is comfortably greater than the actual pay of the lowest paid decile (£116 a week). Figure 4.11 highlights these trends and patterns for Glasgowvii.

Figure 4.11

Gross Weekly Pay for all Employees, Glasgow, 1998 versus 2005 Source: Annual Survey of Hours and Earnings, Office for National Statistics

£800 £744

£700

£600 £555

£500 1998 2005

£ £400

£300

£200

£116 £94 £100

£- 10 20 25 30 40 60 70 75 80 90 Percentile

Accurate estimates of overall income from all sources are difficult to come by beneath council level. However, modelled estimates calculated by the marketing company, CACIviii, illustrate the relative differences in gross annual household income across the West of Scotland. It should be noted, however, that it is difficult to verify the accuracy of these estimates, and, thus, they should be interpreted with caution.

Figure 4.12 shows the estimated average annual gross household income figures in 2003 for Scotland (approximately £26,500) and West of Scotland communities (the latter ranging from around £18,400 in Maryhill, Woodside & North Glasgow to approximately £38,400 in Anniesland, Bearsden & Milngavie: a two-fold relative difference, and an absolute difference of around £20,000). It is notable that the areas with the highest and lowest incomes are all in Greater Glasgow.

vii These pay comparison estimates relate to people in employment in Glasgow rather than to employees who are Glasgow residents and, thus, will include workers who commute into Glasgow. viii Provided by Communities Scotland. Details of how these estimates were created are provided in Appendix 1.

90 Figure 4.12

Average Annual Gross Household Income, 2003 West of Scotland and Greater Glasgow communities Source: Communities Scotland (CACI Paycheck Data) £45,000

£40,000

£35,000

£30,000

£25,000 £ £20,000

£15,000

£10,000

£5,000

£0

d n ll y n d d e n re le en ds nd re l r de an ou ow aw yde l o En l sgow ridge a t bri st ish b ergl lan m s rnau la asgow lasg h w o wshi Kil stwood nni W rnV L Ayrshi re a Scot Gl nvercl ut Hamilto ydesdale E N G t MotherweI R Sha h Cl mbe nf De eve ut e Strathkelvi & East Ayrshi& Coat & er ow Weo Cu East East G North Ayrshire t S de h a sg Eastern tGlasgow e la est R rdrie and L ang r geton & y sl G G W odsi South Wes Sou Ai o sle /W Brid ll Clydebank & Drumchapel Pai Cambu ryhi enfrew & niesland/Bearsden/Milngavie a R n M A Community

Figure 4.13 presents the same data at a small area level, showing the ten postcode sectors in the West of Scotland with the lowest average annual gross household income next to the ten sectors with the highest. Note that (a) all bar one of these 20 areas are located within Greater Glasgow, and (b) the relative difference between the area with highest income and the one with the lowest is four-fold, and the absolute difference is almost £36,000 (ranging from under £13,200 in Bridgeton East to almost £49,000 in the sector covering Cumbernauld Village & Dullatur).

Figure 4.13

Average Annual Gross Household Income, 2003 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: Communities Scotland (CACI Paycheck Data) £55,000

£50,000

£45,000

£40,000

£35,000

£30,000 £ £25,000

£20,000

£15,000

£10,000

£5,000

£0

ll E W N n e S y k n d n ton rns c yglen ad nock re ltonhill e ea iff us b geton h o m Scotland lmarnock mi tlemilk rkh Carnty rk G H ill; Thorn ;Mea u id a s Ruchazie h D Br D Ha a Pa Pa armunnock C gad; Roysto C nd; Dowanhi n a Kirkhill lmadie; Tor Castle ; Gar yndl m Po H earsden - Kilmardin earsden - denKessington - oo B B s Br

Bear Cumbernauld Village; Dullatur Postcode sector

91 Income Support claimants The rate of Income Support claimants provides a proxy measure of low income and shows a large variation across the West of Scotland. However it is within Greater Glasgow that the largest differences exist. In Eastwood and in Anniesland, Bearsden & Milngavie, 5% of the working age population in the year 2000 were claiming Income Support (IS), while in Maryhill, Woodside & North Glasgow and in Bridgeton & Dennistoun over 30% of working age adults were claiming these benefits (Figure 4.14).

Figure 4.14

% of working age population claiming Income Support, 2000 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from DWP data) 35 31 32 30 26 25 25 24 22

20 17 18 18 16 17 % 16 16 15 15 15 15 14 13 12 11 11 11 11

10 8 8 5 5 5

l in ld e e e d y w e n e w n nd ale ir nd ir a g ds p o ow la ood lv au d h o En lle h id n a g g tou t w e n shir rs rsh is la h s s o hk r w milton w la is e e Lom Ay a n Va W atbr thergle Sc fr t H r o u Glasgowmc Glasgow Gla nn East mb n s Motherwell West e Inverclyde ru n t e Strat u e Clydes uth Ay a w v s East Kilbride R o e r Sha D e C t E North Ayrshire e & D s So sg dL ie & C & W e& N G e eat ng & R h East k h d la an dr r la n Easter t si W G G s u d y Air u Sout ba o & le e S idgeton nd/Bearsden/Milngavie w is d la ly Woo Br fre Pa C ill/ es n Camb h i e y R ar Ann M Community

The difference in rates of claiming is more dramatic when small areas are compared. In the ten areas with the lowest rates of claimants, between 1.5% and 3.5% of adults were claiming IS in 2000, while in the ten areas with the highest rates of claimants (nine out of ten of which were in Glasgow) 43% to 60% of adults were IS claimants (Figure 4.15).

92 Figure 4.15

% of working age population claiming Income Support, 2000 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from DWP data)

60.7 60 57.5 54.3 50.2 50.6 50 47.3 45.0 45.5 43.3 43.5

40 % 30

20 12.6 10 3.0 3.1 3.3 3.4 3.5 1.5 2.0 2.5 2.6 2.7 0

l d rn n k y e E a ill n ton rns ton o to a s N tr h a s a ston Bay w l d N n dS ock tl u s ter o ou e a e ton E rn o o s Th h p Calton Me H e sing Giffnoc C ge Sc Clark ; ill; s rkhe k id lma h Park a c a - W le P o Parkhea Hamilton Br D ; AuchinlochWemys Castlemilk W mcha S st n - Ke ru en e en a e e i d D r rsd s Doonfoot; All G m; Kirkhill a n - C r e a roo Lenz Be d e B rs B a Be Postcode Sector

Between 2001 and 2003, there was a small increase in the percentage of the working age population claiming Income Support nationally and across all the West of Scotland councils. In 2003, East Dunbartonshire had the lowest rate in the West of Scotland (5.6%) and Glasgow City had by far the highest (19.4%), equating to over 91,000 claimants.

Income deprivation This indicator is again taken from the Scottish Index of Multiple Deprivation (SIMD) and provides a measure of the percentage of adults and children living in households with lower than average incomesix.

At a national level it is estimated that in 2002 there were over 750,000 people, or 15% of the population, living in ‘income deprivation’. Across the West of Scotland this percentage was higher (19%), but it varied greatly from 8% in East Dunbartonshire and East Renfrewshire to 28% in Glasgow City (Figure 4.16).

ix Appendix 1 provides a more detailed definition of this measure.

93 Figure 4.16

% of population who are 'Income Deprived', West of Scotland council areas, 2002 Source: Scottish Neighbourhood Statistics (from SIMD) 30% 28%

25%

21%

19% 20% 19% 19% 19% 18%

16% 16% 15% 15% 14% % of population 10% 8% 8%

d ire ire ire re ire ire ire ire an and h tl tl sh sh wsh rkshi rkshire a ton Sco Sco fre Ayrsh n Ayrs na verclyde r artonsh th nfrew st a In a of en u e Glasgow City R R nb st Ea hL North Ayrsh u So uth La rt D We No st East So e East Dunb W Council

At a data zone level across the West of Scotland, the proportion of working age adults categorised as income deprived varies hugely from areas where no one is living in income deprivation to areas where the percentage of the population in income deprivation ranges from 64% to 80%. While the majority of these data zones (seven out of ten) are in Glasgow City, two are in Paisley and one is in Craigneuk in North Lanarkshire (Figure 4.17).

Figure 4.17

% of population who are 'Income Deprived', 2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: Scottish Neighbourhood Statistics (from SIMD)

90 80.5 80 71.1 66.5 66.7 67 68.5 70 64.1 64.7 64.8 64.9

% of population 30

20 15.0

10 0 000000000 0

r r d m n th ld th u ill ill be r u t ch uk on lie far o o to field nh e lt rsde lo N afie lla rt o a head en C k S u Kit a s eenslie ign C house rk rgus e c w a hamlock u a e Scotlan r Bea o ck dD e M t rth Kelvin Pa F G n dSe n uk/ r St. James Q Cr o eppochh ff fno e St N K i an if n Ay Gar Easter G t G ea o oss fo ton n s M

rDoo Ay ,Carrick d

rwoo e st e W Data Zone Name given is that of the ward within which the Datazone is contained

94 Free school meals At a council level, Glasgow City stands out as having the highest proportion of primary school pupils eligible for free school meals. At 42%, this is double the national figure and around five times the rate of East Dunbartonshire, the council area with the lowest eligibility rate in the West of Scotland (see Figure 4.18). In terms of trends, the graph also shows that the proportion of eligible pupils has fallen very slightly across all Scotland (from 24% in 1997 to the current figure of 21%) and Glasgow City has experienced a similarly small decrease over the eight-year period – down from 46% in 1997 to 42% in 2004.

Figure 4.18

Primary school pupils entitled to free school meals, by West of Scotland local authority, 1997-2004 Source: Scottish Executive Education Department

60.0 Glasgow City

West Dunbartonshire

50.0 North Ayrshire

Inverclyde 40.0 North Lanarkshire

Renfrewshire 30.0 East Ayrshire

Scotland 20.0

South Lanarkshire

10.0 South Ayrshire

East Renfrewshire

0.0 East Dunbartonshire 1997 1998 1999 2000 2001 2002 2003 2004

Figure 4.19 shows the variation within Glasgow between the ten schools with the lowest, and the ten with the highest rates (note that the data is presented by location of school). Schools with the lowest rates have between 3% and 13% of pupils eligible. At the other end of spectrum, the schools with the highest rates have between 76% and 92% of pupils eligible.

95 Figure 4.19

Glasgow primary school pupils entitled to free school meals, 2004 Comparison of 10 schools with highest rates and 10 with lowest rates Source: Scottish Executive Education Department

100.0 92 90.0 84 85 80 81 77 78 79 79 80.0 76

70.0

60.0

50.0 42 40.0

% of school roll 30.0 21 20.0 12 12 13 9 11 6 6 7 7 10.0 3 0.0

y k k s t n s r N S r ox E l oc n n a to ton zie r NE a Cit n rnon a Ib se l rb otland w n Pa to thc ys haws u o u n Ve ro ks oys ch o pe go in iesto ewland Ca R u Cowlairs h a Sc s m ill nt illies R ; G r L u N ob ter n t; R mch o Gla Ca o Ba Baillieston N Ba Pollo Castlemilk W u st fo h; Eas e ft c rngad; Dr d o a G Tra Cr mullo Kelvindale; Kelvinside r Sandyhills; Mo Ba

Location of school

The figures on children living in workless households, which vary hugely across the West of Scotland and within Glasgow, are also clearly relevant to building up a picture of relative economic circumstances of households. In 2001, 36% of children lived in households in Glasgow where no one was in work7. This was double the Scottish figure. Further detail on children living in workless households is contained in Chapter 9: Children and adolescents.

4.4 House prices

House prices are included in this section as they not only give an indication of the relative attractiveness of living in different neighbourhoods but, given their nature, are an indicator of wealth and, by extension, the affordability of living in particular areas.

The figures presented (provided by Communities Scotland) cover the year 2003 and, given the striking year-on-year increases in house prices within Scotland, will already be out of date. However, the relative differences between areas are unlikely to have changed significantly in the intervening period.

Figure 4.20 shows average house prices by West of Scotland community in 2003. The national average in this year was approximately £86,500, but at a community level this ranged from £51,500 in Wishaw to around £161,000 in Anniesland, Bearsden & Milngavie.

96 Figure 4.20

Average House Price, 2003 West of Scotland and Greater Glasgow communities Source: Communities Scotland (Communities Scotland/SASINE) £180,000

£160,000

£140,000

£120,000

£100,000 £ £80,000

£60,000

£40,000

£20,000

£0

l y e n d n d d el re ld e w ire in n le yde ton hire land rw dge apel au l s ride ou ands E oo t shaw e ri sgow Val rc b rsh kelv ist l w gavie co h tb ch yrshi la esdal amil ergl asgo h n Wi a m A ve rew h Kil Lomon Ay est S G rn yd H f ut Gl enn W Mot ru In h East Co rth Ayrshire umbern Cl R ut Strat D w & est eve & East o o East No L C & ter Shaw e d st Ren g h East S n ri hW Eastern Glasgow e t o arsden/Mil ut an an et rea e bank & D y G Glasg Aird e So usl Sou dg b ri isle m B Clyd Pa Ca Renfrew & W Maryhill/Woodside & N Glasgow Anniesland/B Community

As ever, the variation at a small area level is even more striking. Figure 4.21 shows the ten postcode sectors with the lowest average price alongside the ten sectors with the highest price, with the figures ranging from under £25,000 in parts of Easterhouse to over £225,000 in Bearsden.

Figure 4.21

Average House Price, 2003 Comparison of 10 small areas with highest rates and 10 with lowest rates West of Scotland and Greater Glasgow Source: Communities Scotland (Communities Scotland/SASINE)

£250,000 £225,000 £200,000 £175,000 £150,000

£ £125,000 £100,000 £75,000 £50,000 £25,000 £0

l ll n E l y k ee S o tle hil and il nhi s N orn n och ock tl o l h reck owa n use W ead lt nst gside b ll ff co Pen Nitshil h n m Barl i S o ape ill; T u owa A G rk ami eve h D ; - erh a St Spri D ot armunnocKessington st P H tle fo vie C - a s E Easterhouse E land; n Drumch Ca oon lnga e - i sd entre; Staneca D M r C n Hynd e e n Broom; Kirkhill; Mearns Bearsden - KilmardinnyBea Irvi Bearsd Postcode sector

97 It is widely known that house prices have been rising in all parts of Scotland for over a decade. Figure 4.22, which shows average house prices for the period 1993-2004, illustrates this upward trend, but also shows the growing attractiveness of Glasgow’s housing, which in terms of average house sale values has caught up with the Scottish average.

Figure 4.22

Average House Price, Glasgow City & Scotland 1993-2004 Source: Scottish Neighbourhood Statistics £120,000

£100,000 Scotland Glasgow City £80,000

£ £60,000

£40,000

£20,000

£0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

4.5 Households without access to a car or van

This is a measure normally derived from the Census and is a component of the Carstairs deprivation indexx. Access to a car is also a reasonable proxy for car ownership and, thus, for relative affluence, although patterns and trends in the prevalence of access to a car clearly also have important environmental influences (see Chapter 6: Physical environment).

Across the West of Scotland, and in Glasgow in particular, there is a huge variation in the percentage of households who do not have access to a car or van. In Eastwood and in Anniesland, Bearsden & Milngavie less than 20% of households do not have access to a car, while in Bridgeton & Dennistoun, the figure is above 70% (Figure 4.23).

98 Figure 4.23

% of households without access to a car or van, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data) 80 71 70 67

60 57 54 52 53 50 50 45 41 42 43 39 37 38 % 40 36 34 33 33 34 31 32 29 29 30 24 25 19 20 17

d ie le d e n e w e e w o v a ire ire o ir g len d ow pel o a d h h h g ly nds End g a toun tw s rs mon rs isha r rc la t s s hkelvin e o milt tbrid herwell e w s la lasgo is a t d L a W t th ve a e n Scotland ly Ay H o u n G E /Milng hAy M I W nG rumch t Stra C Coa R Sh w r s Den en East Kilbrideouth e d Cumbernauld East Ayrshir Nort & st s S ie g & sgo e & N Glasgown& r n a k & D thEa d o a la reater Ea n u si t West Renfrews s G Gl o d /Be Airdr S outh West Glasgow & bu S nd m ew a Woo Bridge r C Paisley and Levern Valley Clydeba ill/ iesla h n y n Renf ar A M Community

At a postcode sector level, comparing the ten sectors in the West of Scotland with the highest rates of access to the ten with the lowest rates, these differences are more pronounced with less than 10% of households without access to a car in some areas, but 77 to 81% in the areas of low car ownership – all of which are in Glasgow (Figure 4.24).

Figure 4.24

% of households without access to a car or van, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data)

90 81.0 77.9 78.3 78.5 79.4 80 77.1 77.2 77.4 77.7 77.7

50 % 40 34.2

8.3 8.4 9.0 9.1 9.4 10 7.2 7.2 7.3 7.4

y s y x a ur n a n in n ie o S ill n t o to u to d N h r ock d n E h B w horn g ston a eW c b n o s lla T y s head I ea t cotland llo in o n ar h e Mear Houst s R w mla g S ;Du ; A Clarks s o a lm id mys ill; e t Glen Fr d; arkhe rhou T C a r e h Ke a P e D Park B Hamilton W irk K en - East Castlehill; d arng ld Villag Doonfoo - s G u n r de Broom; erna rs Bea a mb u Be C Postcode sector

99 Figure 4.25 illustrates the downward trend in the population without access to a car over the last 20 years or (put another way) the growth of car ownership. In Scotland as a whole only a quarter of the population did not have access to a car in 2001 compared to 41% in 1981, while in Greater Glasgow lack of access to a car dropped from 57% in 1981 to 39% in 2001. It should be noted that this measure is slightly different from that used in Figures 4.23 and 4.24, which were based on households without access to a car or van.

Figure 4.25

% of all persons in private households without access to a car or van,1981-2001 Greater Glasgow and Scotland Source: Census 60.0 56.8

50.0 49.2

41.3 40.0 38.6 33.8

% 30.0

Greater Glasgow Scotland 25.6

20.0

10.0

0.0 1981 1991 2001

4.6 Social grade / social class

Social grade is the socioeconomic classification used by the market research and marketing industriesxi. The analyses described below compare the percentage of adults in households classified as social grade ‘AB’ (higher and intermediate managerial, administrative, professional) and as social grade ‘E’ (on state benefit, unemployed people, lowest grade workers) by community and postcode sector, based on data from the 2001 Census. Across West of Scotland communities, the percentage of adults (16+) who are in households classified as ‘AB’ varies from 8% in Maryhill, Woodside and North Glasgow to 36% in Eastwood and 38% in Anniesland, Bearsden & Milngavie (Figure 4.26).

xi Appendix 1 provides further details on the definition of ‘social grade’.

100 Figure 4.26

% of adults (16+) in households classified as AB (Higher and intermediate managerial / administrative / professional), 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data) 45

40 38 36 35

30 26 25 23 24 22 21 21 % 19 20 20 20 18 18 17 18 16 16 17 14 14 15 13 13 10 10 10 10 10 8

w w n e e n n le d e s d in ie o u aw ge ire d o n ire d v o pel h ly uld h rid En lv g a h rid shir c a t e s h b erwell r r ergle rn milt mo s k ga la nist c t h e h a esda o Kilb e th Scotland n Wis a v t be H L t awlan a e um o In u h Ayrs s W Eastwood/Miln NG D r C Mot st Ay rth Ayrs Clyd a o Ea rSh Str en & E N Levern ValleyCum ow d n & ie & Sout ate s h West Glasgo o k & D r h East Glasgowng & R st Renfrewshiree r t Easternt Glasgown d la lasg a dside e ir s Gr G e o Sou A Sout u o ridg d/B mb n l/W B a ew & We il Clydeba C Paisley and r h iesla y n r Renf n Ma A Community

At a postcode sector level the differences in the social composition of populations are even more apparent (Figure 4.27). The ten areas with the lowest percentage of adults classified as ‘AB’ are all in recognisably deprived parts of Glasgow, where the percentage of adults classified as ‘AB’ ranges between 2% and 4%. In contrast, the ten areas with the highest rates are recognisably affluent areas, and adults classified as ‘AB’ make up between 41% and 47% of the adult population.

Figure 4.27

% of adults (16+) in households classified as AB (Higher and intermediate managerial / administrative / professional), 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data)

50 47 47 47 45 45 43 41 42 42 42 40

30 %

19 20

10 3 3 4 4 4 2 3 3 33

d k il e y n n ill c ie E n de in a o ns ill h o ss z y i ru olm eck t h n ouse o t w r g n r el N n ins a rdinny use W p r nF llo sin w geton E o hP a lv A mb s Mear o Scotlan h lma Rucha C t; ill; Thor u r a Parkh ig Ke Gle Kilmac h D ll; D Brid te Hamilton D H Ke hi ; Kilma s Castlemilk W mcha le; - k d - ru a nfoo Ea D o Castle en lan en o d d d D rs yn s n- a H Kelvind e room; Kir ear rsde B B B Bea Postcode sector

101 Across West of Scotland communities, the percentage of adults classified as social grade ‘E’ (those claiming benefit, unemployed people and the lowest graded workers) varies from 13% in Anniesland, Bearsden & Milngavie to 42% in Maryhill, Woodside & North Glasgow (Figure 4.28).

Figure 4.28

% of adults (16+) in households classified as E (On state benefit, unemployed, lowest grade workers), 2001, West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data) 45 42 41 40 36 34 35 33 31 30 30 28 28 27 26 26 26 25 25 25 25 25 22 22 21 22 22 % 20 19 20 18

14 15 13

e d e y e e l n ire ir ir ds w e w d ale lle n len a p ow ow land on d sh End sh ilton idg h gow g twood s t r la rshire r is s istou s ot om e yr s w erclyde y lasg lasgo la c thkelvin Kilbri L d e nVa v atb W S Milngavie a t bernauld ly r Ham n o Gla mcha G G Eas s m nfrewsh th A W e th Ay I Motherwell t ru nG t n/ Str a u e C w v r Rutherg s D r s e E C o East A & C e e & N Sou Le N & st R d rie thEa k lasgo an d u East th W G Greater Sha an eton & Denndside y Air So b o le e Sou o w& We is d ridg and/Bearsd e ly B W sl Pa C ill/ e Cambuslang & h enfr R Anni Mary Community

At a postcode sector level the contrast in social composition of areas is even clearer. In the ten areas with the lowest concentration of adults from social grade ‘E’ households, between 6% and 11% of adults are from households classified as social grade ‘E’. While at the other extreme in the ten areas with the highest concentrations of adults from social grade ‘E’ households, over 50% of adults are classified as being from social grade ‘E’ households (Figure 4.29).

Figure 4.29

% of adults (16+) in households classified as E (On state benefit, unemployed, lowest grade workers), 2001. Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data) 70

60 60 55 55 55 53 53 51 51 52 52 50

40 % 30 22 20

10 10 10 10 11 8 9 9 10 6 7

r n h n n s e in ill c o ad s ru or ton h rns e W u nE llatu h s gto st a and h ad S o u T inlo in k l n e t cotland nF h Me milk h S D ill; Hou c ss w le rkho k ge myss Bay ; h Dowan e Clar ll; Carntyne Oat id Gle e Au ; To Pa ge tle K hi ls Hamiltonhill Dalmarnock Par Br W s k a Cast illa a enock Central ie S; en - Kir e V C z ld sd m; Gr Gorb n- en o ; au Hyndland; L ar o n rn Be r w e B to Bearsde Cumb tcheson u H Postcode sector

102 Changing nature of employment and social class in Glasgow As recently as the 1971 census, Glasgow’s employment was dominated by heavy engineering, textiles and chemical manufacturing. At that time, the policy emphasis was on moving toward light engineering and electrical products. Furthermore, large numbers of workers were engaged in the distributive trades for these manufacturing industries and in the production of food (including bread), drink and tobacco. The intervening period has seen a collapse in manufacturing but improved quality of work for those in employment. One way of capturing this change is to explore how social class has changed over the past 25 years.

With almost four out of ten of its population now in the top two social classes8 (see Table 4.2), Glasgow is not only comparable to the rest of Scotland in this regard but is similar to most other leading cities in the UK. In the same period, Glasgow has seen a 104% increase in owner occupation of housing (larger than the increase for Scotland as a whole at 80%).

Table 4.2 Social Class I and II in 1981 and 2001 Social Class I & II Social Class I & II % change 1981 2001 Glasgow 18% 38% +111%

Rest of West 28% 37% +32% Central Scotland Scotland 28% 37% +32%

James Arnott, an analyst with Glasgow City Council and a member of the Glasgow Centre for Population Health’s ‘Observatory Group’ will be bringing out a detailed analysis of the size and nature of such changes in Glasgow later in 2006. The publication of his report will be an opportunity to discuss these findings in more detail.

103 Summary x In terms of business, it is clear that Glasgow has retained a position within the UK as a major business centre, and is rated second only to London as a retail centre. However, its economic output, although rising, is still growing more slowly than the Scottish average and Glasgow’s ranking in terms of economic output has fallen relative to other UK cities in recent years. The service sector has grown to a position of predominance in Glasgow’s economy, providing the bulk of the city’s economic output and employment. In contrast, manufacturing has declined over the last 50 years and continues to do so. x There are now more women than men in employment in Glasgow and part-time work has grown to represent more than a quarter of all jobs. The number of Glasgow residents in employment has grown in recent years (by more than 45,000 jobs in the period 1998-2004) but employment levels remain considerably lower than the Scottish average, although the gap has reduced. x The official unemployment rate and the claimant unemployment rate have both reduced greatly over the last four to five years. Relative inequalities in employment between different parts of the West of Scotland, and within Glasgow, remain however, and official unemployment rates do not provide a true measure of the extent of worklessness. In Glasgow it is estimated that there are 110,000 adults who are not economically active, equating to 30% of the working age population. x The ‘employment deprived’ measure used in the Scottish Index of Multiple Deprivation provides a measure of ‘worklessness’ due to unemployment, illness or disability and emphasises the size of this problem in the West of Scotland. In 2002, 235,000 adults in the region were defined as ‘employment deprived’, 54% of the Scottish total. Glasgow City alone contributed 85,000 people or 19% of the Scottish total. This measure, analysed at a small area level (data zone), illustrates the massive inequalities in employment that exist in the West of Scotland – ranging from 1 to 2% of adults being ‘employment deprived’ in the more affluent areas compared to over 60% of adults in the most deprived areas. x Income for those in work has risen in recent years, both nationally and in Glasgow. However income inequalities are widening with those in the best-paid occupations having gained more relatively, and far more absolutely, in terms of pay. x Income Support provides a good measure of those on low income (whether in employment or not) and it is across Greater Glasgow communities that the greatest inequalities are apparent. In 2000, there was a six-fold variation in the proportion of the working age population claiming Income Support; ranging from 5% in Eastwood and Anniesland, Bearsden & Milngavie to over 30% in Bridgeton & Dennistoun.

104 x A broader measure of income deprivation, taken from the Scottish Index of Multiple Deprivation, illustrates that, while across the West of Scotland 19% of the population are estimated to live in ‘income deprivation’, this figure varies greatly from 8% in East Dunbartonshire and East Renfrewshire to 28% in Glasgow City – the latter figure equating to over 160,000 of the city’s population. In the most income deprived datazones of the West of Scotland, two thirds of the population live in ‘income deprivation’. x In terms of ‘free school meals’ eligibility, Glasgow City (at 42%) has double the national rate of pupils eligible for free school meals. Although this proportion represents a small reduction on the rate in 1997, Glasgow’s eligibility rate is still the highest rate in Scotland and around five times the rate of East Dunbartonshire. x In other ways, though, Glasgow appears to have become a wealthier city, although, or maybe because of this, the inequalities in wealth and status have become starker.

o House prices have risen hugely in the last ten years and to a level in many areas where affordability has become a very real issue, especially for those on lower incomes. The variation in house prices across Glasgow at a small area level is striking, with average house prices (in 2003) ranging from under £25,000 in parts of Easterhouse to over £225,000 in Bearsden.

o There has been an overall trend towards greater numbers of households with access to a car, but there are large variations in access levels across the West of Scotland and especially in Glasgow.

o The proportion of Glasgow’s population in the top two social classes has more than doubled since 1981 so that in 2001 four out of ten adults in Glasgow were classified as either Social Class I or II. Essentially, Glasgow now has more middle class jobs and its employment structure is similar to most other leading cities in the UK. However, there are wide variations in the distribution of these ‘better’ jobs across the city. For example, in Maryhill, Woodside & North Glasgow in 2001, 8% of adult residents came from households classified as ‘AB’ (higher and intermediate managerial / administrative / professional) compared to over 35% in Eastwood and Anniesland, Bearsden & Milngavie. x In short, Glasgow has developed a service based economy over the last 20 years and is no longer dependent on manufacturing. While the city’s middle class has grown and some parts of the city prosper from greater employment and higher wages, other parts of Glasgow have seen little improvement in circumstances. For those in the ‘other Glasgow’, many are dependent on income, disability and unemployment related benefits, and those who are earning are in low paid jobs.

105 References

1 Glasgow City Council, Scottish Enterprise Glasgow. Glasgow Economic Monitor, Autumn 2005. 2005 http://www.glasgoweconomicfacts.com/library%5Fsection/

2 Cushman & Wakefield Healey & Baker, European Cities Monitor, September 2004 http://www.cushmanwakefield.com/cwglobal/jsp/servicesDetail.jsp?serviceId=25000 30&Country=EMEA&Language=null

3 NHS Health Scotland. Constituency Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/constituencyprofiles

4 NHS Health Scotland. Community Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/communityprofiles

5 Scottish Executive. Scottish Index of Multiple Deprivation 2004: technical report. 2004 http://www.scotland.gov.uk/library5/society/siomd-00.asp

6 Office for National Statistics (ONS). Annual Survey of Hours and Earnings (ASHE) [1998 and 2005 results]. http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=13101&Pos=4&ColRank=1 &Rank=160

7 General Register Office for Scotland. 2001 Census results – Theme Table T16, 2003 http://www.scrol.gov.uk

8 Arnott J. Socio-economic change in the Glasgow conurbation. In press

106 Chapter 5: Social environment minority of any Scottish Council.” Scottish of any communities of Scotland council areas. Dunbartonshire the have highest and Glasgow and second highest rates of o-thirds of Greater residents felt look out forthat Glasgow neighbours st st es of assault admission in Glasgow are much are higher thanes of assault admission in Glasgow the across Scottish average o-thirds of Greater Glasgow residents feel residents o-thirds thatGreater of Glasgow neighbours look out for each other in t w erage for the much and are last eight years higher proportionately than in the other ars. er three to one and the peak ages for offenders the and victims are mid-teenage elatively low proportions reported residents low of Greaterelatively Glasgow feeling isolated from ears to of violent offenders early of residence areas The twenties. of and victims oung people display strong patterning. socio-economic he West of Scotland, Glasgow has the of Scotland, Glasgow highest rates for a range of crimehe West types. hose from more affluent more hose from areas. heir local area and that and heir local area people can be trusted in their local area. “Glasgow City has by far the highest City has by proportion“Glasgow of pupils from Analysis of violent crime in Glasgow shows thatAnalysis shows male offenders of violent crime in Glasgow outnumber females by ov y highlyviolence are correlated with In some smaller communities in deprivation. one in ten been the people have of a violent crime victim in the over lastGlasgow three ye We of Scotland. in the West domestic abuse, respectively, Ra all ages. Admissions after a sharp object’ ‘assault by predominate, a reflection of the high rates of knife crime in the city. Glasgow City has the highest overall crime City has the rate among councils in Scotland and withinGlasgow highest overall t ethnic “T each other in their local area and that people can be trusted in their local area.” rate crime among councils in City has the highest“Glasgow overall Scotland.” Homelessness applications in Glasgow have been consistently been have Homelessness applications in Glasgow double the Scottish av We R of respondents). (15% friends and relatives perception of their a positive local The majority have residents of Greater Glasgow in more people living and to bring as a place toarea live up children. However, partsdeprived the of much city are about their compared less positive to areas local t Summary far the has by City highestGlasgow proportion minority from of pupils ethnic has the pupils. It also equating to 7,500 (10.9%), Scottish council of any communities highest percentage less affluent of pupils from 42% of primary households – school school free double the to eligible 2004, meals in national average. receive pupils were of educational attainment among adults and participation Levels by in higher education y high proportions are There parts families of lone parent in many of Greater Glasgow, but also great polarity with areas between (e.g. high concentrations Bridgeton & Dennistoun) and those with Eastwood). (e.g. concentrations much lower Tw t Guide to data presented in this chapter % of dependent children living in hous eholds where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 5: Social environment

How we behave, our relationships, our gender and ethnic group, our education and work, the conditions and communities in which we live, and how we feel about ourselves are all elements of the social environment. These elements overlap and interact with elements of the physical environment to influence our health and impact on the quality of our lives, as well as how long we live. The fact that the social environment encompasses such a large number of different yet overlapping topics means that there is a similarly large number of different data sets relevant to its measurement and understanding.

Many of the topics relevant to describing the social environment of Glasgow and the West of Scotland are covered in other chapters (e.g. ethnicity, changes in patterns of employment, behavioural trends, etc.). In this chapter we focus on only a handful of topics: education, vulnerable households, social capital, crime and homelessness. Given this limited set of topics, we do not claim that this represents a comprehensive overview of the social environment of the city and the wider surrounding area. However, we believe that much of the data compiled is either new or has not been brought together in such a way before, and the insights these data provide will aid our understanding of life in Glasgow and the West of Scotland area.

5.1 Education

This section covers three main themes: the size of the school populationi, and its socio-economic and ethnic composition; educational attainment of adults; trends and patterns in participation in higher education.

Size of the school population In 2004 there were 170,000 primary school children in the West of Scotland, representing 43% of all Scottish primary school children. Within Glasgow City there were just over 40,000 primary school children, 24% of the total for the West of Scotland. At secondary school level there were 136,000 pupils in the West of Scotland, representing 43% of the Scottish total, while Glasgow City had 28,900 secondary school pupils, 21% of the total for the West of Scotland. Figure 5.1 shows school pupil numbers across the West of Scotland council areas.

i All pupil figures quoted relate to pupils in publicly funded schools in Scotland.

109 Figure 5.1

Total children in primary and secondary schools, 2004 West of Scotland council areas Source: SE, Pupils in Scotland 2004 80000

70000 Total Number of pupils in secondary schools Total Number of pupils in primary schools 60000 28914 50000

40000 22363 20018 30000 Numbers of pupils of Numbers

20000 40544 11657 9205 8255 8690 27989 7384 7625 25043 10000 5571 6397 13925 9869 11409 6492 7550 8407 8676 9469 0

e e e e e e ty ire ir ir r h h h s rshire rshir shire w Ci y r wshir rks o ton ews Ay e g r A fr t as Inverclyde s nfr en nbartonshir rth Ay e Lana Lanarkshi Gl Ea u o R h h South t R N rt s o Ea Sout N West Dunba East D Council

Socioeconomic and ethnic background of school pupils Glasgow City has the largest proportion of pupils from low income families, as was demonstrated in Chapter 4: Economic factors, with reference to the proportion of pupils eligible for free school meals. 42% of all Glasgow primary pupils were eligible for free school meals in 2004, representing over 17,500 of the 42,000 primary pupils in Glasgow. This proportion is double the national average and five times the level of eligibility in East Dunbartonshire.

In terms of ethnic background, 10.9% (over 7,500) of Glasgow’s primary and secondary pupils were from minority ethnic groups in 2004 (Figure 5.2). This is by far the highest proportion of any Scottish local authority and is three times the Scottish average. Elsewhere in the West of Scotland there were above average percentages of pupils from ethnic minorities in East Dunbartonshire (5.6%) and in East Renfrewshire (8.9%)

110 Figure 5.2

Percentage of school pupils from ethnic minority groups, 2004, West of Scotland council areas Source: SE, Pupils in Scotland 2004

12% 10.9%

10% 8.9%

6% 5.6% Percentage 4% 3.5% 2.2% 2.2% 2.4% 1.9% 1.9% 2% 1.1% 1.1% 1.4%

e re re re re re and hire hi hi l shi s s shi s r clyde kshire k onshir y er r Scot t rew rtonshi rew t A Inv nf Lanar e Glasgow City Eas Renf h unba Dunbar North AyrshireSouth Ayr tR t D as es North Lana Sout E W East Council

Educational attainment of adults Comparing attainment on three measures – adults of working age with three or more 'Highers'; a degree; no qualifications – across West of Scotland council areas, clear patterns emerge (see Figure 5.3). Glasgow has a lower proportion of adults with three or more Highers than Scotland as a whole (52% vs. 57%), the same proportion of adults with a degree as the Scottish average and more people without a qualification (22% vs. 16%). Two West of Scotland Councils, East Dunbartonshire and East Renfrewshire, stand out as having much better qualified residents on average than in the rest of the West of Scotland and in comparison to the Scottish average.

Figure 5.3

% of adults (of working age) with: 3 or more Highers; a degree; no qualifications, 2003, West of Scotland council areas Source: SNS 90% 25%

80% 76% 72% 70% 20%

57% 58% 60% 54% 56% 56% 52% 54% 50% 51% 51% 15% 50%

40% 10% 30% 27% 27% % No Qualifcations with qualifications (by type) 20% 15% % 15% 14% 14% 5% 12% 11% 8% 9% 8% 8% 10%

0% 0%

y e e e d ir hir hire land shire shire shire shire shire sh ot rs k r k r c y ews on S gow Cit A r frew st h Ay Invercly h Ay art las a Lanar t enf G E out R Ren th Nor S unb t or outh Lanar as N S E West Dunbartonshire East D Council

% people with at least 3 highers % people with degree level qualifications % people with no qualifications

111 Adults with no qualifications at community and postcode sector level The following graphs show the pattern of adults (16-74) with no qualifications across the West of Scotland in more geographic detail, drawing on data published in NHS Health Scotland’s Community Health profiles1. In Scotland as a whole 33% of adults aged 16-74 did not have a qualification in 2001. Across West of Scotland communitiesii, there are wide variations in this measure: in Anniesland, Bearsden & Milngavie and in Eastwood, 18% and 20% of adults, respectively, did not have a qualification, while in South West Glasgow, Eastern Glasgow and Maryhill, Woodside & North Glasgow, 45% or more of adults had no qualification (Figure 5.4). In the last of these areas, over half of all adults did not have a qualification.

Figure 5.4

% of adults (16-74) with no qualifications, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data)

51 48 50 46 44 44 42 43 41 41 38 38 38 40 36 37 37 35 33 32 33 33 33 33 28 29 % 30 26

20 20 18

d d d e d e ll n o d re ey l ire w en on e re ge el un w o lvin ll h o l lt aw o shi a da s g d ap h o gow w ilbri mon r mi erw is cotla st yr lasg h yrshi lasg as asgow a K Lo Ayr nV des a W S r ly G uthe H A nnist G E West Entrathke mbernauld Inverclyde st rumch e nGl w S enfrewshireuth Shawlands C R Mot a r East R o r eve E est e & N Gl Cu L North A W st sgo S d n & D a e a n th East k & D o E a u an et uth Gl Greatey o e So Airdrie & Coatbri S deb oodsid sl mbuslang & y Bridg a l l/W frew & West Pai C C nniesland/Bearsden/Milngavie Ren A Community Maryhil

At a postcode sector level there are even greater variations observed (see Figure 5.5). In the ten areas with the lowest percentages of adults with no qualifications, between 7% and 16% of adults do not have a qualification, while in the areas with the highest rates (all in deprived parts of Glasgow) between 59% and 66% of adults have no qualification.

112 Figure 5.5

% of adults (16-74) with no qualifications, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data) 70 66 66 64 65 63 63 61 62 59 60 60

40 33 %

20 16 14 14 15 15 15 13 14 9 10 7

d u s il n k n hill ad in s c la inny ru orn arn ston kW yne d h e k il os nt se W ouse rno ton E ot inside m P Calto ead S u h a e c owan Hillhe l; T v M h h rk S len F Clar le ig Car rk lm D G erho Pa a ; lehil ; Kel H Pa t Hamiltonhill D Bridg - Kilmar st nsburgh; Rhle irkhill; Cast as n a le E dland e n H Hy om; K Kelvinda Bearsde Bro Bearsden - Kessington earsden - C B Postcode sector

Trends and patterns in participation in higher education Figures on entrants to higher education, provided by the Higher Education Statistics Agency (HESA), shed some light on the backgrounds of new entrants to full-time first-degree courses. Across Scotland in the university year 2002/03, 87.5% of students came from state schools or colleges, while in the main higher education institutions of the West of Scotland the percentage is higher, although there is considerable variation between institutions2 (Figure 5.6).

Figure 5.6

% of young (under 21) first-time entrants to full-time first degree courses from state schools or colleges, 2002/03 Comparison by country and institution Source: HESA, Performance Indicators 2002/03 100 98.8 98.1 97.0 97.2

92.4

% 90 89.2

87.2 87.5

80 Total UK Total Scotland The University of The University of Glasgow Glasgow School of The University of Bell College Glasgow Strathclyde Caledonian Art Paisley University Country/Institution

113 HESA have also classified entrants by whether they come from ‘low participation’ neighbourhoodsiii (see Figure 5.7). The percentage of young first-time entrants to higher education from such areas was 18.6% across Scotland in 2002/03 and varied considerably among the West of Scotland Higher Education institutions from 15.4% of new students of Glasgow School of Art to 51.9% of new young entrants to Bell College.

Figure 5.7

% of young (under 21) first-time entrants to full-time first degree courses from 'low participation' neighbourhoods1, 2002/03 Comparison by country and institution Source: HESA, Performance Indicators 2002/03

60 51.9 50

40 34.9

% 30 26.3

18.6 18.5 19.5 20 16.8 15.4 13.3

0 Total UK Total Scotland Glasgow The University The University The Royal Glasgow The University Bell College School of Art of Glasgow of Strathclyde Scottish Caledonian of Paisley Academy of University Music and Drama Country/Institution

1Low-participation neighbourhoods are defined as areas for which the participation rate is less than two-thirds of the UK average rate.

Data provided by HESA has facilitated a detailed geographic analysis of new student participation rates across the West of Scotland for students domiciled in Scotland. Before discussing the results it is worth noting a major caveat surrounding this analysis, which relates to the accuracy of the population denominator used to create the ratesiv. Given this caveat, the actual rates created should be treated with caution, although we believe that the figures are robust enough to make relative comparisons between areas.

A comparison of annual rates (averaged over three recent years – 2001/02-2003/04) across West of Scotland communitiesv shows wide variation in participation rates (see Figure 5.8). While the Scottish figure is 34%, in Maryhill, Woodside & North Glasgow the participation rate was estimated to be only 12%. It was only slightly higher at 15% in Clydebank & Drumchapel. In four Greater Glasgow communities (including these two) participation rates are estimated to be less than 20%. At the other end of the spectrum, participation rates in Glasgow West End and Strathkelvin are estimated to be above 40% and, in Anniesland, Bearsden & Milngavie and in Eastwood, 65% or above. iii Low-participation neighbourhoods are defined as areas for which the participation rate is less than two-thirds of the UK average. iv In the absence of more up to date population data, the population of 17 year olds in 2001 (from the Census) has been used as the denominator in order to create participation rates. This denominator is clearly not precisely matched with the numerator in terms of time period or age range. v The same communities used in NHS Health Scotland’s Community Health and Well-being profiles1.

114 Figure 5.8

Estimated new student participation rates in Higher Education, annual average, 2001/02- 03/04, West of Scotland and Greater Glasgow communities Source: Calculated from data supplied by HESA1

80 70 70 65

47 50 44 38 40 40 34 34 34 35 36 36 32 30 30 30 31 27 29 29 30 23 24 19 21 20 15 17 12 10

Estimated participation rate per 100 population ll e s d w e en ire ire d nd in ie o w hir h ley ride h lv v oo apel idge auld s rgl al b E e h br rn r V tw lasgow t her y he Kil hk nga Scotland G Wishaw t Glasgowt n desdale Lomond Ayrshire il as oa o tA nverclydet u er y Hamilton West rat M E M s I v Cl th / rn umbe as enfrews u w St e C Ea orth Ayrs East R en West Glasg nd C E N So go d and Drumc a s rs th East ie reater Shawlan la k u outh ng and R and Le West G la y G So irdr S s le d A is an deban a y P Bridgeton and Dennistoun ambu niesl'd/Bea Cl frew M'yhill/Woodside/N.Glasgow C An Ren Community

1HESA does not accept responsibility for any inferences or conclusions derived from the data by third parties

It has been possible to create trends over recent years based on three-year average rates at a community level, although the participation rates are subject to the same caveats as above. At a national level, there has been a rise from 31.7% to 34.4% and rises have also occurred across many of the West of Scotland communities, including many of the more deprived communities (Figure 5.9). The graph shows trends for selected communities. The majority of ‘below average participation’ communities have shown a rise, although in one, Clydebank & Drumchapel, the rate appears to have fallen. Despite general increases in rates of participation in Higher Education, there does not appear to be any narrowing of the gap between the traditionally ‘high participation’ communities of Anniesland, Bearsden & Milngavie and Eastwood and the rates in less affluent communities.

Figure 5.9

Trends in estimated new student participation rates in Higher Education, 3 year rolling average rates, 1998/00 - 2001/03, selected West of Scotland communities Source: Calculated from data supplied by HESA1 80

Eastwood 70 Anniesland, Bearsden and Milngavie 60 Scotland

50 West of Scotland

Inverclyde 40 Motherwell

30 Eastern Glasgow

Bridgeton and 20 Dennistoun timated participation rate per 100 population South West Glasgow Es 10 Clydebank and Drumchapel 0 1998/00 1999/01 2000/02 2001/03

1HESA does not accept responsibility for any inferences or conclusionsderived from thedatabythirdparties

115 At a postcode sector level, the caveats about the accuracy of estimated participation rates are even more pertinent. Nevertheless, bearing this in mind, the comparison of the ten highest participation areas (postcode sectors) with the ten lowest participation areas produces striking results (see Figure 5.10). The ten areas of lowest participation all have rates of below 10%, while, in the highest participation areas, rates of participation are above 80%. While there may be considerable inaccuracy in the estimated rates for individual areas, the overall pattern is clear. There are parts of the West of Scotland where a university education is the ‘norm’ for the majority of young people, while, at the other extreme, there remain many other areas where only a small minority of pupils would be expected to go on to this level of education.

Figure 5.10

Estimated new student participation rates in Higher Education, annual average, 2001/02- 03/04 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: Calculated from data supplied by HESA1 120

98.9 100 94.3 89.8 85.0 86.2 81.8 82.4 82.7 82.9 84.7 80

40 34.4

20 7.1 7.5 4.0 4.2 4.3 5.5 5.5 5.9 6.1 6.6 timated participation rate per 100 population 0 Es

l k y ill d k nd W hill r W ie ny az wa ton olm ea ec la el ovan on itshil o ls c fnock ot lt enilee h rdin a if c ap G i N lie Pa P ouse c engarth a S h m s u m G Hillh c a idgeton E rh R ch ouga m m r u Kil Dumbr H B ;D Kil ru umchapel NE aste - nd; Dowanh D Fergu ne n la Dr E oonfoot; All igle; A D de nd e ysto s Hy ear Broom; Kirkhill; Mearns- Ke B ie av

Postcode sector Skelmorlie; M Milng

1HESA does not accept responsibility for any inferences or conclusions derived from the data by third parties

5.2 Vulnerable households This section focuses on levels and distributions of lone parent and lone pensioner households across the West of Scotland.

Lone parentsvi In 2001, lone parent households made up 25% of all households with children. Across the West of Scotland communities (see Figure 5.11), this measure varies from 13% in Eastwood and 14% in Anniesland, Bearsden & Milngavie to 49% and 50%, respectively, in Maryhill, Woodside & North Glasgow and in Bridgeton & Dennistoun.

vi It should be noted that the measure described in this section – lone parent households with dependent children taken as a percentage of all households with dependent children – is slightly different to that used to describe lone parent households in the household projections section of Chapter 3: Population and life expectancy.

116 Figure 5.11

Lone parent households with dependent children, 2001 West of Scotland and Greater Glasgow communities Source: 2001 Census 60.0 53 49 50.0 41 40 40.0 37 37 34 31 29 30 30 28 28 28 29 30.0 26 25 24 25 21 22 22 20 20 20.0 18 13 14

10.0

% of all households with dependent children 0.0

d d w y l nd de ire ire l on de e nd ow la ri h h ilt ha dge rwell ly g ape oun m is bri rshire c h ist hkelvin omond ernau a t y er lasgow lasgow ilngavie desdale Ayrs L W v G G Scot EastwooM rat y t b H A n hawlandsWest E enn Cl ast Kilb th Ayrshire m Coa Mothe h I S n rumc N St enfrewsas u rt r w D D E R E C o e er & Sou N g & Rutherglen go & s de & n rie & n eat la East th East Glas nk i o r u et West G G ds g Aird So South Westeba Glasgow sley and Levern Vall d ew & Woo Brid r Pai Cly ill/ nf Cambusla h e ry nniesland/Bearsden/ R a A M Community

At a postcode sector level, the variations across the West of Scotland are even more pronounced (Figure 5.12). In the ten areas with the lowest rates, the percentage of lone parent households varies from 6%-10%, while in the ten areas with the highest rates the percentage of lone parent households varies from 59%-70%. All ten areas with the highest rates are in Glasgow.

Figure 5.12

Lone parent households with dependent children, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: 2001 Census 80.0 70 70.0 61 61 61 62 62 59 59 59 59 60.0

50.0

40.0

30.0 25

20.0 10 10 8 8 8 8 9 9 9 9 10.0 6

% of all households with dependent children 0.0

r r rt u n k n ill S ton e a t W als ad land ood c ock rui ilk E d t w kston la se rb he th r ul m Gova ltonh pel NE co a mbreck la geton E Go i a S Giffnock C u marn len F d lmarnoc ; m h rkhea How ilmardinny D C e; D G rhou ri a a Town K Kil e B Da on H P - Kessing lag Castle t mc n Vil East Dru briggs N; Cadd ld ades p rsden - Tr ea rnau BearsdeBisho B umbe C Postcode Sector

Household projections, commented on already in Chapter 3: Population and life expectancy, predict that the proportion of lone parent households will increase, and in Glasgow it is predicted that lone parent households will become almost as common as households with two adults and children (48% in 2016).

117 Lone pensioners Nationally, lone pensioner households made up 15% of all households in Scotland in 2001. Across West of Scotland communities (see Figure 5.13), this measure varies from 12% in Cumbernauld to 17% in South West Glasgow, but for most communities is close to the national average.

Figure 5.13

Lone pensioner households, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from 2001 Census data) 20

18 17 17 17 17 16 16 16 16 15 15 15 15 15 15 15 15 15 15 15 15 15 14 14 14 14 14 13 13

12 12

% of all households all % of 6

n d e ll d n nd ld ire ds re w ire h dge aw ow le ow yde h ow tla au s ilton an avie l apel g kelvi bri sdal erwe sh erg rc istoun co h t h wl yrshi ng lasg asgo h lasg ch las S rew Ham Lomon Wi A G Gl G ve m Ayrs nn G f oa yde Eastwoo ut h mbern Cl Mot Sha rn In ru De Strat e rth Ayrshire ut Cu East Kilbride Ren East ow West End o & N o & e & C N g & R e S rsden/Mil th East n est reater East an o rdri Glasg dsid et Ai G Bea Sou o bank & D g & W d/ e South West w n Brid re Paisley and Levern Valley ambuslll/Wo Clyd nf iesla C Re Ann Community Maryhi

Greater variation is apparent at a postcode sector level (see Figure 5.14). In the ten areas with the lowest percentages of lone pensioners, only 4-8% of all households were occupied by lone pensioners, while in the ten sectors with the highest percentages of lone pensioners, 25-36% of households were lone pensioner households (Figure 5.14). In the latter areas the high proportion of lone pensioners is related to the high proportion of elderly living in the area. It is also known that in some areas, for example, Knightswood and Mosspark, many residents bought their houses from the Council and have remained in the area for much of their adult lives, and that this may contributed to the older age structure in these areas.

118 Figure 5.14

Lone pensioner households, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from 2001 Census data)

40 36 35

29 30 28 29 26 26 25 25 25 25 25

20 15 15 % of all households 10 888 7 7 7 7 6 6 5 4

d y l s e rt k ad go S rg o ar rie rove e ghil khill n d a ston dN p d ntral g Fruin stown in c L id e ss Ba n illh la bu al hous ss R y in Houston e H dd B g rk woo Millp C Scotlan lv o ath s k e; Dullatur e Gl Pa Townhead Mo g K Jame Str n; Wem ll; a; R illa r Knightswoo Knight V nhi one; Dou igto reenoc o st ra G B y C auld n lie; Dou - Ke ie mber v u ; Sour C n to e c Milnga Per Postcode sector

Projections of lone pensioner households are not available. However, given the projected increases in the elderly population in most West of Scotland councils and predicted increases in single adult households, it seems likely that lone pensioner households will also continue to rise.

5.3 Social capital

In this section various measures of social capital are presented, mainly for the Greater Glasgow area as a whole, but also broken down by deprivation. The data presented are taken from the 2002 Greater Glasgow Health and Well-being Survey3,vii. The measures included are: civic engagement, reciprocity, trust, membership, feelings of isolation, volunteering, and perception of area as a place to live and bring up children. The final part of the section describes patterns and trends in voter turnout and attitudes to voting.

Civic engagement Figures 5.15 and 5.16 present two measures of civic engagement: first, whether respondents had undertaken any ‘responsibilities’ in terms of being a committee member/event organiser/fund-raiser etc. in the previous three years (Figure 5.15), and, second, whether respondents had taken any actions to solve a local problem in the previous three years (Figure 5.16). In both cases, the proportion of respondents to whom this applied was small: 7% and 11% respectively. In both cases, the proportions within the three deprivation groupings used in the analysis differed significantly: respondents in the less deprived areas were more likely to have been a committee member etc. (11%), while those in the more deprived areas were more likely to have taken action to address a local problem (13%). vii Comparisons with figures from a previous survey in 1998 are made where significant changes in results have been noted.

119 Figure 5.15

Civic Engagement: % of respondents with 'civic responsibilities' (e.g. committee/school board member) in previous 3 years Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002 12 10.9

8.5

8 7.0

% 6

4.6

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Figure 5.16

Civic Engagement: % of respondents having taken action to solve local problem in previous 3 years Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002

14 13.1

12 11.4

10.2 10 8.6

8 %

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Reciprocity Figure 5.17 presents a measure of ‘reciprocity’ – the proportion of respondents who feel that neighbours look out for each other in their local area. The figure for all Greater Glasgow is 66%, with significant differences between those living in the least deprived areas (76%) and those in most deprived (60%).

120 Figure 5.17

Reciprocity: % of respondents who think neighbours 'look out for each other' Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002

100

80 76.0 71.8 70 66.6

59.7 60

% 50

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Trust Figure 5.18 shows the proportion of respondents who believe that people can be trusted in their local area. Overall 69% of respondents believed this was the case, but the proportions were significantly higher in the less deprived areas (82%) than in the more deprived (59%).

Figure 5.18

% of respondents believing people can be trusted in local area Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002

90 82.5

80 75.5

68.6 70

58.9 60

50 % 40

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

121 Membership Membership of clubs, organisations etc. is a frequently used proxy for social networking or social capital. Figure 5.19 shows the results from the 2002 NHSGG Health and Well-being Survey. One in five respondents were members of clubs or other such organisations, with significant differences between the least deprived (25%) and most deprived (16%) areas.

Figure 5.19

Social networks: % of respondents belonging to clubs, associations, church groups etc. Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002 100

% 50

30 25.1 23.2 20.1 20 16.2

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Figure 5.20 shows that between the 1999 and 2002 surveys there was a significant decrease in the numbers of respondents who were members of such clubs/organisations, with the total for all Greater Glasgow falling from 30% to 20%.

Figure 5.20

Social networks: % of respondents belonging to clubs, associations, church groups etc. Greater Glasgow Source: NHSGG Health/Well-Being Survey, 1999 and 2002 100 1999 2002 90

% 50

40 37.4 37.1 30.2 30 25.1 23.2 23.7 20.1 20 16.2

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

122 Isolation Figure 5.21 shows the proportion of respondents who feel isolated from friends and family. Overall, 15% of respondents fall into this category, but there are again significant differences across the three deprivation groups, ranging from just 8% in the least deprived areas to 18% in the most deprived. For the whole of Greater Glasgow, the proportion of respondents feeling isolated is down slightly (but significantly) from the 1999 survey.

Figure 5.21

% of respondents feeling isolated from family & friends Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002

20 18.3 18

16 14.8

14 13.2

10 8.1 8

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Volunteering The proportion of Greater Glasgow respondents who said they “act as a volunteer” is shown in Figure 5.22. According to the 2002 survey, only 7% fell into this category, although the figure in the least deprived areas was significantly higher at 11%. There was little difference in the overall responses between the 1999 and 2002 surveys. However, the Scottish Household Survey asked a related, but slightly different, question around the same time (2001/02), which showed that around 21% of respondents within Glasgow City had volunteered in the previous 12 months.

123 Figure 5.22

Civic engagement: % of respondents volunteering Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002

12 11.3

8 7.3 6.6 % 5.9 6

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Perception of the local area Perception of the local area is relevant to – and is quoted within – Chapter 6: Physical environment. However, overall perception of a neighbourhood as a place to live (Figure 5.23) and a place to bring up children (Figure 5.24) is also relevant to the notions of social capital and social connectedness.

Figure 5.23

% of respondents with a positive perception of their local area as a place to live Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002

100 91.7 90

79.8 80 72.8 70 61.1 60

% 50

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

124 Figure 5.24

% of respondents with positive perception of local area as a place to bring up children Greater Glasgow Source: NHSGG Health/Well-Being Survey, 2002 100

88.8 90

80 73.1

70 64.4

49.5

% 50

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

As can be seen from these charts, the majority of respondents in 2002 viewed their areas in a positive light (73%). However, the figures were markedly, and significantly, higher in the more affluent parts of Greater Glasgow, where 92% viewed their area in this way (the corresponding figure for the most deprived areas was 60%). Similarly, a large 'deprivation effect' is also visible in terms of the proportions of respondents who have a positive perception of their local area as a place to bring up children. Although 64% fell into this category overall, in the most deprived areas the figure was less than 50%, and in the least deprived it was almost 90%. There was little change in either measure between the 1999 and 2002 surveys.

Voter turnout Voter turnout in the 2003 Scottish Parliamentary election was 49%. Figure 5.25 shows how this varied at a constituency level (from 35% in Glasgow Shettleston to 58% in Eastwood).

125 Figure 5.25

Voter turnout by constituency, 2003 Scottish Parliamentary Elections West of Scotland and Greater Glasgow constituencies Source: NHSHS Constituency Profiles 70%

60% 58%

49% 50%

40% 35%

30% % turnout

20%

10%

l ts th h n h h ie e hil rn an art on hill rt ut de ton r land v t s haw dale hi Ayr elvin o hot ou hc out ys s cly sden wood ot K liestonG S ell bar ilbride ws t c Mary hr thergle er ear as S ail ley No ley So um tK re pringbu B ow e & S ilton S &B s s Inv E S g i & C h ai Clyde D as enf gow w m t P E R ow Annieslandirdr lasgow Pollok well & Wis Pai nk & Milngav t in & B go Glasgowgow Glas g A Ha asgow Cat G idge ck & k & Doon Valley Glas as Gl nninghame her ba tbr on Nor unninghame North oc Wes Glas Gl Cu lt Glasgow Ru eeno C Glasgow Shettleston Glas oa i Mot lmarnock & Loudoun C Cumbernauld & KilsythKi Gr Clyde umn am Strathkelv H ,C rrick Ca Constituency

Figure 5.26 presents those figures at a council level and contrasts them with the proportion of respondents in the 2001/02 Scottish Household Survey who said they believed voting to be important. Thus we see that, for example, in Glasgow, although 74% of adults apparently believe it is important to vote, only 41% did so in the 2003 elections.

Figure 5.26

% Adults who think voting is important (2001-2002) vs. Electoral turnout (2003) West of Scotland council areas Source: SHHS/SNS; Electoral Commission 100 think voting is important 2003 turnout 86 86 90 83 83 81 81 80 80 80 80 80 81 80 74 70 58 60 56 56 52 53 49 51 50 50 51 49 46

% 50 41 40

e g ity ire ire ire ire re ire ire h h h tland sh sh s shire s rksh rk rclyde w co Ayr e on Ayrshi Ayrs S Avera na na t fre rt d s Inv n th h lasgow C ba u enfrew G Re R ort hLa hLa Ea o N ut Dun S st ort o a N S st Dunbartonshire E t of Scotlan We East s We Council

126 Figure 5.27 shows the trend in voter turnout at general elections from 1945 onwards for Scotland as a whole and for Glasgow constituenciesviii. Despite dropping from the high levels of the early 1950s, turnout remained above 70% up to, and including, the 1992 election. However, in subsequent elections turnout dropped sharply to 58% nationally in 2001 and to 50% in Glasgow. Despite a slight rise in 2005, there is broad agreement, from this evidence and that of other elections, that the general public has become less inclined to vote. Figure 5.27 also, perhaps, suggests that this has become a progressively more prominent trend in Glasgow than nationally.

Figure 5.27

Voter Turnout in Westminster General Elections, 1945-2005 Glasgow Constituencies & Scotland Sources: UK Election Statistics; Political Guide to Modern Scotland

40 % turnout

20 Scotland Glasgow Average 10

0 1945 1950 1951 1955 1959 1964 1966 1970 1974 1974 1979 1983 1987 1992 1997 2001 2005

5.4 Crime

At the start of this section, recorded crime levels and trends in recorded crime (for a range of crimes) at a council level are presented. Following on from this, crime patterns within Glasgow are described. There is a particular focus on violent crime within Glasgow and related figures on domestic abuse and hospital discharges after an assault are also reported. Two final sub-sections comment briefly on imprisonment rates and fear of crime.

viii Due to numerous changes in constituency boundaries over the period, the trend for Glasgow should be considered as very approximate.

127 Recorded crime levels In 2004/05 over 430,000 crimes were recordedix in Scotland4, 44% of the Scottish total occurring in the West of Scotland and 18% in Glasgow City. Glasgow City has the highest overall crime rate among councils in Scotland. Within the West of Scotland, Glasgow has the highest rates for a range of crime types including non- sexual crimes of violence, crimes of indecency, crimes of dishonesty, serious assaults, crimes involving offensive weapons and domestic housebreaking (See Tables 5.1 and 5.2).

Table 5.1

Number of crimes recorded by the police per 10,000 population and crime index, West of Scotland council areas, 2004/05 Source: Scottish Executive

Rate and Index

Non - sexual Fire - raising, Index Crimes of Crimes of Council area crimes of vandalism, Other crimes Total crimes (Scotland indecency dishonesty violence etc. =100)

Scotland 29 14 414 253 152 863 100 Glasgow City 78 34 589 334 315 1,350 157

East Dunbartonshire 16 3 209 190 82 500 58 East Renfrewshire 17 3 217 206 66 509 59 South Lanarkshire 27 7 265 235 146 680 79 South Ayrshire 24 10 311 234 114 692 80 East Ayrshire 31 11 341 256 130 770 89 North Lanarkshire 27 11 315 260 168 782 91 North Ayrshire 28 12 339 288 156 823 95 Renfrewshire 35 10 476 246 126 892 103 Inverclyde 39 7 411 285 231 974 113 West Dunbartonshire 48 11 413 356 203 1,032 120

Table 5.2

Number of crimes recorded by the police and rate per 10,000 population for selected crimes, West of Scotland council area, 2004/05 Source: Scottish Executive

Number Rate per 10,000 population

Council area Serious Offensive Domestic Serious Offensive Domestic Vandalism 1 All crimes Vandalism 1 assault weapons housebreaking assault weapons housebreaking

Scotland 6,775 9,545 23,613 119,855 438,093 13 19 46 236 Glasgow City 2,187 3,184 4,004 17,265 78,014 38 55 69 299

East Dunbartonshire 101 118 315 1,842 5,325 9 11 30 173 East Renfrewshire 70 123 374 1,749 4,561 8 14 42 195 South Lanarkshire 442 641 1,065 6,765 20,775 14 21 35 222 South Ayrshire 157 107 327 2,487 7,741 14 10 29 222 East Ayrshire 240 218 584 2,806 9,214 20 18 49 234 North Lanarkshire 441 632 1,223 7,686 25,227 14 20 38 238 North Ayrshire 215 297 653 3,652 11,200 16 22 48 268 Renfrewshire 298 380 1,026 3,855 15,223 17 22 60 226 Inverclyde 194 308 495 2,095 8,027 24 37 60 254 West Dunbartonshire 219 290 482 2,955 9,491 24 32 52 321

1. Includes vandalism, malicious damage and malicious mischief only.

In contrast, East Dunbartonshire and East Renfrewshire have overall crime rates that are approximately one third of the Glasgow rate (Figure 5.28).

ix It should be noted that the reported crime level for many crime types is a considerable underestimate of the true crime level, as many crimes are not reported to the police.

128 Figure 5.28

Index of overall crime rate per 10,000 population, West of Scotland council areas, 2004/05 Source: Scottish Executive 180

157 160

140 120 120 113 100 103 100 95 89 91 79 80 80

58 59 60 Index (Scotland = 100)

d e ity r ire an hire hire hi hire hire h yde C s shire s shire l shire rs r w ons ews y erc on Scotl gow t r ark A fre rt h nark Inv Lan La en ba Glas Renf out R unbar East Ay North Ayrs st S Dun tD outh North st as Ea S e E W Council

Recorded crime trends Using slightly older data (for the period 1997-2003x) a comparison of crime trends within the West of Scotland council areas can be made. The rate of ‘serious violent crime’, which includes murder, serious assault, robbery, rape and attempted rape, rose by 19% between 1997 and 2003 across Scotland, and rose even more sharply in North Ayrshire, West Dunbartonshire and Glasgow (Figure 5.29). Glasgow has the highest prevalence rate for this type of crime, followed by West Dunbartonshire. In contrast, in East Dunbartonshire a 33% reduction in this type of crime was recorded over the same period.

x Trends by council for more recent years than 2003 have not been published.

129 Figure 5.29

Serious Violent Crime per 10,000 population, 1997 vs 2003 West of Scotland council areas Source: SNS 100

88 90 1997 2003 80

68 70

60 52 50 46 43 40 39 40 37 32 33 27 27 30 25 25 26 26 25 23 22

Crimes per 10,000 population 21 21 19 19 20 14

y e e e ir re ir ire ire ire Cit h shir hi h h h lyde h ns rs rs c ns ew y y er o Scotland rto fr arks A A v rt n t h Ayrshire In lasgow e Lan as ut enfrews ba G R h E orth R rt So N st o t Dun a s E N South Lanarkshire e East Dunba W Council

Rates of domestic housebreaking reduced by 32%, nationally, over the same period and by 25-50% in most of the West of Scotland councils (Figure 5.30).

Figure 5.30

Domestic Housebreaking per 10,000 population, 1997 vs 2003 West of Scotland council areas Source: SNS 160 153 1997 2003 140

121 119 120 110

100 87 81 80 72 71 65 66 62 61 63 62 63 64 57 60 60 49 48 42

imes per 10,000 population 37 40 33 34 Cr

d y t ire ire ire re ire ire re h h s sh h s nshire rsh on rk w o wshi Scotlan rt na Ayrshi fre Ay re n art st nf Inverclyde asgow Ci La b Gl nba h Ea Re Du South Ayrshire North Dun ort t N s South Lanarks East Re e East W Council

‘Fire-raising, vandalism etc.’ rates rose by 25% in Scotland. In parts of the West of Scotland, such as Inverclyde, there were even steeper rises (Figure 5.31). This increase partly reflects improved recording of minor incidents of such crimes by Scottish police forces.

130 Figure 5.31

'Fire-raising,vandalism etc.' per 10,000 population, 1997 vs 2003 West of Scotland council areas Source: SNS 300 272 267 1997 2003 247 244 250

198 199 199 200 184 188 168 172 159 151 155 154 144 150 131 128 126 126 113117 118 94 100 Crimes per 10,000 population 10,000 per Crimes

e e e e e e e ity r ire ir ir r r h h h C s s shi lyde nshi rs kshir rshi c ow o r w Scotland g Ay na Ay fre art th Inver b ast Ayr uth r bartonshir Glas E La Ren un So No un t D uth s North Lanarkshire East Renfrew So est D Ea W Council

Perhaps, the most concerning trends are those for drug related crimes, which rose by 38% nationally over the six years up to 2003. Many of the individual West of Scotland councils had even greater rises (Figure 5.32). Glasgow stands out as having a rate that is more than double the national average.

Figure 5.32

Drug related crime per 10,000 population, 1997 vs 2003 West of Scotland council areas Source: SNS 200

175 180 1997 2003

160

140 125 118 121 120 98 100 92 80 79 76 77 74 80 70 65 58 57 60 50 49 49 45 43 Crimes per 10,000 population 10,000 per Crimes 39 40 35 26 25 20

d e e e e e ire r r r ire r an h tl shi shi shire shir s o nshi k nshi c o w r S re Ayr to art f na nark ar b th a Inverclyde Glasgow City or La nb Ren East Ayr N th L u South Ayrshire uth r No East Renfrewsh So est D East Dun W Council

131 Crime patterns within Glasgow The data used in this analysis were provided from the Strathclyde Police Corporate Database for the fiscal year 2004/05 and only cover the Glasgow City area. The crime types included within this analysis were disorder, vandalism, vehicle crime and housebreaking. All the crimes were assigned to the postcode sector in which the crime occurred and analysed as rates per 1,000 resident population at a postcode sector level across Glasgow City.

Crimes of vandalism The city centre has the highest rate of crimes of vandalism. However if the city centre is excluded, a wide variation in the levels of vandalism per head of population can still be observed across the city, varying from 10-18 per 1,000 in the lowest rate areas to 52-74 in the highest rate areas (Figure 5.33). An association with deprivation is clear. The areas with the highest rates of vandalism are notably amongst the most deprived in the city, while the opposite is true of those areas with the lowest rates of vandalism.

Figure 5.33

Crimes of Vandalism per 1,000 population, 2004/05 Comparison of 10 small areas with highest rates and 10 with lowest rates Glasgow Sources: Strathclyde Police Corporate Database & 2001 Census 160 142 140

120

100

80 72 74 74 59 60 60 60 52 54 55

40 Rate per 1,000 population 32 18 14 16 16 20 10 10 11 12 12 13

l il ill e s rk ill x N h h on d d a N k S ro k E n m st si n r b l tickhill n lan hazie I entre elvi wan ou w gsp sto Nitsh Calton Govan head N ar K o h lvi in mbreck ie uc yC Glasgow P Broo D la u ill R it ; l Ke Ne K D a astlemi d ; Park C n Be le B C a a eston; Gorbals l s; d Kinning Pa n ield Trad Hynd sh elvi k K llo o P Postcode sector

Crimes of disorder The prevalence of crimes of disorder varies greatly across the city. In 2004/05 in the ten postcode sectors with the highest rates, the rate varied from over 100 disorder crimes per 1,000 residents to over 1200 (Figure 5.34). The latter was in the city centre, and clearly reflects the large numbers of people socialising there in the evenings and at the weekend. The ten areas with the lowest rates of this crime tend to be in more affluent parts of Glasgow.

132 Figure 5.34

Crimes of Disorder per 1,000 population, 2004/05 Comparison of 10 small areas with highest rates and 10 with lowest rates Glasgow Sources: Strathclyde Police Corporate Database & 2001 Census 1400

1214 1200

1000

800

600

400 305 Rate per 1,000 population

151 171 200 118 119 132 133 137 147 66 10 13 14 15 18 19 21 22 23 24 0

w ill N l x S e h on N N hil o d re go side t in nt n ton ark S Ibr ad on E vi elv Ruc P et owanhill ewlands room Yoker ies khe khead N Glas B el K idg r yCe D DumbreckN K ar r eadowsi n; Gorbals ellahous aill Govanhill N P B Pa o Cit B B inning M ; est K d indale; ra lv Jordanhill; Temple T Hyndland; e K shields lok Pol Postcode sector

Vehicle crime While the level of vehicle crime varied widely across the city in 2004/05, and was particularly high in the city centre, it is difficult to observe a pattern related to deprivation (Figure 5.35). The areas with the lowest rates of vehicle crime are a mixture of deprived and more affluent areas, although the areas with the highest rates of vehicle crime are (with the exception of the city centre) noticeably more deprived than average.

Figure 5.35

Vehicle Crimes per 1,000 population, 2004/05 Comparison of 10 small areas with highest rates and 10 with lowest rates Glasgow Sources: Strathclyde Police Corporate Database & 2001 Census 140 129

120

100 81 80 population

1,000 60 53 47 50 40 40 33 36 28 Rate per per Rate 26

20 14 3 4455555 5 6 0

l E k N k n ill E N S ls hil o lee an rox e er ar st ch oun b k ba sgow spar k P ni t I on W ar a ington er Ru ddens Gov P Centre hous room ill ng Yo wood N Pe a Gl B H Linn s get g y ter ; Ki ; ennis ridgeton arkhead id n t D B P ni ton; Gor Cit as Summ night Br in E tfoo K K nald N of rades do Cr T Car oodlands; Cowc ;W us

rk Circ Postcode sector Pa

133 Housebreaking The areas that had the highest rates of housebreaking in 2004/05 were quite mixed socio-economically and, perhaps surprisingly, the areas with the lowest rates of housebreaking tended to be among the most deprived (Figure 5.36).

Figure 5.36

Housbreaking Crimes per 1,000 population, 2004/05 Comparison of 10 small areas with highest rates and 10 with lowest rates Glasgow Sources: Strathclyde Police Corporate Database & 2001 Census

25 23 21 20 20

16 15 16 15 15 15 14 13

7 Rate per 1,000 population 5 3 3 3 3 3 2 2 2 1 1

k E ll x e ton on W W on hie hi o on re gow s loc lk E t e s van ead t nt s ilk W i al gt on Ibr haws o rov h a er m C pel n et lac s G ng ill em m le illi ros i Gl ham t hous C lok H tyCe rt ridg elv i n; Gorbals astl um a as er Cam Woodlands C S G C t N; H B Pol ; K ellahous o C rumcha as s B st D E ; nald rade ields Dunda T ardo t sh C or P lok Pol Postcode sector

Violent crime patterns within Glasgow Data were supplied by Strathclyde Police’s Violence Reduction Unit on the location (by data zonexi) of incidents of violent crime and the (data zone of) residence of victims and perpetrators of violent crime covering a three-year period from July 2002 – June 2005 for Glasgow City. Offences that are classified as ‘violent offences’ include: murder, attempted murder, serious assault, simple assault and possession of an offensive weapon.

Police intelligence records suggest that there were approximately 13,725 offenders living in Glasgow City, who offended on at least one occasion in the three-year period, July 2002-June 2005. There were substantially more male than female offenders (10,743 vs. 2,982), a ratio of 3.6 males to one female. The age profile of violent offenders is strongly skewed towards a peak offending age of 15/16 years (Figure 5.37)xii. From this peak the numbers of male and female offenders drop gradually with increasing age, although numbers of offenders remain high, particularly for men, between late teenage years and mid twenties.

xi Populations c600/700. xii Please note that the column values for males and females in Figure 5.37 (and in subsequent similar graphs – Figure 5.38, 5.40 and 5.41) are independent, not cumulative e.g. in Figure 5.37, the number of 16 year old male offenders is 514 and the number of 16 year old female offenders is 168.

134 Figure 5.37 Violent offenders by age and gender over a 3 year period, July 2002 - June 2005 Glasgow City Source: Violence Reduction Unit, Strathclyde Police 600

Female Male

500

400

300 No. of Offenders 200

100

0 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 82 97

Age of offender

Rates of violent offenders by age and gender show similar patterns (Figure 5.38). It is worth noting that rates of violent offenders among young males of 15 or 16 years were double that of those aged 22 years. The equivalent rates for females, while much lower, show an even sharper decline by age; the offending rate among 14 to 16 year old females was three times that for 22 year old women.

Figure 5.38

Violent offenders per 1,000 population by age and gender over a 3 year period, July 2002 - June 2005, Glasgow City Source: Violence Reduction Unit, Strathclyde Police 160

Female (rate per 1000) Male (rate per 1000) 140

120

100

60 Violent offenders per 1,000 population

0 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 82

Age of offender

135 A comparison of the geographic concentration of violent offenders within the population – at a data zone level – shows a huge variation across the city (Figure 5.39). In the ten areas with the highest rates of residents who have committed a violent offence, there are 60-100 offenders for every thousand residents while, in the 10 areas with the lowest rates of offenders, there are only 1-3 offenders per 1,000 residentsxiii. The areas with low rates of offenders are generally more affluent but not exclusively, while the areas with the highest rates of offenders are among the most deprived in Glasgow. This is confirmed by a strong statistical correlationxiv at a data zone level between deprivation (as measured by SIMD) and rates of offenders.

Figure 5.39

Violent offenders per 1,000 population over a 3 year period, July 2002 - June 2005 Comparison of 10 small areas with highest rates and 10 with lowest rates Glasgow City Source: Violence Reduction Unit, Strathclyde Police 120

100 100 88

80 76 77 78 72 72 66 67 68

40 Violent offenders per 1000 population Violent 20

1 1 1 1 1 2 2 2 2 3 0

l ill k n tick ton on ws to ton ton ton anhill alt ha s d lands Par ayburn Govan C der oys ngs ordanhil ordanh ew H arrowhill Toryglen Roys R Ki J J Jor N Newlands G loks ood Park ictoria Par Crooks Queenslieol An V P tsw

Knigh Data zone (named after relevant electoral ward)

The distribution of victims of violent offences by age and gender is similar to that for violent offenders (Figure 5.40). Victims are more likely to be male than female and numbers of victims are highest in the age range 15-25.

xiii It should be noted that ward names repeat on the graph where more than one data zone from the same ward is present. xiv R2 = .77, where 0 would represent no correlation and 1 a perfect correlation.

136 Figure 5.40 Victims of violent offences by age and gender over a 3 year period, July 2002 - June 2005, Glasgow City Source: Violence Reduction Unit, Strathclyde Police 600

Female Male

500

400

300 No. of Victims 200

100

0 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 83 86 91

Age of victim

The chart of victim rates (Figure 5.41) by age shows that the peak age for a male or female being a victim of a violent offence is fifteen. From this age the rate drops steadily until the mid-twenties where it remains stable before dropping again around forty.

Figure 5.41 Victims of violent offences per 1,000 population by age and gender over a 3 year period, July 2002 - June 2005, Glasgow City Source: Source: Violence Reduction Unit, Strathclyde Police 160

Female (rate per 1000) Male (rate per 1000) 140

120

100

40 Victims of violent offences per 1,000 population

0 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 83 86 91

Age of victim

137 A comparison of the geographic concentration of victims of violence in Glasgow (Figure 5.42) shows that in some data zones over one in ten people have been the victim of a violent crime in the last three years, while at the other extreme in the ten areas with the lowest rates of victims between five and 11 people per 1,000 population have been victims of violent crime. There is a strong correlationxv between areas with high concentrations of victims of violent crime and deprivation (as measured by SIMD at a data zone level).

Figure 5.42

Victims of violent crime per 1,000 population over a 3 year period, July 2002 - June 2005 Comparison of 10 small areas with highest rates and 10 with lowest rates Glasgow City Source: Violence Reduction Unit, Strathclyde Police

180 168

160 142 144 139 140 129 123 118 119 120 121 120

100

60 Victims per 1000 population 40

20 9 9 99910 11 5 7 8 0

d d t n s n ill n ck r on irs ir h o nds ca tick slie to lan h r rsto n st la s dla ll Park la d e e haws wla rdan n e Pa d ks oy o yn Cat Royston ue R Cow Co Toryglen King J Hy xw New H HyndlandAn Q armunn a C M Victoria Park PollokshawsPollo Data zone (named after relevant electoral ward)

Rates of violent incidents per 1,000 residents for data zones were also analysed. The graph below (Figure 5.43) clearly shows that these offences tend to concentrate in particular parts of the city centre, such as Anderston and Kingston.

xv R2 = .71, where 0 would represent no correlation and 1 a perfect correlation.

138 Figure 5.43

Violent incidents per 1000 population over a 3 year period, July 2002 -June 2005 Comparison of 10 small areas with highest rates and 10 with lowest rates Glasgow City Source: Violence Reduction Unit, Strathclyde Police 4500 4118 4000

3500

3000

2500

2000 1786

1500

1000 857

Violent Incidents per 1000 population 600 612 464 518 536 500 316 353 0 1334 55555 0

n s s d ill ill n k e d n ale o n h h o ton ton c v a ton ton d lvin st a n n s s ro s e y an r rno r in Partick d da Calton rkhe lv hK yndl r r ders derston dersto rt H o o tVe King King lma nde Ke o Newland Newland J J n a Pa A An An An N Robro ou Kelving M n/D eto g id Br Data zone (named after relevant electoral ward)

Domestic abuse Statistical reporting of incidents of domestic abuse by the police only started relatively recently, in 1999. Since recording started a number of patterns have become established (statistics quoted are based on 2004 national figures)5: x The majority of incidents involve a female victim and male perpetrator (88%). x Where information was available on whether or not the victim had previously been reported as being a domestic abuse victim, 52% of the cases involved known repeat victimisation. x Nearly 45% of incidents of domestic abuse recorded by the police involved co- habitees or spouses and in 32% of cases, the victim and perpetrator were ex- partners or ex-spouses. x The overwhelming majority of incidents of domestic abuse took place in the home (91% of all incidents where the location was recorded).

The latest domestic abuse statistics show that across the West of Scotland (see Figure 5.44) rates of recorded incidents of domestic abuse vary hugely from 1,409 per 100,000 in West Dunbartonshire (64% above the Scottish average) to 364 per 100,000 in East Renfrewshire (58% below the Scottish average). The rate for Glasgow is the second highest in the West of Scotland and is 56% above the Scottish average.

139 Figure 5.44

Domestic Abuse Incidents per 100,000 population, 2004 West of Scotland council areas Source: Scottish Executive 1600

1,409 1400 1,339

1200

967 1000 937 957 893 860 875 812 800 708

600

364 368 Rate per 100,000 population 400

200

y e e e e ir ir ir land Cit h h h hire shire lyde hire ot w ks c c ons rks ew ons S go rt fr Ayrshire t na t Ayrshir Inver s anar en Glas Renfrews Ea L R outh nbar t North Ayrshire h s Dunba S outh La ort tDu Ea st S N Ea Wes Council

Hospital discharges after an assaultxvi There are approximately 6,000 hospital discharges after assaultxvii in Scotland, annually. Greater Glasgow, contributes disproportionately to this figure, accounting for a quarter to a third of all such admissions within Scotland, while at a council level, Glasgow City had the highest rates for males (see Figure 5.45) and females until 2003/04, when there was a large reduction; although, this drop is likely to be artefactual, rather than a real reductionxviii.

xvi Appendix 1 provides details of the diagnoses used to define assaults. xvii It is worth noting that these figures are based on discharges after inpatient or day case treatment in hospital and do not include patients treated in accident and emergency departments who are not then admitted. Thus, the figures clearly underestimate incidences of assault, although they are likely to be less of an underestimate of assaults resulting in serious injury. xviii Changes in the organisation of the A&E receiving wards at Glasgow Royal have had a knock-on effect on actual patient admissions and this may account for part of the drop in Glasgow City.

140 Figure 5.45

Assault discharges for males as a rate per 1,000 population, 1995/96 - 2003/2004 Selected West of Scotland council areas Source: ISD Scotland

4 Glasgow City

North Ayrshire 3

Scotland

Rate per 1000 population 2

East Renfrewshire

East Dunbartonshire

0 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04

Age and gender breakdowns of assault discharges highlight that males are far more likely to be involved and that the rates are highest among young males with the peak rates in the age ranges from 15-29. A comparison of assault discharges for males between Glasgow City and Scotland (see Figure 5.46) shows that the rate in Glasgow is consistently higher in each age band. For 15-19 year olds the rate was double the Scottish rate in 2003/04 and was the highest among the West of Scotland councils.

Figure 5.46

Assault discharges per 1,000 population for males by age, 2003/2004 Comparison of Glasgow City rates to Scottish rates Source: ISD Scotland 12.00

10.8 Scotland Glasgow City

10.00

8.8

8.00 7.5

6.0 5.9 6.00 5.3 5.1 Rate per 1000 per Rate

4.00 3.4 3.4

2.0 2.00 1.4 1.4

0.7 0.6 0.3 0.1 0.1 0.2 0.00 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 39 40 - 49 50 - 64 65+ Age Group

141 Among 20-24 year old males, the rates of discharge after assault were highest in Inverclyde and North Ayrshire (11.8 and 13.8 per 1,000 population, respectively), while, for 25-29 year old males, Inverclyde had the highest rates (16 per 1,000 population).

The diagnostic codes used to define assault include 25 separate diagnoses, but four account for the majority of assaults. Across Scotland, ‘assault by bodily force’ is the most commonly coded diagnosis accounting for nearly one in two cases, but in Glasgow City (Figure 5.47) the pattern is different with ‘assault by (a) sharp object’ the most common cause shown (46% of all assaults).

Figure 5.47

Four main assault diagnoses as a percentage of all assault discharges, 2003/2004 Comparison of Glasgow City to Scotland Source: ISD Scotland

100% 97% 98%

Scotland Glasgow City

80%

60%

46% 47%

40%

25% 19% 20% 17% 16% 12% 12%

0% Assault by sharp object Assault by blunt object Assault by bodily force Assault by unspecified Four categories as a % of means total assault discharges Diagnosis

Repeat admissions with an assault diagnosis are relatively unusual. Just over 5% of individuals were discharged more than once after an assault in 2003/04. While multiple admissions after an assault are rare, these are clearly cases to cause concern. Figure 5.48 highlights the numbers of persons admitted in the West of Scotland in 2003/04. It is notable five men had four assault admissions, while one woman had six such admissions in the yearxix.

xix It should be noted that some of these multiple admissions may be readmissions for treatment of injuries caused in one rather than many assault incidents.

142 Figure 5.48

Frequency of assault discharges by sex, 2003/2004 All West of Scotland Council areas Source: ISD Scotland

3000 2729 Male Female

2500

2000

1500 Number of persons Number 1000

500 338

138 10 18 1 5 0 0 1 0 One admission Two admissions Three admissions Four admissions Six admissions Number of times admitted in year

Currently hospital discharge data do not record where an incident of assault occurred. However, it is possible to look at where victims admitted to hospital after an assault normally reside at a small area level. An analysis across the West of Scotland at a postcode sector level shows large variations between low assault discharge rates for populations in relatively affluent areas and the highest assault discharge rates associated with people living in more deprived areas (Figure 5.49). The differences are stark. The rates in the ten sectors with the highest rates are three to seven times higher than the Scottish rate, while, in the ten areas with the lowest rates, rates are less than a quarter of the Scottish rate. Although these rates are still based on small numbers – in the sector with the highest rate the actual number of assault discharges recorded in 2003/04 was 25 – taken collectively it is clear that people living in more deprived areas suffer far higher levels of assaults that require overnight hospital treatment.

143 Figure 5.49

Assault discharges, 3 year average rate per 1,000 population, 2001/02-03/04 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: ISD Scotland

10.0 9.2 9.0

8.0 7.5 7.2 6.9 6.9 7.0 6.4 6.2 5.7 6.0 5.3 5.5 5.0

4.0 Rate per 1,000 3.0

2.0 1.4 1.0 0.1 0.2 0.2 0.2 0.2 0.3 0.3 0.3 0.3 0.3 0.0 l il re s m ie d k ck E n on od ton de z k S Ayr n on land st o nh si a own r o mo t rnga gst gal esha Pa a et Calto oww owa Bal Mearn gl lvin Scot ou D l; Ruch g G lmarno dg Kin H myss Bayil Ke Ea ; nin rguslie ParDa Bri ce; We n e e; D i F land; Kirkh dale HutchesonK on rran n To m; Hynd Kelvi - Keyst Bearsden - KessingBroo e Biggar; Leadhills; Abington gavi n Mil Postcode sector

Imprisonment rates A recent report investigated imprisonment and social exclusion in Scotland6 and this section summarises a selection of the findings.

A comparison of imprisonment rates across the West of Scotland (Figure 5.50), as at June 2003, shows that the lowest rates of imprisonment were in East Dunbartonshire and East Renfrewshire, while the highest rates occurred in Inverclyde (five times the rate in East Dunbartonshire) and Glasgow City (six times higher).

Figure 5.50

Imprisonment per 100,000 on 30th June 2003, West of Scotland council areas Source: Houghton, Glasgow Caledonian University 300

261

250

204 200

145 150 136 138 130 125 116 122 102 100 Imprisonment per 100,000 48 50 42

y e e e e ir r re r h hire i hi land Cit shi shire shire ot w rs k r rclyd c y ws y e S ark A re A sgo h h Inv a Lan t Lanar enf t Gl Renfrews ou R th th East Ayrshire unbartonsh Nor st S ou or tD Ea S N East Dunbartonshire Wes Council

144 The socioeconomic background of prisoners was also investigated by an analysis of the proportions of prisoners coming from Group H housing – an ACORNxx classification that includes housing areas characterised by high unemployment, overcrowding, council ownership, high proportion of lone parents and poorer families. This analysis reveals that, in June 2003, 60% of prisoners from Glasgow came from Group H type housing compared to a Scottish average of 28% (Figure 5.51).

Figure 5.51

% imprisoned coming from type H housing on 30th June 2003, West of Scotland council areas Source: Houghton, Glasgow Caledonian University

59.7 60

50 44.9

38.9 40

30.8 30 28.4

20.9 20 18.2 12.8 13.9 8.6 8.9 10 4.7 % Imprisoned coming from type H housing 100,000 % Imprisoned coming from 0

e e e e e e ire ire r re City yd i tland sh cl sh o r n ow yr rkshir ewshi Sc A rtonsh a frewshir ve r rto sg an n In nf a L uth Ayrshir e b Gla o East Ayrshir North R rth S st Re Dun o a N st South LanarkshireE e East Dunba W Council

While there are 1,222 local government wards in Scotland, the home address of a quarter of the prisoner population (of 6,007) is in just 53 wards, where 7.0% of the population live. Of these 53 wards, 35 are in Glasgow. There is a strong correlation between the probability of spending time in prison and deprivation (SIMD).

Fear of crime In this section a question from the Scottish Household Survey is used to illustrate safety concerns within neighbourhoods. The question asked respondents to state whether they felt safe walking in their neighbourhood alone after dark. Across the West of Scotland in 2003/04, the proportion of respondents stating that they didn’t feel safe ranged from 17% in East Dunbartonshire to 36% in Inverclyde, while the figure for Glasgow was 32% (Figure 5.52).

xx ACORN is a housing classification produced by the market research company CACI. The Scottish ACORN version classifies housing into 43 types, which aggregate up to eight groups, of which Group H is one; 10.2% of the Scottish population live in this type of housing.

145 Figure 5.52

Fear of Crime - % of respondents stating they don’t feel safe walking in their neighbourhood alone after dark, 2003-04 West of Scotland council areas Source: Scottish Household Survey

40% 36% 35% 32% 33% 33% 31% 30% 29% 26% 24% 25% 23% 22% 20%

% 20% 17%

15%

10%

d y e e e e e e n t ir ir ire Ci shire shir sh w n yr yr ksh nshir rclyde o ewshir ewshir to Scotla rto A fr A nar fr ve a th anarkshire st Ayrsh a ar In L a rth b Glasg Ren Ren E No th L Sou uth r Dumb o Dum st East S No a E West Council

5.5 Homelessness

Across all Scotland in 2003-04 there were approximately 55,000 applications made under the Homeless Persons legislation7. This figure increased steadily over the previous 12 years – for example the figure in 1992-93 was under 43,000. Of those 55,000 applications, just under a quarter related to Glasgow City; a figure of just over 12,500, which has changed little over the past eight years.

Proportionally, however (i.e. as a crude rate per 100,000 population), homelessness applications in Glasgow have been considerably higher than the combined total for the West of Scotland local authority areas, and indeed the rate for 2003-04 is around twice the rate for the whole country in that year (Figure 5.53).

146 Figure 5.53

Homeless applications expressed as a rate per 100,000 adults, 1996-97 to 2003-04 Glasgow city and West of Scotland Source: Scottish Executive 3000

2500

2000

1500

Crude rate per 100,000 1000

500

0 1996-97 1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04

Scotland West of Scotland Glasgow City

Finally, Figure 5.54 shows homelessness application rates in 2003-04 broken down for each individual West of Scotland council area. Glasgow again stands out as the council area with by far the highest proportion of homelessness applications.

Figure 5.54

Homeless applications expressed as a rate per 100,000 adults, 2003-04 West of Scotland Source: Scottish Executive

3000

2621

2500

2000 1641 1643 1532 1500 1323 1204 1075 987 1008 1040 1042 1000 810

Crude rate per 100,000 pop 553 500

ity e e and hir hire hire hire tl land C hire lyde s o ot ns c rs rs nshir c y y yr o Sc to A A Inver tA h asgow bar as bart tofS Gl Renfrews Renfrewshire E out North t Dun S Dun t Wes as North Lanarkshire E as South Lanarkshire E West Council

147 Summary x Glasgow City has the highest proportion of pupils from minority ethnic communities of any Scottish council (10.9%), equating to 7,500 pupils. It also has the highest percentage of pupils from less affluent households – 42% of primary school pupils were eligible to receive free school meals in 2004, double the national average. x In terms of attainment, East Dunbartonshire and East Renfrewshire stand out across the West of Scotland as having the highest proportion of adults with qualifications at degree level or with three ‘Higher’ qualifications. x Estimates of new student participation rates – despite many caveats – suggest a strong degree of socio-economic patterning in terms of who attains a university level education. While in many of the affluent parts of the West of Scotland, a university education is the ‘norm’, only a minority of young people from the most deprived areas would currently be expected to enter higher education. x Over recent years there have been increases in participation rates. However, there does not appear to be a narrowing of the gap in participation rates between the traditionally high participation communities of Anniesland, Bearsden & Milngavie and Eastwood and the rates in less affluent communities. x The high proportions of lone parent families in many parts of Glasgow are highlighted by these figures. Equally, the polarity across Glasgow in the concentrations of lone parents as a percentage of all households with children is highlighted. While in Eastwood and Anniesland, Bearsden & Milngavie 13-14% of households with children are lone parent households, in Maryhill, Woodside & North Glasgow and Bridgeton & Dennistoun the percentages rise to around 50%. x In terms of social capital, recent surveys present a mixed picture. Levels of civic engagement appear to be relatively low. However, while those in less deprived areas are more likely to have been a committee member etc. (11%), those in the more deprived areas were more likely to have taken action to address a local problem (13%). One in five Greater Glasgow residents are members of clubs or organisations, with significantly more membership in the least deprived areas (25%) compared to the most deprived (16%) areas. x Levels of reciprocity and trust are relatively high as measured by survey results. Two-thirds of Greater Glasgow residents feel that neighbours look out for each other in their local area and that people can be trusted in their local area. However, levels of reciprocity and trust are significantly higher in the least deprived areas compared to the more deprived. Relatively low proportions of Greater Glasgow residents reported feeling isolated from friends and relatives (15% of respondents).

148 x The majority of Greater Glasgow residents have a positive perception of their local area as a place to live and to bring up children: 73% and 64%, respectively. However, respondents from more deprived parts of the city are much less positive about their local areas compared to those from more affluent areas. x Voter turnout patterns and trends show that levels of voting are generally lower in Glasgow than in the rest of Scotland, and that there has been a dramatic drop in voting turnout since 1992. x Glasgow City has the highest overall crime rate among councils in Scotland. Within the West of Scotland, Glasgow has the highest rates for a range of crime types including serious assaults, crimes involving offensive weapons, domestic housebreaking, non-sexual crimes of violence, crimes of indecency and crimes of dishonesty. x Crimes of disorder, vandalism, vehicle crime and housebreaking are all highest in the city centre area of Glasgow. Crimes of disorder and vandalism show a clear correlation with deprivation, while vehicle crime and housebreaking appear to be less related to social patterning of areas. x Detailed analysis of violent crime patterns in Glasgow shows that male offenders outnumber females by over three to one and the peak ages for offenders and victims are the mid-teenage years to early twenties. The area of residence of offenders and victims is highly correlated with deprivation and in some smaller communities in Glasgow over one in ten people have been the victim of a violent crime in the last three years. Incidents of violent crime are highly concentrated in the centre of the city. x Recorded incidents of domestic abuse vary considerably across the West of Scotland with the highest recorded rate in West Dunbartonshire (64% above the Scottish average) and the lowest in East Renfrewshire (58% below the Scottish average). The rate for Glasgow is the second highest in the West of Scotland and is 56% above the Scottish average. x Rates of assault admission in Glasgow are much higher than the Scottish average across all ages. The specific diagnosis of assault that predominates in Glasgow is ‘assault by sharp object’, which is likely to be a reflection of the high rates of knife crime in the city. People from more deprived areas suffer far higher levels of assault that result in hospitalisation. x Across the West of Scotland, the lowest rates of imprisonment occur in East Dunbartonshire and East Renfrewshire, while the highest rates are in Inverclyde (five times the rate in East Dunbartonshire) and Glasgow City (six times higher). There is a very strong correlation between deprivation and imprisonment. x Homelessness applications in Glasgow have been double the Scottish average for the last eight years and are much higher proportionately than in the other West of Scotland council areas.

149 x In summary, Glasgow is a city where deprivation/affluence clearly matters, whether it is in relation to educational attainment, the chances of being a lone parent or likelihood of being affected by crime. And while for some measures of social capital, Glasgow’s profile is quite positive (e.g. in terms of trust, low levels of isolation, high levels of satisfaction with the local area), other measures, particularly levels of violent crime, domestic abuse and imprisonment, reflect a darker side to the city.

150 References

1 NHS Health Scotland. Community Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/communityprofiles

2 HESA. Performance Indicators in Higher Education in the UK 2002/03. 2004 http://www.hesa.ac.uk/pi/0203/home.htm

3 Jones R, Borland E, Boyd A, Lorenzetti K, Scouller J, Carey L, Tannahill C. The Health and Well-being of the Greater Glasgow Population; summary report. 2003 www.show.scot.nhs.uk/gghb/PubsReps/Reports/health_promotion/health+wellbeing/h ealth+wellbeing_city_nov03.pdf

4 Scottish Executive. Recorded Crime in Scotland, 2004/05. 2005 http://www.scotland.gov.uk/Publications/2005/10/19155942/59484

5 Scottish Executive. Domestic Abuse Recorded by the Police in Scotland, 1 January- 31 December 2004. 2005 http://www.scotland.gov.uk/Publications/2005/09/16120959/10005

6 Houchin R. Social Exclusion and Imprisonment in Scotland: A report. 2005 http://www.sps.gov.uk/Uploads/C1D3FBFB-E123-4643-8D83-AB0F622E7755.pdf

7 Scottish Executive. Operation of the Homeless Persons Legislation in Scotland: National and Local Authority Analyses 2003-04. 2004 http://www.scotland.gov.uk/stats/bulletins/00363-00.asp

151

Chapter 6: Physical environment iations in the levels of both indictors across Glasgow and the West of Scotland are of Scotland are the and of bothiations in the Glasgow West indictors across levels r affic volume has increased year on year in the West of Scotland in recent times and it of Scotland in recent in theaffic on year West year increased has volume There have been major improvements in housing in Glasgow and West and West in housing in Glasgow been major improvements There have The ten small areas rates with the of owner-occupancy lowest are all in vident today. “ Central Scotland in recent decades.” “ with eight out of ten areas with theGlasgow, highest rates also located communities.” within Glasgow issues (e.g. dog dirt,“Environmental traffic, people hanging young as to be perceived around, activities) are alcohol and drug more likely partsproblems in the of the more deprived city.” Summary in recent of Scotland and the in Glasgow in housing West Despitemajor improvements significantdecades, properties numbers of still suffer rising from damp, poor heating efficiency, and mould. condensation and a of overcrowding, the in decrease a dramatic seen levels have The last 20 years equally striking in the occupiers. However, increase dramatic numbers of owner va e issues tocauses of concern be a range of environmental to Surveys shown have and these residents, other concerns backedGlasgow of data are up by which sources concern Considerable of litter and dog fouling in the levels high city. highlight relatively people (e.g. young behaviour in Glasgow of problematic about levels also exists drinkhanging around, and drug especially activities), in the parts deprived more of the city. Tr furtheris projected to grow decades (with in the two almost rise a 25% next in Glasgow 2021). predicted by served the well by council in terms relatively are areas deprived of Glasgow’s been identified have areas access is a where However, accessibility to centres. leisure major problem. Significant in proportions of Scotland live of the and the population of Glasgow West to land, landfill derelict sites or sitesproximity of potential industrial pollution. Guide to data presented in this chapter % of dependent children living in households where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 6: Physical environment

The physical environment has long been recognised as a key determinant of health, and is described as such in many of the current models of health. The surroundings in which people live and work can influence health both directly (e.g. through toxic, allergenic, or infectious agents) and indirectly through influencing behaviours (e.g. the availability of a local environment in which to walk or cycle). The quality of their physical environment also affects people’s mental health and well being (which in turn may affect their physical health). This chapter summarises a few examples of data relevant to the physical environment for the Glasgow and West of Scotland area. These data have been grouped into six broad categories: housing; neighbourhood characteristics and perceptions; traffic volume and air quality; access to services; sites of environmental concern; and ‘greenspace’.

6.1 Housing

House condition The last 25 years have seen large-scale investment in the quality of housing stock in Glasgow and the surrounding West of Scotland area, both in terms of renovation of existing properties and in the creation of new developments. However, analysis of the 2002 Scottish House Condition Survey1 (including sub-analysis of the Glasgow Housing Association (GHA) stock) shows that, for many people, problems remain: x An estimated 20,000 properties in Scotland (1% of the total number) are classed as below tolerable standard’ (BTS)i and, of these, one fifth (4,000 properties) are located within Glasgow. x Nationally, about 6% of properties have rising/penetrating damp, and this is also true for the West of Scotland generally, and for Glasgow specifically (although the figure for GHA properties within Glasgow is higher at 10%). At a council level, the proportion ranges from 4.6% (East Dunbartonshire) to 9.1% (East Ayrshire). These figures equate to over 20,000 properties in Greater Glasgow, including approximately 8,000 GHA properties. This is all illustrated in Figure 6.1.

i The ‘tolerable standard’ is the minimum standard of house condition required by Scottish law.

155 Figure 6.1

Estimated proportion of properties with rising/penetrating damp, West of Scotland council areas, 2002 Source: SHCS; Newhaven Research

12.0

10.0 10.0 9.1

8.0 8.0 7.6 6.8 6.4 6.3 6.5 6.0 6.0 6.2 6.0 5.5 5.2 4.9 4.6 of properties

% 4.0

2.0

0.0

d w s e e e e nd o ie ire ir ir ir ire ire la rt t tlan sg e sh rshire clyd sh sh sh a p w rksh r w rkshire yr yr co o tonsh e e Sco S Gl r r fr na fr A A f r sgow City p th Ay a Inve h st e la r ut at G Ren L st o No h Ren o Ea e re GHA st ut S W G o orth Lana Ea S N East Dunba West Dunbartonshire Council

More than one in ten propertiesies in Scotland, the West of Scotland, and Greater Glasgow have mould in at least one room, ranging (at a council level) from 7% in East Renfrewshire to 15% in East Ayrshire (Figure 6.2). For the West of Scotland this equates to an estimated 100,000 properties (with, for example, over 30,000 such properties in Glasgow, and 17,500 in North Lanarkshire).

Figure 6.2

Estimated proportion of properties with mould in any room, West of Scotland council areas, 2002 Source: SHCS; Newhaven Research

18.0

16.0 15.3 13.8 14.0 12.0 12.0 11.0 10.8 11.2 11.1 10.0 10.1 9.3 9.4 9.5 10.0 8.9 8.3 8.0 6.9 of properties

% 6.0

4.0

2.0

0.0

d w s e nd o ie ire ire ire ire ir ire la rt yde t tlan sg e sh cl sh sh a p r yr kshire rksh yr co o Sco Gl r frew frewsh ve A ar a A f S r sgow City n In h n e la p e rt a st at G Ren R o L st o N th th Lan Ea e re GHA st u South Ayrshire r W G Ea So No West Dunbartonshire East Dunbartonsh Council

156 Figure 6.3 shows that over 30% of properties in the West of Scotland are estimated to be in “urgent disrepair”ii, ranging from 25% in East Renfrewshire to 50% of all properties in South Ayrshire. The figure for Glasgow is 28% (Figure 6.3). This represents over 300,000 properties in the West of Scotland, over a third of which are within the Greater Glasgow area.

Figure 6.3

Estimated proportion properties with any urgent disrepair, West of Scotland council areas, 2002 Source: SHCS; Newhaven Research

60.0

49.9 50.0 45.7 46.7 41.6 41.8 40.0 37.6 33.0 34.1 29.0 30.0 28.0 28.3 27.9 28.4 25.2 25.7 of properties

% 20.0

10.0

0.0

d s e e e e nd w e ire ir ire ir a o ti yde tl tlan r sh sh shir sh sg e ksh kshire rcl co a p n n w Sco Gl ro rew ar re ve Ayrshir f S r sgow City f arto arto n f a p b a In th e l b L u st o at G Ren n n Ren East Ayrshire e e u u th North Ayrshire So r GHA st D orth Lanar D u W G st st Ea e N a So W E Council

It should also be noted that an estimated 27,000 properties in Greater Glasgow have poor heating efficiency (as defined by the National Home Energy Ratingiii). Included in this number are an estimated 10,300 GHA properties (13% of the total GHA stock).

It is worth noting that in Glasgow a new, and large, programme of regeneration of the city’s socially rented housing stock is soon to be undertaken2. To accompany this, the Glasgow Centre for Population Health has been commissioned to carry out a research programme to investigate the impacts of neighbourhood change in a number of communities, including some which will undergo major programmes of regeneration (‘the GoWell programme’). Although this is a ten-year research programme, interim reports will be produced as data become available.

ii Urgent disrepair defined as: disrepair, that if not repaired, would cause the fabric of the building to deteriorate further and/or place the health and safety of residents at risk. iii Full definition available from the 2002 Scottish House Condition Survey report (see references section of this chapter).

157 Overcrowding Levels of overcrowdingiv (a key indicator of socio-economic deprivation, and used in a variety of deprivation indices such as Carstairs3 and the new Scottish Index of Multiple Deprivation (SIMD4)) have declined dramatically in Scotland over the past 20 years. Expressed in terms of individuals (the measure used in the above deprivation indices), the proportion of the population living in overcrowded households in Scotland decreased from 18% of the population in 1981 to less than 5% in 2001v. A similarly dramatic decline took place across all Greater Glasgow. This is illustrated in Figure 6.4vi.

Figure 6.4

% of population living in overcrowded households, 1981-2001 Source: 1981, 1991, 2001 Censuses

25.0 23.6

20.0

18.3

15.0

11.2 of population 10.0 %

7.2 7.4 5.0 4.6

0.0 1981 1991 2001

Scotland Greater Glasgow

Despite this overall decline, huge variations in rates of overcrowding remain. Expressed in terms of households (as was done in the Community Profiles5), the proportion of all households in Scotland classed as overcrowded in 2001 stands at just under 12%. However, at a ‘community’vii level across Greater Glasgow and the West of Scotland this figure ranges from 6% in Eastwood to around 30% in Bridgeton & Dennistoun (Figure 6.5). At a small area level (Figure 6.6), the contrasts are again greater: from around 1% to 4% of households in the areas with the lowest rates (e.g. Alloway, Giffnock, Newton Mearns); to around 30% to 35% in the small areas with the highest rates (e.g. Govan, Easterhouse, Parkhead).

iv See Appendix 1 for definition of this, and all other, indicators included in this chapter. v Note that other published figures quote the 1981 overcrowding figure for Scotland as 25%. However, to allow valid comparison with 1991 and 2001, a correction factor has been applied to the 1981 figure. vi Data in Figure 6.4 is for all ‘communities’ within NHS Greater Glasgow, the boundaries of which differ from the exact NHSGG boundary. vii These are primary care-based localities (mainly the old Local Healthcare Cooperative (LHCC) areas or, in some cases, the new Community Health (Care) Partnerships (CH(C)Ps)) with populations ranging from 20,000-140,000 people. For further details see ‘Preface to Chapters 2-12’.

158 Figure 6.5

Proportion of households classed as overcrowded, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from 2001 Census data)

35.0

29 30.0 26 25.0 22 22 21 21 20.0 19 16 17 14 15 15 15 15.0 14 14

of households of 12 12 10 10 % 9 9 10 10 8 9 10.0 7 6 5.0

0.0

l d e n le e ld e e n e s d w w n n vie ir a u ir r d o o a lvi glen ilto haw n En ou sh r a sg sgow st ilbride hke esd yr omond m wl st la la ilng Ayrsh K t Ayrshir L the Wis verclyde e Scotla a lyd berna A Ha n oatbridge ha Glasgow G Glasg nni Eastwood/M th st tr th m Motherwell I n e n S C r ast st w W r st NG e ou Ea E r S e o a No Cu te ste E rsd S a W a rie & C e th E th ea u u B bank & DrumchapGr Glasg dside & Aird e So So o d/ o ridgeton & D n w & West Renfrewshi isley and Levern Valley yd W e l l/ B Cambuslang & RuPa C ryhil Renfr a Anniesla M Community

Figure 6.6

Proportion of households classed as overcrowded, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from 2001 Census data)

40.0 35 35 33 34 34 32 32 32 33 33 30.0

20.0

of households of 12

% 10.0 3 3 4 4 4 4 4 1 2 3 0.0

d n r r n s n in e ny tu E tre N N a ru to d n a ock ead va en ill d l g i n h se d h ad S rd n Go e ea cot sin Cad a w ou ouse W S s ; m Giff rh ty Cen van h Glen F Clarkston e N ill; Mearns To e wcad o arkh r s o Ci HamiltonhillG Parkh P e - K -Kil Ayr; Belmont C n ast ast rigg E E oonfoot; Alloway b en ds; D p sd n rsde r om; Kirkh ea a o dla B r o Bisho Be ernauld Village; Dull B o b W Cum ircus; C

Park Postcode sector

159 Tenure Housing tenure is an indicator which could just as easily sit in Chapter 4: Economic factors, as in this chapter. It is another indicator that has shown massive change in the past 20 years, with the proportion of properties owner-occupied in Glasgow having doubled between 1981 and 2001 (from 24% to 49%). However, huge variation in the levels of owner-occupancy across Greater Glasgow and the West of Scotland remain. Nationally in 2001, 63% of the population owned their own home. At a community level across the West of Scotland, however, this ranged from 34% in Maryhill, Woodside & North Glasgow to almost 90% in Eastwood (Figure 6.7). Greater Glasgow communities have the three highest and three lowest rates of owner occupancy in the West of Scotland.

Figure 6.7

Owner-occupiers - proportion of population owning their own home, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from 2001 Census data)

100.0 88 90.0 86 77 80.0 75 70 71 71 70.0 63 64 64 64 65 59 60 60 61 61 56 60.0 53 54 55 50 52 52 50.0 43

of population of 40.0 34 34 % 30.0

20.0

10.0

0.0

d w w ll d s e d n le n d e e n un o n ge ire d n a e ir ire id od o apel id n lley o ilto gl aul r avie o tla st sg r sh la a r sh sh b g w i ch a erwe b V m esd rn il kelvin co lasgow n Wisha l h yr o am he e yr h iln st S G n m at A verclyde L H yd t rew A e u Glasgow G Glasgow o haw In u f st K Ea N D st rn Mot st vern Cl R a Dr e S e E Strat en/M & & ste Ea East L North Ayrshir Cumb Ren n W a d st South sd th eater ng & e r to nk th E u an a a e a u Glasgowi rdrieWest & E C Gr W g So A y /Be oodside &d So W isle w & l/ Bri e and Clydeb Pa Cambusl sl ryhil nie a Renfr n M A Community

At a small area level, huge contrasts are again evident: the ten small areas with the lowest rates of owner-occupancy (between approximately 10% and 20%) are all in Glasgow, while eight of the ten areas with the highest rates (between 93% and 98% owner-occupancy rates) are also located within Greater Glasgow communities (Figure 6.8).

160 Figure 6.8

Owner-occupiers - proportion of population owning their own home, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from 2001 Census data)

110.0 96 96 98 100.0 93 94 94 94 95 95 95 90.0 80.0

70.0 63 60.0 50.0

of population of 40.0 % 30.0 19 19 20 21 20.0 15 15 16 17 11 12 10.0 0.0

r n ie n e s S ck ck ay ay W ton n d o ch va k W re B d w s ock rn b n pel NE ea a la Go llo m m yss Giff Scotland rkh lm ; Roysto a brigg a C stlemil Du m p Clarkston Hamiltonhill Bridgeton EPa D ad a - Wester asterhouse W g C We irkhill; Mear E iggs N; Cadonfoot; A K Drumcha arn r o Bisho G D arsden e B Bishopb Bearsden - KessingtonBroom; Postcode sector

Vacant dwellings Figure 6.9 shows the proportion of households within each of the West of Scotland communities which are vacant dwellings. The national figure is just under 4%, but across Scotland it ranges from around 1% (Strathkelvin) to 7% (Paisley & Levern Valley).

Figure 6.9

Vacant dwellings - proportion of all household spaces which are unoccupied, 2001 West of Scotland and Greater Glasgow Communities Source: NHSHS Community Profiles (from 2001 Census data)

8.0 7 7.0 6 6.0 5 5.0 5 4 4 4 4 4 4.0 4 4 4 3 3 3 3 3 3 3.0 3 2 2 2 2 2 2.0 2 2

% of all household spaces 1 1.0

0.0

l l in d e l e n w e e d y nd vi en e ir un e lv a we l ilto nds o ll tla g r sgow sgow a sh a ilbride n e bridg a nauld m isha esdale a ist co thke il th t l W l wl yr n S a K o G ber Ha d a n Lomon rn V r Eastwoost /M Glasgowe Inverclyde n M Coa m th Ayrshir Cly NG st A st D ve St Ea u r Sh a e e & Cu & Rutherg & e E & Le sd So North Ayrshire e r rie at W n a d Eastern e th o nd ir Glasgow West End dsid u et a /Be A o Gr South East Glasgow g ebank &o Drumchap So d nd lyd /W Bri aisley C l P iesla Cambuslang n ryhil a Renfrew & West Renfrewshire An M Community

161 Figure 6.10 shows the same figures at a small area (postcode sector) level, contrasting the ten areas with the lowest rates (all under 1% of households) with the ten highest (e.g. Laigh Park and Ferguslie Park in Paisley, where almost one in five dwellings were vacant at the time of the 2001 census).

Figure 6.10

Vacant dwellings - proportion of all household spaces which are unoccupied, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from 2001 Census data)

25.0

19.4 20.0 18.8 17.8

15.0 13.9 11.3 11.7 11.9 10.3 10.8 9.4 10.0

5.0 3.8 % of all household spaces 0.6 0.6 0.6 0.7 0.7 0.8 0.8 0.8 0.8 0.8 0.0

ld rk rn ls E n rk re der st. u a d rb ck w N ruin Pa nt stfie lmore ernon inloch s E sb ead N e F e e a V n e arnock fr n rskine E inn Pa i i Go kh n illarsto igh Scotland E B llieston S nt d ; m e n C slie Park ; W u L N; Ca n R M Gle La w u ce; o Auch t; Par Dal Greeno n Bai M o Moo sto a ggs er; Ma e Ferg lloch ftfo i b d a lls; o lo a B Torr hi r pbr y C o -C Tr d Lenzie S; n ish B avie Sa g iln M - Harbour and W To Ayr Postcode sector

This highlights the fact that a number of the more deprived areas in the West of Scotland were characterised in 2001 by having high proportions of unoccupied properties. This is clearly likely to have a negative impact on the overall environmental quality of a neighbourhood. Further aspects of the overall quality of neighbourhoods are examined in the second section of this chapter.

162 6.2 Neighbourhood characteristics and perceptions

Cleanliness, litter and adverse environmental quality indicators Levels of ‘cleanliness’ of different areas in Scotland can be assessed by means of data collated by the Keep Scotland Beautiful organisation. This is based on a 2% random sample of streets across the 32 council areas in Scotland, from which areas are graded according to the 1999 Code of Practice on Litter and Refuseviii. Four grades of cleanliness are used:

Grade A No litter or refuse Grade B Predominantly free of litter and refuse – apart from small items Grade C Widespread distribution of litter and refuse with minor accumulations Grade D Heavily littered with significant accumulations.

Under this system, sites graded ‘C’ or ‘D’ are deemed unacceptable. Figure 6.11 shows the grading of sites in Glasgow and, for comparison, Scotland. This shows that in Glasgow 17% of sites were ‘unacceptable’ (Grades C and D), compared to the national figure of 6.4%. Although not illustrated here, this is the highest figure among all West of Scotland councils (the lowest is in South Lanarkshire: 1%).

Figure 6.11

'Cleanliness': % of sites graded A, B, C or D, 2004/05 Source: Keep Scotland Beautiful

78 79 80

40 % of sites

20 16 16

10 6 4 0.4 1 0 Scotland Glasgow City

Cleanliness Grade A (No litter or refuse) Cleanliness Grade B (Predominantly free of litter and refuse apart from small items) Cleanliness Grade C (Widespread distribution of litter and refuse with minor accumulations) Cleanliness Grade D (Heavily littered with significant accumulations)

viii Relates to Part IV of the Environmental Protection Act (EPA) 1990. Full details of relevant definitions, and methods used, are listed in Appendix 1.

163 From this grading information, Keep Scotland Beautiful has derived an Overall Cleanliness Indexix. The figures for each West of Scotland council area are presented in Figure 6.12. This shows that Glasgow has the lowest ‘cleanliness’ score of the 11 areas (in fact, it has the lowest score of all 32 council areas in Scotland6).

Figure 6.12

Overall Cleanliness Index for 11 West of Scotland Councils, 2004/05 Source: Audit Scotland Performance Indicators ( from Keep Scotland Beautiful data)

75 73 73 72 71 71 70 70 70 69 68 67 66

62 Index out of 100 of Index out

d e e e e n ir ir r ire a l sh sh rclyd kshi shire cot yr n n S A Ayrsh sgow City nve arto nar h arto a I b a t b l ast n L r n G E Renfrewshire u h o u D N South Ayrshire D st st e Nort South Lanarkshire East Renfrewshire W Ea Council

Keep Scotland Beautiful has also analysed litter problems at a council level and by source of litter. Figure 6.13 presents a summary of these data for Glasgow and Scotland, showing that pedestrians or individuals are by the far the most common sources of litter, with animal faeces the next most common source. In comparison to the other West of Scotland councils (not shown), Glasgow had the largest problem in terms of pedestrian/individual litter (93% of sites). It also had the second highest percentage for animal faeces (18%) after South Ayrshire (22%). The most common types of litter found were: smoking related litter, sweet wrappers, drinks related materials, and fast food litter.

ix Full methodology outlined in Appendix 1.

164 Figure 6.13

Litter: % presence of different sources of litter, 2004/05 Source: Keep Scotland Beautiful

100 93 90 82 80

50 % of sites 40

20 18 10 11 8 10 6 4 3 1 2 2 0 SCOTLAND Glasgow City Council

Pedestrian/Individual Business Domestic Construction Animal Faeces Other

Keep Scotland Beautiful also produces ‘Adverse Environmental Quality’ indicators at a council level, showing the percentage of sites for which dog fouling, vandalism, graffiti, weeds, detritus (includes muck, grit, loose particles and leaves) and flyposting were noted as a problem. Figure 6.14 summarises these indicators for the eleven West of Scotland councils. The key features of this graph are that while ‘detritus’ and weeds appear to be the most common problems across all the councils, perhaps the most concerning issues for Glasgow are dog fouling (second highest level in West of Scotland) and graffiti (highest).

Figure 6.14

Adverse Environmental Quality Indicators, West of Scotland council areas, 2004/05 Source: Keep Scotland Beautiful

80 73 71 70 67

60 56 57 53 50 51 51 49 48 49 50 46 44 42 41 40 39 38 40 35 35 32

% of sites 31 30 26 21 19 20 18 13 11 10 9 8 8 9 8 10 6 6 5 4 4 4 5 5 3333 3 2 2 3 1 1 1110011001 00001110 0 0

y it re e re re ND C hire hire w wshire kshi wshi kshi TLA tonshire e ar e O r fr Ayrs Inverclyd anar C lasgo Lan L th Ayrs S G Renfr East Ayrshire orth ou h N h S st Dunba ast Ren out e Nort ast Dunbartonshire E S W E Council

Dog Fouling Vandalism Graffiti Weeds Detritus Flyposting

165 Perceptions of neighbourhoods Issues such as those outlined above will clearly influence residents’ perceptions of their neighbourhoods. These perceptions were measured by NHS Greater Glasgow’s Health and Well-being Survey of 20027. Figure 6.15 shows the results of ten survey questions relating to perceptions of problems in the local area. These are presented for Glasgow City area (results for Greater Glasgow are also available, but are very similar), and analyse responses within the city by those living within Social Inclusion Partnership (SIP) areas at the time of the 2002 survey compared to those who were not. Important issues include: x Young people hanging around (perceived as a problem by almost 70% of the population: 82% in SIP areas) x Drug activity (perceived as a problem by 59% overall: 77% in SIP areas) x Excessive drinking (58% overall: 77% in SIP areas) x Vandalism/graffiti (55% overall: 75% in SIP areas) x Car crime (43% overall: 55% in SIP areas).

Figure 6.15

Perceived problems in local area, Glasgow City and SIP/Non-SIP areas Source: NHSGG Health/Well-Being Survey, 2002

100

90 82 80 77 77 75 74 68 70

59 59 58 60 55 55 51 50 48 47 43 43 42 38 40 36 37 34 31 29 30 30 28 22 21 20 20 15 15 of respondents saying very/fairly common

% 10

0 SIP SIP SIP SIP SIP SIP SIP SIP SIP SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Young people Drug activity Excessive Vandalism / Unemployment Car crime Burglaries Assaults / Domestic Bullying in hanging around drinking graffiti muggings violence schools

Figure 6.16 presents a similar range of ten survey question responses, this time with regard to perceptions of environmental problems in local areas. The biggest identified problems (seen as ‘very’ or ‘fairly’ common) are: x Dog dirt (54% perceiving this as a problem, rising to 62% in SIP areas) x Traffic (45% overall: 51% in SIP area) x Rubbish lying about (40% overall: 47% in SIP area) x Noise and disturbance (28% overall: 38% in SIP area).

166 Figure 6.16

Perceptions of Environmental Problems, Glasgow City and SIP/non-SIP areas Source: NHSGG Health/Well-Being Survey, 2002

100

70 62 60 54 50 51 47 50 45 42 40 38 40 35 30 28 29 30 22 22 22 20 18 20 16 16 14 15 14 15 14

of respondents saying very/fairly common 12 11 10 8 9 % 10

0 SIP SIP SIP SIP SIP SIP SIP SIP SIP SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Non-SIP Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Glasgow Dog dirt Traffic Rubbish lying Noise and Air pollution Contaminated Vacant / derelict Vacant / derelict Abandoned Poor street about disturbance drinking water buildings land cars lighting

These figures suggest high levels of concern about some behavioural and environmental issues in Glasgow neighbourhoods, particularly in the more deprived (SIP) areas. One of these concerns – noise and disturbance – is considered in more detail in the next section below.

Noise complaints Noise complaints are collected by environmental health departments within councils and the data have been collated by Health Protection Scotland as part of their EHS3 projectx. Comparing total noise complaints across all West of Scotland councils, the highest rate of complaints in 2003 was in Renfrewshire followed by Glasgow and then Inverclyde (Figure 6.17).

x Environmental Health Surveillance System for Scotland (EHS3).

167 Figure 6.17

Total Noise Complaints per 10,000 population, West of Scotland council areas, 2003 Source: Health Protection Scotland (from Council Environmental Health Departments)

Renfrewshire 27.8

Glasgow City* 26.0

Inverclyde 24.3

North Ayrshire 22.7

South Ayrshire 22.7

South Lanarkshire 22.0 Council East Dunbartonshire 11.9

North Lanarkshire 11.9

West Dunbartonshire 9.7

East Renfrewshire 6.2

East Ayrshire 6.0

0.0 5.0 10.0 15.0 20.0 25.0 30.0 Complaints per 10,000 residents *Glasgow: based on 9 months data annualised

It should be noted, however, that these figures may be misleading in a number of ways. First, an individual could have complained on many occasions (thus inflating the population rate). Second, the system only records complaints made to an environmental health department (thus underestimating the real scale of noise problems in a council area). Furthermore, the numbers are clearly dependent on how likely people are to make a complaint in each area. Finally it is more important to note that noise complaints can be subdivided by type (e.g. domestic, industrial, etc.) but this level of detail is not reported here, given these concerns regarding the reliability of the dataxi.

6.3 Traffic volume and air quality

The estimated total volume of traffic on Scotland's roads in 2003 was 42 billion (thousand million) vehicle kilometres. The West of Scotland accounted for 35% of that figure (14.5 billion vehicle kilometres).

Figure 6.18 shows the figures for West of Scotland council areas, by year, for the period 1993-2003. Within all Scotland (not shown) there was an 18% rise in traffic volume over this period, with similar rises evident across most of the council areas shown.

xi Some of these discrepancies may be resolved (or partially resolved) in future by means of a European Union Noise Directive requiring (by June 2007) the creation of local "noise maps" for specific areas.

168 Figure 6.18

Estimates of traffic volume in vehicle kilometres, West of Scotland council areas, 1993-2003 Source: Scottish Executive - Scottish Transport Statistics 2004

3500.0 Glasgow City

North Lanarkshire 3000.0

South Lanarkshire 2500.0 Renfrewshire

2000.0 East Ayrshire

South Ayrshire 1500.0 North Ayrshire

Million Vehicle Kilometres 1000.0 East Renfrewshire

West Dunbartonshire 500.0 Inverclyde

0.0 East Dunbartonshire 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

More strikingly, Figure 6.19 showss projections in traffic growth between the years 2001 and 2021 for Scotland and the 11 West of Scotland council areas. Nationally traffic is expected to grow by 27%, ranging in the West of Scotland from 18% in Inverclyde to 33% in North Lanarkshire. The predicted increase for Glasgow is 24%. This raises a number of concerns about future levels of pollution and road congestion, as well as questions about how sustainable such a rise in traffic growth can be.

Figure 6.19

Projected traffic growth from 2001 by West of Scotland council Source: Scottish Executive

35 North Lanarkshire

East Renfrewshire 30 South Lanarkshire

East 25 Dunbartonshire West Dunbartonshire 20 Scotland

Renfrewshire 15 North Ayrshire % growth from 2001

10 Glasgow City

East Ayrshire 5 South Ayrshire

0 Inverclyde 2001 2006 2011 2021

169 Air pollution Recorded nitrogen dioxide (NO2) levels provide a proxy measure of the impact of traffic pollution. Data on NO2 are collected at recording sites and the results are presented here for West of Scotland councils. However, as with noise complaints, a number of caveats should be noted and the figures should, as a consequence, be interpreted with caution: the number and location (kerbside/roadside, intermediate, background) of recording sites varies substantially between councils and there are differences in the methods of analysis used in different laboratoriesxii. The figures presented should thus be interpreted with caution.

Bearing these caveats in mind, Figure 6.20 below shows that, of the 11 West of Scotland councils, Glasgow had the highest annual average recorded levels of NO2 in 2003, while South Ayrshire had the lowest. This is not unexpected as Glasgow has the highest volumes of traffic and the most monitoring sites.

Figure 6.20

* Monthly mean NO2 Readings , West of Scotland Councils, 2003 Source: Health Protection Scotland (from Council Environmental Health Departments) 90 Glasgow City

80 East Dunbartonshire

North Lanarkshire 70

Renfrewshire 60 Inverclyde 50 West Dunbartonshire g per m3 ȝ 40

10 East Renfrewshire

30 East Ayrshire

20 South Lanarkshire

10 North Ayrshire

South Ayrshire 0 Jan-03 Feb-03 Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 * The NO2 data have not been bias corrected. The means provided are an average of all results and do not differentiate between roadside or background monitors.

xii The differences in measurement recording used in different laboratories are usually controlled for: so-called ‘bias correction’. However, the figures presented above have not been bias corrected. They are thus an average of all results and do not differentiate between roadside or background monitors.

170 6.4 Access to services

Access to leisure servicesxiii A study on access to leisure services in Glasgow for non-car users was carried out in 2004 by Fiona Marrison, an MSc student in Geographical Information Systems (GIS) at the University of Edinburgh. The study examined access to the 16 multi-function local authority-owned leisure centresxiv within Glasgow City in terms of public transport, acceptable walking distances and acceptable cycling distances. Such access is an important issue given the rising trend in obesity in Glasgow (see Chapter 7: Behaviour) combined with the fact that a significant proportion of the population within Glasgow, especially those under the age of eighteen or those on low incomes, are non-car users. A full copy of the dissertation is available on request and the main summary points are as follows: x The majority of the leisure centres in Glasgow are, in fact, situated within the most deprived areas of the city. This can be seen in Figure 6.21 where the centres’ locations are mapped against a backdrop of the deprivation distribution (from the SIMD) within the Glasgow City Council boundaries.

Figure 6.21 Map illustrating the extent of multiple deprivation in Glasgow, 2004, and the location of the 16 local authority owned leisure centres.

Donald Dewar Leisure Centre Drumchapel Pool

North Woodside Leisure Centre Springburn Leisure Centre . Yoker Sports Centre Whitehill Pool Easterhouse Sport s Centre

Scotstoun Leisure Centre

Kel v in Hall International Sports Arena

Gor bal s Leisure Centre

Pollok Leisure Ce ntre Legend Holyrood Sports Centre Tollcro ss Par k Leisure Centre Leisure Facilities Glasgow Data Zones

Castlemilk Po ol SIMD Ranking Bellahouston Leisure Centre 2% (most de prived ) Map produced by Fiona Marrison 5% Castlemilk Sports Centre August 2004 10% Source: SportScotland 2004 20% SIMD 2004, Scottish Executive Strathclyde Passenger Transport 50% 02.551.25 Kilometers OS OSCAR Road Network Centreline 51%-100% (least deprived) 2001 Census, Output Area Boundaries

xiii Note for Figures 6.21-6.26: ©Crown Copyright. All rights reserved. Glasgow City Council, 100023379, 2006. xiv There are a total of 24 local authority owned leisure facilities in Glasgow. However, the analysis was confined to those centres which offered a range of different leisure facilities (a selection of: swimming pool, health suite, sports hall, fitness suite (gym), dance hall).

171 x There is generally excellent access to public transport in the city: 99% of Glasgow’s population live within 400m (five minutes walk) of a bus stop. x The entire population (100%) of the city lives within 20 minutes cycling distance (the maximum ‘acceptable’ distance of 5km)xv, 8 of leisure facilities. 60% live within a distance of 2km, and 21% live within 1km. This is illustrated in Figure 6.22.

Figure 6.22

Accessibility to Leisure Facilities by Cycling .

Cycling Thresholds

1km 2km

Map produced by Fiona Marrison 5km August 2004 Leisure Facilities 02.551.25 Kilometers Source: SportScotland 2004 OS OSCAR Road Network Centreline OSCAR Road Network

x However, it is estimated that only 45% of the total population lives within 20 minutes walking distance of a leisure facility (estimated at 1600mxvi). This is well under the Scottish Executive / Sport Scotland’s target for 2007 that 70% of the population should have access to leisure facilities within a 20 minute walk. 9

xv This relates to research published by the Scottish Executive which calculates the ‘maximum acceptable’ cycling distance to reach services as being 5km (acceptable ‘short to normal’ distances: 1km and 2km). xvi 1600m estimate derived from the same published research as above which also stipulated this distance as being the maximum ‘acceptable’ walking distance for reaching services.

172 x Figure 6.23 shows walking accessibility from each leisure facility (areas within 20 minutes/1600m walk of each centre are highlighted) against a backdrop of the health deprivation domain of the SIMD. Figure 6.24 is a similar map, but shows public transport accessibility from each facility (the green lines indicate areas within five minutes walk of a bus stopxvii). Together these two maps suggest that for a number of highly deprived areas in the north side of the city – e.g. Milton, Maryhill and Summerston – access to leisure facilities by public transport is very poor and, at the same time, the relevant walking distances exceed the ‘acceptable’ Scottish Executive threshold. Similarly, there are areas in the eastern side of the city (e.g. Royston, Robroyston, Gartcraig, Garthamlock, Dalmarnock, Bridgeton and Queenslie) with limited accessibility.

Figure 6.23 Health deprivation and accessibility by walking to leisure facilities

Summerston Maryhill

Keppochhill Milton Royston/Robroyston .

Gartcraig Garthamlock

Govan/Ibrox

Dalmarnock/ Health Deprivation Toryglen Bridgeton Parkhead Leisure Facilities netwalk1600shp Health Ranking 2% (most deprived)

Pollokshaws 5%

Map produced by Fiona Marrison 10% August 2004 20% Source: SportsScotland 2004 02.551.25 Kilometers SIMD 2004, Scottish Executive 50% OS OSCAR Road Network Centreline 51-1 00% (le as t deprived) Strathclyd e P ass enger Transport

xvii Glasgow City Council adheres to regional transport planning guidelines stipulating an ‘access goal' of 400m (or five minutes walking time) to a public transport service stop; as 98% of transport service stops in Glasgow are bus stops, these were used in the analysis. Further details / references available on request.

173 Figure 6.24 Health deprivation and accessibility by public transport to leisure facilities

Summerston Maryhill

Keppochhill Milton Royston/Robroyston .

Gartcraig Garthamlock

Govan/Ibrox

Dalmarnock/ Health Deprivation Toryglen Bridgeton Parkhead Leisure Facilities Bus Accessibility Health Ranking Castlemilk 2% (most deprived)

Pollokshaws 5%

Map produced by Fiona Marrison 10% A ugust 2004 S ource: SportsScotland 2004 20% 02.551.25 Kilometers SIMD 2004, Scottish Executive 50% OS OSCAR Road Network C en treline 51-1 00% (least deprived) Strath cl yd e Passenger Transport

x South of the river, there are a number of highly deprived areas which, in fact, have very good levels of access to leisure centres by means of public transport, walking and cycling – for example Castlemilk and Toryglen & Hutchestown. Exceptions to this picture are apparent, however (e.g. parts of Ibrox and Govan). Although not specifically marked on the map, there is a large area north of, and including part of, Pollokshaws which has no accessible leisure centres. It should be borne in mind that Pollokshaws and Govanhill swimming pools were both located within this area but were closed in 1999 and 2001 respectively. x Figures 6.25 and 6.26 compare car ownership levels with access to leisure services through walking (Figure 6.25) and public transport (Figure 6.26). These maps confirm that many of the areas identified above as having poor access to leisure service by means of walking or public transport also suffer from relatively low car ownership – areas such as Gartcraig, Summerhill, Wallacewell and parts of Maryhill stand out in this respect.

174 Figure 6.25 Car ownership levels and accessibility to leisure facilities by walking

Summerhill Drumry

Maryhill

Keppochhill Wallacewell Royston/Robroyston .

Gartcraig

Govan/Ibrox Easterhouse

Kingston

Mo sspa rk

Dalmarnock/ Car Owners hip Levels Bridgeton 81 % - 1 00 % 61 % - 8 0%

41 % - 6 0% 21 % - 4 0% Map produced by Fiona Marrison August 2004 0% - 20 % Source: SportScotland 2004 Le isure Fa cilities Strathclyde Passenger Transport 16 00 m Wa lking Thresh old 02.551.25 Kilometers OS OSCAR Road Network Centreline 2001 Census, Output Area Boundaries No Bus Stop Provision 2001 Census, Car Ownership Levels

175 Figure 6.26 Car ownership levels and accessibility to leisure facilities by public transport

Summerhill Drumry

Maryhill

Keppochhill Wallacewell Royston/Robroyston .

Gartcraig

Govan/Ibrox Easterho use

Kingston

Mo sspa rk

Dalmarnock/ Car Ownership Levels Bridgeton 81% - 10 0% 61% - 80%

41% - 60% 21% - 40% Map produced by Fiona Marrison A ugust 2004 0% - 20% S ource: SportScotland 2004 Leisure Facilities Strathclyd e P assenge r Transport No Bus Stop Provision 02.551.25 Kilometers OS OSCAR Road Network C entreline 2001 Census, Output Area Boundaries Bus Accessibility 2001 Census, Car Ownership Levels

Access to health services A less sophisticated analysis of access – measured solely by drive-time – to a range of local services was carried out in 2001/02 on behalf of the Scottish Executive’s Scottish Neighbourhood Statistics (SNS) programme10. The health services included in the analysis were general practitioners, dentists and hospitals. Note, however, that the analysis was based solely on the physical location of the services and did not take any other issues into consideration.

One illustrative example is presented here. Figure 6.27 shows, by community, the proportion of households within five minutes drive-time of a dentist. At this level, the figures range from 62% of households to 99% to 100% in the majority of the Greater Glasgow communities.

Similar data (not presented here) show that, at a West of Scotland community level, there would appear to be good access to GPs (80% or more households in each area are within five minutes drive-time of a GP) and hospitals (95%-100% are estimated to be within 30 minutes drive time).

176 Figure 6.27

Households within 5 minutes' drive-time of a dentist, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from Scottish Neighbourhood Statistics data)

99 99 99 99 100 100 100 100 100 100 100 96 97 97 100.0 93 93 95 85 82 82 78 81 80.0 74 76 76 71 62 60.0

of households 40.0 %

20.0

0.0

d e e e e n n ll d n l ir w ir ld ge ire el od e w n a u rid lto p lvin lley o ow nds ow sh sh id i sh a a avie gl rwe a isha ilb r m g r sg sg e sg esd yr omond yr b w ch hke V ln stwo lasgow la la wl st E L verclyde W A erna at re m t n i the th a e Scotla lyd n o Ha u ra r u G G o st A I th st K nf Ea n M C a r a St ve R N r st G w W o E &C Re Dr e en/M e r Sh o E N Cumb L & ste te South Ayrshire e d sd g a a k & r n e n an a a E irdri sl Glasg A ba y /Be u Gr South East Gla & West e e b oodside & South W yd isl m W ew and l/ Bridgeton & Dennistoun fr Cl Pa sl n Ca e nie ryhil R n a A M Community

At a small area level, the vast majority of all West of Scotland postcode sectors are within easy access (at least by car) of a GP, hospital and dentist.

Access to other, non-NHS, services Scottish Neighbourhood Statistics also provides similar data on access to other, non- NHS, services. Again, for the sake of brevity, one illustrative example is shown here. Figure 6.28 shows, by council, the percentage of all households that are within a five minute drive of a secondary school. The average figure for Scotland was 74% and across the West of Scotland councils it varied from 87% in Glasgow to 48% in East Ayrshire.

177 Figure 6.28

Households within a 5 minute drive of a Secondary School, 2001 West of Scotland Councils Source: Scottish Neighbourhood Statistics

100 86.6 90 84.0 81.2 80.2 79.5 79.1 80 75.7 74.2 72.8 70 67.3 62.3 60 47.7 50

40 of households

% 30

y d it e e e e re re re e ire yd ir i ire i tlan C sh sh w ksh wshir wshir nsh ksh co o r e e o r on yr S a fr rt a t A Ayrshir sg Invercl n n h h Ayrshi la La t ast G Re nbar ort ou E th Lan th u N S or u D N st Dunba East Renfr a So E West Council

Similar education-based indicators are available from the SNS website providing estimates of drive times to Nursery School, Primary School and Further/Higher Education College. Data are also available for ‘retail services’ (e.g. drive time to post offices, petrol stations, chemists, supermarkets), and other services such as citizens advice bureaux, police stations, job centres, and libraries.

6.5 Sites of environmental concern

This section of the chapter looks briefly at three issues of major environmental concern: derelict land, proximity to landfill sites and proximity to areas with reported industrial pollution.

Areas of derelict land and proximity of population to derelict land Across Scotland derelict landxviii accounts for over 7,600 hectares. Among the West of Scotland councils, North Lanarkshire has the highest area of derelict land (945 hectares – 12% of the Scottish total) followed by Renfrewshire (11%) and Glasgow (10%) (Figure 6.29).

xviii Derelict land (and buildings): defined as that which has been so damaged by development or use that it is incapable of being developed for beneficial use without rehabilitation, and which is not being used for either the purpose for which it is held, or for a use acceptable in a local plan.

178 Figure 6.29

Area of Derelict Land (Hectares), West of Scotland council areas, 2004 Source: Scottish Neighbourhood Statistics (from Scottish Vacant and Derelict Land Survey)

1200

Scotland: 7368 hectares

1000 945

820 800 733

600

451

400 Derelict land (Hectares) 347 275

182 200 123 43 54 64

ity re de re C ly hire hire hi hire hire rs rs shire s s y k k gow ew Inverc th Ay enfr Glas outh A East Ayrshire R S unbartons Nor t Dunbartonshi orth Lanar ast Renfrewshire outh Lanar N E as S E West D Council

In terms of proximity, 27% of the Scottish population live within 500m of derelict land. However this percentage rises to 51% in North Lanarkshire, 57% in Glasgow and 64% in West Dunbartonshire (Figure 6.30)

A recent report produced by Fairburn et al on ‘environmental justice’ in Scotland11, reported that there is a strong relationship between derelict land and deprivation and that “people in the most deprived areas are far more likely to be living near to (this) source of potential negative environmental impact than people in less deprived areas”. They further pointed out that both old and newly derelict sites are found in proximity to substantially greater numbers of people experiencing relative deprivation.

179 Figure 6.30

Proximity to Derelict Sites: % of population living within 500m of any derelict site, 2004 West of Scotland Councils & Scotland Source: Scottish Neighbourhood Statistics (from Scottish Vacant and Derelict Land Survey)

70 64.3

60 57

51.2 50

40 33.8 30.7 31.9 30 27.4 of population 24.8 25 25.9

% 21.9 22.7 20

e e e ity r re de r r C hire hire hi ly hire rshire c rs otland y yrs er y Sc ewshire Inv lasgow enfrews enfr G East A outh A R orth A unbartons S t R N unbartonshi outh Lanarkshi orth Lanarkshi S Eas N East D West D Council

Areas of urban vacant land In Scotland in 2004 just over 3000 hectares of land were designated as urban vacant land: land that is located in or very close to urban settlements and is unused or unsightly, or which could benefit from development or improvement. As is shown in Figure 6.31, Glasgow City boundaries incorporate 582 hectares – 19% of all land of this type in Scotland – while the North Lanarkshire council area also has a significant percentage of this type of land (376 hectares: 12% of the total).

Figure 6.31

Area of Urban Vacant Land (Hectares) by West of Scotland Council, 2004 Source: Scottish Neighbourhood Statistics (from Scottish Vacant and Derelict Land Survey)

800 Scotland: 3023 hectares

700

600 582

500

400 376

300

195 205

Urban Vacant Land (Hectares) 200 153

100 67 79 38 44 13 21 0

e e e e r ire r ire r r h h yde shi shi cl kshi ew onshi yr ewshire nar A r h Ayrs Inver th enfr La enf Lanarkshire Glasgow City out unbart East Ayrs h or R h S D N t ast R s st Dunbartonshire out Nort E e a S W E Council

180 Proximity to landfill sites Figure 6.32 shows that 13% of the Scottish population lived within two kilometres of a landfill site in 2001. Within the West of Scotland, 28% of East Dunbartonshire residents and 26% of East Renfrewshire residents lived within two kilometres of a landfill site, while in Glasgow the figure was only 10%.

Figure 6.32

Proximity to Landfill Sites: % of population living within 2km of a landfill site, West of Scotland council areas, 2001 Source: Scottish Neighbourhood Statistics (from SEPA data)

30 28.3

25.9 25

20.1 20.2 20

16.4

15 13.3

10 10 8.7

5 4 2.5 1.8 of population living within 2km of a landfill site a landfill of 2km living within population of 0.1 % 0

ity re e yde hire hire hire hire C s s s shire r k cotland ercl yrs y S Inv t A lasgow as enfrew G E outh A R orth Ayr S unbartonshire N t D orth Lanar outh Lanarkshire N ast Renfrewshi S es E ast Dunbartonshir W E Council

Note that this information relates only to population numbers living in proximity to a landfill site in 2001. No attempt was made to identify how many people (if any) are exposed to pollutants from these sites. To determine the specific health risks of these pollutants it would be necessary to know such factors as prevailing wind direction and the location of local watercourses12.

The report on environmental justice by Fairburn et al (referred to previously) reported that patterns of relationship between deprivation and landfills were indistinct and that nationally there is no evidence to suggest that more deprived populations are more likely than others to live near to landfill sites.

Proximity to EPER sites (sites on the European Pollutant Emissions Register) Thirty two per cent of the Scottish population lived within two kilometres of an EPER site (i.e. a site of potential industrial pollution) in 2002 (Figure 6.33). Within the West of Scotland, 50% of Inverclyde residents, 49% of South Lanarkshire and Renfrewshire residents respectively lived within two kilometres of an EPER site, while in Glasgow the figure was 44%.

181 Figure 6.33

Proximity to EPER Sites: % of population living within 2km of a EPER site, West of Scotland council areas, 2002 Source: Scottish Neighbourhood Statistics (from SEPA data)

50.4 49.2 50 48.7 43.8

40 36.5

32 31.4 30 25.9

19.2 20 18.6

11.7 10 % of population living within 2km an EPER site 1 0

e e e e ity r r r r de and C hi shire hire hi cotl S Invercly asgow th Ayrshi enfrew enfrewshi Gl outh Ayrshire or East Ayrshire R S N unbartons orth Lanarks outh Lanarkshire N est Dunbartons East R ast D S W E Council

Referring again to the recent environmental justice report, a clear relationship between proximity to sites of potential industrial pollution (IPPC sitesxix) and deprivation was established, with the highest proportion of people living in proximity to an IPPC site being found within the most deprived decile (of the SIMD). Concentrations of such sites were noted particularly in the more deprived parts of Glasgow. Clusterings of multiple IPPC sites near to more deprived populations was also noted.

A few other key points from the report on environmental justice – relevant to this, and other sections, of this chapter – are summarised briefly below. It is likely that the general summary of relationships between environmental indicators and deprivation discussed in the report are applicable to Glasgow and the West of Scotland, although there may be local variation. x Industrial pollution, derelict land and river quality were all related to deprivation with people in the most deprived areas being far more likely to be living in proximity to these sources of potential negative environmental impact. x At a national level and for urban areas, there was no clear relationship between deprivation and population proximity to landfills, quarries and open cast sites.

xix IPPC – Industrial Pollution Prevention and Control. IPPC sites are those that fall within the IPPC Directive and constitute those with the potential to contribute significant levels of polluting emissions to air, water or land. A proportion of IPPC sites are reported to the European Pollutant Emission Register (EPER).

182 x In terms of air quality it is clear that people living in the most deprived areas are most likely to experience the poorest air quality. This was found to be true for nitrogen dioxide, PM10, benzene and carbon monoxide but not for sulphur dioxide. Those areas exceeding the nitrogen dioxide objective (annual mean) are strongly concentrated in the most deprived areas. x People living in more deprived areas are less likely to live near woodland but there is evidence that new woodland development has been planted to a relatively greater degree in more deprived areas. x The analysis of greenspace showed that both the least and most deprived areas in Scotland have high percentages of people living near designated local wildlife sites. A separate more detailed study in Glasgow highlighted the complex issues in assessing environmental justice in relation to greenspace.

The issue of ‘greenspace’ is discussed further in the final section of the chapter below.

6.6 Greenspace

Glasgow and Clyde Valley Green Network dataset The importance of greenspace to health and well being has been increasingly recognised in recent years and, while it will be some time before good quality greenspace data are available across the whole of Scotland, a recent project has been instrumental in producing the first detailed categorisation of land usage in the West of Scotland. This project, jointly commissioned by Forestry Commission Scotland (FCS), Glasgow and Clyde Valley Structure Plan Joint Committee (GCVSPJC) and Scottish Natural Heritage (SNH), has produced a GISxx-based classification of land usage for the Structure Plan area. This classification divides land usage into the following broad groupings (and sub groups of): roads, water courses, railways, paths, buildings, open spacexxi (e.g. public parks and gardens, amenity greenspace, sports areas, woodland, other functional greenspace, etc.) and other open space (e.g. farmland, moor land). The dataset aims to provide a comprehensive and consistent mapping of open space across the main urban areas in western Scotland.

The dataset has only recently been produced and requires further quality assurance. There are currently no concrete examples of its use, but clearly it will be a valuable resource for planners, particularly for the purposes of regeneration and redesign of urban land.

Figure 6.34 illustrates this greenspace data on a map stretching from the west end to the east end of Glasgow.

xx Geographical Information System. xxi Based on a modified version of the Scottish Executive’s PAN65 open space typology – further details are included in Appendix 1.

183 Figure 6.34

184 Summary

This chapter highlights a number of important issues relevant to the health of the people of Glasgow and the West of Scotland: x There have been major improvements in housing in Glasgow and the West of Scotland in recent decades. However, serious issues concerning the living conditions of considerable numbers of the population remain. For example an estimated 30,000 households in Glasgow have evidence of mould, and 20,000 properties have rising/penetrating damp. x There has been a striking decrease in the proportion of the population living in overcrowded conditions, but equally striking variations in the levels of overcrowding across the West of Scotland are still evident. Similarly, rates of owner-occupancy have changed considerably over the past two decades (doubling between 1981 and 2001) – again, however, considerable variations persist. x Data collected by the Keep Scotland Beautiful organisation highlight a number of environmental issues for many parts of the West of Scotland. Glasgow stands out with the highest proportion of areas in the city deemed as unacceptably littered. There are also concerns around the levels of, for example, dog fouling. x Unsurprisingly, such environmental concerns are also highlighted as issues by residents of Glasgow in terms of their perceptions of their neighbourhood. A number of problems are emphasised, both environmental (e.g. dog dirt, traffic) and behavioural (e.g. young people hanging around, drink and drug activities). These issues are more likely to be perceived as problems in the more deprived parts of the city. x Concern over traffic levels are well-founded. Traffic volume has increased year on year in the West of Scotland in recent times and it is projected to grow further in the next two decades (with almost a 25% rise in Glasgow predicted by 2021). x Glasgow’s more deprived areas are relatively well served by the Council in terms of accessibility to leisure centres. However, areas have been identified where access is a major problem. x Significant proportions of the population of Glasgow and the West of Scotland live in proximity to derelict land, landfill sites and sites emitting industrial pollution.

185 References

1 Communities Scotland. Scottish House Condition Survey 2002. 2003 http://www.shcs.gov.uk/downloads/downloads.htm

2 Glasgow Housing Association. Neighbourhood Renewal Strategy 2005/07. http://www.gha.org.uk/content/mediaassets/doc/neighbourhoodRstrategy2005_07.pdf

3 Carstairs V, Morris R. Deprivation and Health in Scotland. Aberdeen: Aberdeen University Press, 1991

4 Scottish Executive. Scottish Index of Multiple Deprivation 2004. http://www.scotland.gov.uk/stats/simd2004

5 NHS Health Scotland. Community Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/communityprofiles

6 Keep Scotland Beautiful. Local Environmental Audit and Management System (LEAMS) Benchmarking Report 2004-2005.

7 Jones R, Borland E, Boyd A, Lorenzetti K, Scouller J, Carey L, Tannahill C. The Health and Well-being of the Greater Glasgow Population; summary report. November 2003 http://www.show.scot.nhs.uk/gghb/PubsReps/Reports/health_promotion/health+wellb eing/health+wellbeing_city_nov03.pdf

8 Halden D, McGuigan D, Nisbet A, McKinnon A, Derek Halden Consultancy. Accessibility: Review of Measuring Techniques and their Application. 2000 http://www.scotland.gov.uk/cru/resfinds/drf89-00.asp

9 SportScotland. Sport 21 2003-2007: The National Strategy for Sport – Shaping Scotland’s Future. 2003 http://www.sportscotland.org.uk/ChannelNavigation/Our+activities/TopicNavigation/ Sport+21/

10 Scottish Neighbourhood Statistics http://www.sns.gov.uk

11 Fairburn J, Walker G, and Mitchell G. Investigating environmental justice in Scotland: links between measures of environmental quality and social deprivation. Scotland and Northern Ireland Forum for Environmental Research (SNIFFER). 2005 http://www.sniffer.org.uk/results.asp?bool=OR&proposed=1&active=1&complete=1 &theme=%5BUrban%20Environment%5D&title=Urban%20Environment&location= research_areas&refer=res_area_waste_1.asp

12 Scottish Neighbourhood Statistics http://www.sns.gov.uk

186 Chapter 7: Behaviour ” fifth of males and almost a quarter of females in Greater are Glasgow ,000 live in Glasgow). in Glasgow). ,000 live erweight. uarter classified half estimated of females now as to are be obese, with over well ecent years have also seen notable increases in recorded rates of sexually transmitted rates sexually of notable also seen in recorded have increases ecent years 990s, there a striking has been relatedin numbers of alcohol deaths increase and As is the case nationally, smoking rates in Glasgow have fallen consider- smoking rates have in Glasgow As is the case nationally, “Since the beginning of the 1990s there has been a striking increase in “Since the beginning of the 1990s of alcohol relatednumbers deaths and hospitalisations within both Scotland and the Greater area.” Glasgow “A half classified as overweight.” estimatednow to over be obese, with well “ ably in the last thirty years. infections in Greater Glasgow (and elsewhere). infectionsin Greater Glasgow Drug also rising, related deaths are and there estimated in Greater Glasgow are to be than (of whom more of Scotland drug problem 25,000 users in theapproximately West 11 persist. profound inequalities in prevalence falling. are However, Smoking levels Survey data taking exercise, suggest are regular people in Greater Glasgow more especially in some of the areas. deprived more R Summary major is a Alcohol for cause concern. estimated are There than to more be 13,500 and since the of the beginning within City, users’ resident alcohol ‘problem Glasgow 1 hospitalisations within the area. Greater Glasgow one fifth rising, of obesity are in Greater and Glasgow Levels and almost of males a q ov Guide to data presented in this chapter % of dependent children living in households where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 7: Behaviour

This chapter summarises current trends in a selection of health related behaviours among the population of Glasgow and the West of Scotland. As with other chapters, it is not – and cannot be – a comprehensive list of all the factors relevant to this topic, but it attempts to cover what most would agree are the key issues. These are (in no particular order): alcohol, drugs misuse, smoking, obesity, diet, oral health, sexual health, and physical activity.

7.1 Alcohol

Alcohol consumption It is notoriously difficult to determine levels of alcohol consumption within communities accurately. However, the most recent data available (from the 2003 Scottish Health Survey) suggest that approximately 24% of adults (ages 16+) in Greater Glasgow (32% of males, 17% of females) were exceeding the recommended weekly limitsi. These are higher than the overall figures for Scotland (20% overall, 27% of males, 14% of females).

Restricting the age group to 16-64 only, we can show a trend in excess alcohol consumption from the 1995, 1998 and 2003 surveys. Overall levels in Greater Glasgow have increased slightly (from 24% to 27%), but as Figure 7.1 shows, the survey suggests a decrease in consumption among males, and an increase among females.

Figure 7.1

% of adults (aged 16-64) exceeding weekly recommended units of alcohol, Greater Glasgow, 1995, 1998 & 2003 Source: Scottish Health Surveys

40.0 37.6 36.6 35.0 32.3 30.0

25.0

21.1 20.0

15.0 of adults aged 16-64 14.4 % 13.9 10.0

Males 5.0 Females 0.0 1995 1998 2003

i 21 units per week for males; 14 units per week for females.

189 Problem alcohol use Estimates of the number of ‘problem alcohol users’ within Glasgow City have been calculated by the Centre for Drugs Misuse at Glasgow University as part of a report on children affected by parental substance misuse in Glasgow1 (this is discussed in more detail in Chapter 9: Children and adolescents). The authors calculate that more than 13,500 such users are resident within Glasgow, approximately 80% of whom are male. The breakdown of numbers (presented as a percentage of the population aged 15-64) in each Glasgow City Council Social Work Area Service Team areaii is shown in Figure 7.2. However, it should be emphasised that these figures are statistically modelled estimates and, given the lack of any accurate data on prevalence of problem alcohol use in Glasgow (as acknowledged by the report’s authors), it is extremely difficult to gauge the accuracy of these findings.

Figure 7.2

Estimated prevalence of 'problem alcohol use' within Glasgow City, 2003 Source: University of Glasgow Centre for Drugs Misuse Research

6.0

Glasgow City: 3.4% 5.0 5.0 (13,650 individuals)

3.9 4.0 3.7 3.8 3.4 3.4 3.3 3.3 3.1 3.0

of population aged 15-64 2.0 1.8 %

1.0

0.0 Glasgow City North West South West South East North East North Greater South West East Pollok Glasgow City Council Social Work Area Service Team

Drunk-driving Approximately 4,500 drunk-driving offences were recorded in the West of Scotland in 2003, of which over one third (1,666) took place within the Glasgow City Council area. As a rate per head of population, Glasgow has the highest recorded rates of drunk-driving offences in the West of Scotland: 3.6 per 1,000 population, compared to the national figure of 2.9 and a rate of 2.7 for all the West of Scotland council areas (Figure 7.3) (although clearly a proportion of offences recorded in Glasgow may relate to residents of other areas). As detailed in the subsequent chart (Figure 7.4), trends over the past five years have been relatively flat.

ii Areas with an average population of around 65,000 (ranging from just under 35,000 to over 94,000).

190 Figure 7.3

Drunk-driving offences, rate per 1000 population aged 17+, 2003 West of Scotland council areas Source: Scottish Executive Justice Department

4.5 Number of offences: 4.0 Scotland: 11,566 3.6 West of Scotland: 4,544 3.5 Glasgow: 1,666

3.0 2.9 2.7 2.7 2.6 2.5 2.5 2.5 2.5 2.3 2.3 2.4

2.0 1.6 1.7 1.5

1.0 Rate per 1000 population aged 17+ 0.5

0.0

d d e e e e e e e e e n ity r ir ir r ir ir la C tlan shir shi sh rshire clyd sh w n w w rksh r nshi yr rksh cot co e e to a S S rto r fr na Ay ve r A f sgo nf a th th Ayrshir In an la ba e r u ba ast L G n Ren L n st o u h No E th e D ut So r W st ast R o st Du a E S e No E W Council

Figure 7.4

Drunk-driving offences 1999-2003, rate per 1000 population aged 17+, West of Scotland council areas Source: Scottish Executive Justice Department

4.0 Glasgow City

3.5 Scotland

North Lanarkshire 3.0 East Ayrshire

2.5 West Dunbartonshire

Inverclyde 2.0 South Ayrshire

1.5 North Ayrshire

Rate per 1000 population aged 17+ 1.0 South Lanarkshire

Renfrewshire 0.5 East Renfrewshire

0.0 East Dunbartonshire 1999 2000 2001 2002 2003

191 Alcohol related / attributable hospitalisations Figure 7.5 shows that the alcohol related and attributable hospitalisation rate of the majority of the West of Scotland and Greater Glasgow ‘communities’iii, 2 in the period 1999-2001 exceeded the national figure, and that the rate in Bridgeton & Dennistoun (the area with the highest recorded figures) was more than twice the national rate and more than four times the level recorded in Anniesland, Bearsden & Milngavie. The figure for Scotland increased by almost 50% between 1990/92 and 1999/01. Figure 7.6 shows that this rate of increase is generally matched, and in some cases exceeded, by that of the Greater Glasgow communities.

Figure 7.5

Alcohol related/attributable hospital admissions, 1999-2001 Average annual age-standardised rates per 100,000 population, West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from ISD Scotland data)

3000

2427 2500

2072 2000 1696 1479 1530 1500 1315 1334 1215 1218 1221 1225 1269 1131 1156 1163 1168 1179 1049 1077 923 950 1000 905 911 744 795 566 609 500 Age-standardised rate per 100,000 pop 0

l e in d e y od r v ell nd ir nd len e ow land w E h haw o g ll yde oun wo sdale shi r a cl sgow st ngavie ilbride rshire is chape yrshire asgow cot il K ew he W her la l S ast yde r Hamilton ot Ayrs Lom A G /M E nf rum ut Inver t Cl Strathkel M ast Shawlands R s East r & ern Glasg Re Cumbernaul E North Ay &D Ea sden South ast e & N G eate th d est lasgow West ang and Levern V drie & CoatbridgeE G sl r ou Gr Ai S d/Bear &W ebank bu ey South West Glasgow yd sl an ew ai /Woodsi Bridgeton & Denni r Cl am P esl C nf yhill nni Re ar A M Community

192 Figure 7.6

Alcohol related & attributable hospital admissions Age-standardised rates, 1990/92 - 1999/01, Greater Glasgow communities Source: NHSHS Community Profiles (from ISD Scotland data)

3,000.0 Bridgeton & Dennistoun

Maryhill/Woodside & N Glasgow 2,500.0 South West Glasgow

South East Glasgow

2,000.0 Eastern Glasgow

Cambuslang & Rutherglen

1,500.0 Clydebank & Drumchapel

Greater Shawlands

Glasgow West End 1,000.0 Scotland

Strathkelvin 500.0

Ave. annual age-standardised rate per 100,000 pop Eastwood

Anniesl'd/Bearsdn/Milngavie 0.0 1990 - 1992 1993 - 1995 1996 - 1998 1999 - 2001

Furthermore, at a small-area level, differences in rates of increase between areas in Greater Glasgow/West of Scotland with the lowest rates of hospitalisation and those with the highest are even more striking. This is shown in Figure 7.7 where a widening gap between the two sets of areas is also visible. (Note, however, that 95% confidence intervals are not shown on this graph, manyny of which will be overlapping at the postcode sector level given the relatively small populations involved.)

Figure 7.7

Alcohol related/attributable hospital admissions, 1990/92 - 1999/01 West of Scotland and Greater Glasgow Comparison of 10 small areas with highest rates and 10 with lowest rates Source: NHSHS Community Profiles (from ISD Scotland data)

4,500 Townhead Ayr - Harbour and W Town Centre 4,000 Tradeston; Gorbals Dalmarnock 3,500 Hamiltonhill Bridgeton E 3,000 Ibrox Govan 2,500 Easterhouse W Ferguslie Park Scotland 2,000 Clarkston Hyndland; Dowanhill 1,500 Lugton; Dunlop Bearsden - Kessington 1,000 Houston Milngavie - Keystone; Dougalston 500 Kilmacolm Ave. annual age-standardised rate per 100,000 pop Cathcart Bearsden - Kilmardinny 0 Broom; Kirkhill; Mearns 1990 - 1992 1993 - 1995 1996 - 1998 1999 - 2001

193 Alcohol related mortality Figure 7.8 shows the number of alcohol related deaths for the Greater Glasgow area between 1980 and 2003. The overall number of deaths for this cause remained reasonably constant throughout the 1980s, but increased strikingly in the subsequent decade with a four-fold increase evident between 1991 and 2002. This is principally due to the increase in deaths among men, although it should be noted that the number of female deaths also more than doubled over the period shown.

Figure 7.8

Numbers of alcohol related deaths by year and sex, Greater Glasgow 1980-2003 Principal ("underlying") and Secondary ("contributing") Causes of Death Source: GRO(S)

600

500

400

300 Number of deaths 200

100

0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Male Female Total

In 1980 alcohol related deaths in Greater Glasgow accounted for just 2% of all male deaths in the area, and 4.6% of all male premature (age <65) deaths. By 2003, these figures had risen to 7% and 17% respectively. Further details of causes of premature death in Glasgow and the West of Scotland are presented in Chapter 11: Illness and disease.

Liver cirrhosis Looking at one subset of alcohol related mortality – liver cirrhosis – Figure 7.9 presents mortality rates from this cause for Greater Glasgow, and Scotland, in a European context (the green trend lines represent the minimum, maximum and mean values in each year for 16 Western European countriesiv).

iv Austria, Denmark, Finland, France, Germany, Ireland, Italy, N. Ireland, Netherlands, Norway, Portugal, Scotland, Spain, Sweden, Switzerland, England & Wales. Other relevant definitions are detailed in Appendix 1.

194 Figure 7.9

Liver cirrhosis mortality age standardised rates among men aged 15-74 years Scotland and Greater Glasgow in the context of maximum, minimum, and mean rates for 16 Western European countries Source: WHOSIS

100

Greater Glasgow 60

Maximum 40

Mean

Rate per 100.000 population per year 20

Scotland Minimum

0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 Year of death

This shows that, in a European context, cirrhosis mortality rates in Greater Glasgow in the 1970s and 1980s were consistently at, or below, the European average; between 1990 and 2001, however, mortality increased sharply to a level far in excess of both the European average and maximum values.

This information is considered further at the end of this chapter.

7.2 Drugs misuse

Drugs misuse prevalence Analyses carried out by Glasgow University Centre for Drugs Misuse Research and the Scottish Centre for Infection and Environmental Healthv calculated that in 2003 there were an estimated 51,500 ‘problem drug usersvi’ between the ages of 15 and 54 in Scotland3. Of these, almost half were resident in the West of Scotland, with over 11,200 living in Glasgow (Figure 7.10).

v Now renamed NHS Health Protection Scotland. vi Defined as individuals ‘misusing opiates or benzodiazepines’.

195 Figure 7.10

Location of 'problem drug users' (aged 15-54) in Scotland, 2003 Source: Glasgow University/SCIEH

Edinburgh City Aberdeen City 5,667 (11%) 2,810 (5%) Dundee 2,522 (5%)

Other West of Scotland councils (excl. Glasgow) 14,111 (27%)

Rest of Scotland 15,237 (30%)

Glasgow City 11,235 (22%)

Proportionally,lly, Glasgow City has the highest level of problem drug users among the West of Scotland council areas (over 3% of 15-54 year olds), with East Dunbartonshire the council with the lowest (0.7%). This is illustrated in Figure 7.11.

Figure 7.11

Estimated proportion of 'problem drug users' (aged 15-54), 2003 Source: Glasgow University/SCIEH

3.5 3.3

3.0

2.6 2.6 2.5 2.4 2.2 2.2 1.9 2.0 1.8 1.9 1.9 1.7

1.5 1.4

1.1

of population aged 15-54 1.0 % 0.7

0.5

0.0

d e e n ity ire ir ire la gow C s sh rshire rshire rshire clyd w rksh w kshire r cot a e ar S fr n Ay Ay ve sgo th Ay h st artonsh In ter Gla r ut b Gla Ren o th Lan th La No Ea Renfrewshire u S Dun West of ScotlandGrea or ast N E So st East Dunbartonshire We Council

196 In terms of trends, there was no significant change in problem drug use prevalence in Scotland between 2000 and 2003. However, rates in three of the West of Scotland councils did change significantly: Glasgow (where rates decreased from 3.9% to 3.3% – a 15% decrease), North Lanarkshire (32% decrease), and South Ayrshire (124% increase). This is shown (with 95% confidence intervals) in Figure 7.12.

Figure 7.12

Estimated proportion of 'problem drug users' (aged 15-54), 2000 vs. 2003 Source: Glasgow University/SCIEH 5.0

4.5

4.0

3.5

3.0

2.5

2.0

1.5 % of population aged 15-54 aged population % of 1.0

0.5

0.0 Scotland 2000 Scotland 2003 Inverclyde 2000 Inverclyde 2003 Glasgow City 2000 Glasgow City 2003 Renfrewshire 2000 Renfrewshire 2003 East Ayrshire 2000 East Ayrshire 2003 North Ayrshire 2000 North Ayrshire 2003 South Ayrshire 2000 South Ayrshire 2003 North Lanarkshire 2000 North Lanarkshire 2003 South Lanarkshire 2000 South Lanarkshire 2003 East Renfrewshire 2000 East Renfrewshire 2003 East Dunbartonshire 2000 East Dunbartonshire 2003 West Dunbartonshire 2000 West Dunbartonshire 2003 Council/Year

Within Greater Glasgow, there is more than seventy fold variation between the estimated drug misuse prevalence rates in the LHCCvii area with the lowest rates, Anniesland & Bearsden (0.15 per 100 population aged 15-54), and the area with the highest, Dennistoun (11.2 per 100). This is shown in Figure 7.13 (but note that these are again modelled estimates and the figures should therefore be interpreted with cautionviii).

vii Local Health Care Cooperative. LHCCs have now been replaced by the new Community Health Partnerships (CHPs) (Community Health and Care Partnerships (CHCPs) within Glasgow). viii The report authors note that the prevalence estimate for Glasgow is “more reliable and robust that the estimates for the smaller LHCC areas”. It should also be noted that the estimates at LHCC level were based on aggregations of data at the postcode district level (e.g. G31) – thus the definition of an LHCC area may differ considerably from recognised LHCC boundaries.

197 Figure 7.13

Estimated proportion of 'problem drug users' (aged 15-54) within Greater Glasgow LHCC areas, 2003 Source: Glasgow University/SCIEH

12 11.2

8 7.3 6.4 6 4.8 4.0 4 3.4

of population aged 15-54 3.0 2.6 2.8 % 1.8 1.8 1.9 2 1.6 1.2 0.6 0.6 0.2 0

d d k e s e n n o n d w el w o o n o p o ba On a sid et tou w e st sg sg g is e wl la od a id n Scotlan ast yd Camglen a o r /Bearsden E /W G W B d Strathkelvin Cl e rn ll/ Den LHCC areas d rSh ast Glasgow i Drumcha te ste E G slan rsi a a North Gl e e e E ll G Maryh A Riv Gr outh West Glasgow Anni S South LHCC area

Drugs related deaths Between 1997 and 2001 there were 765 drugs related deaths in the West of Scotland, of which 459 (60%) related to residents of Greater Glasgow communities. Figure 7.14 shows the total five year figure, expressed as a crude rate per 100,000 population, for West of Scotland communities: Bridgeton & Dennistoun clearly stands out with more than seven times the national rate.

Figure 7.14

Drugs related deaths over 5 years (1997-2001) per 100,000 population; West of Scotland and Glasgow communities Source: NHSHS Community Profiles (from GRO(S) data)

250

201 200

150

99 100 70 71 62 53 54 Crude rate per 100,000 38 41 44 50 31 32 34 34 27 23 25 26 27 28 29 29 29 16 16 <5 <5 0

le e n n el y w vie id ire p le ds o idge r lvi lto a well l ond n yde ga r b r la sgow cl sg n ishaw rshire ch e rshire m a r a istoun tb Kil thke W th w n Scotland a a Hami Ay frewsh m o Ay rn Va Lo a ve Gl /Mil Eastwood st tr n u h In n Clydesda a S st e M rt N E R Dr eve rSh Cumbernauld Ea No L te & ie & Co South Ayrshire st d a e k & n e d e n r Easternsi Glasgow a G Glasgow West End d /Bearsde uslang &Airdr Rutherglen W y a South Eastouth Glasgow West Gl o d eb e S idgeton & Den w & yd isl r e a /Wo B slan r Cl P e Camb nf Re Anni Maryhill Community

198 Figure 7.15 shows the total number of drugs related deaths by year between 1996 and 2004, for the Greater Glasgow area. The numbers have risen by a third over the period, although there has been some year-on-year fluctuation within that overall trend.

Figure 7.15

Numbers of drugs related deaths 1996-2004, Greater Glasgow Source: GRO(S)

140

120

100

60 Number of deaths

0 1996 1997 1998 1999 2000 2001 2002 2003 2004

7.3 Smoking

Smoking prevalence Unfortunately, no long term trend in smoking prevalence in Glasgow is available. However, we know that, as is the case nationally, adult smoking rates have fallen considerably in the last thirty years. Figure 7.16 shows that the current rate in Glasgow (from the 2003/04 Scottish Household Survey) is about 33% for adults (aged 16+). This exceeds the national figure of 27%, but represents a slight fall since the 1999/2000 survey.

199 Figure 7.16

Percentage of adults smoking, 1999/00 - 2002/03 Source: Scottish Household Survey 40

20 of adults % 15

Glasgow City 5 Scotland

0 1999/2000 2000/2001 2002/2003

To look at how current smoking prevalence varies within Greater Glasgow and the West of Scotland we can use the modelled estimates produced by Portsmouth University for NHS Health Scotland (and used in the Community Profiles). Again, as with all modelled estimates, the accuracy is uncertain. Nevertheless, the relative variations in smoking prevalence between different areas are likely to be reasonably robustix.

Figure 7.17 shows that Eastwood and Anniesland, Bearsden & Milngavie are the communities which have the lowest estimated smoking prevalence (22%), while the estimated prevalence of smoking is double this in four other Greater Glasgow communities – Clydebank & Drumchapel, South West Glasgow, Bridgeton & Dennistoun and Maryhill, Woodside & North Glasgow.

ix Note also that the estimates are based on 1995 and 1998 Scottish Health Survey data. As Figure 7.16 shows, smoking prevalence in Glasgow is likely to have fallen slightly since then.

200 Figure 7.17

Estimated smoking prevalence (16-74 years of age), 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles, 2004 (from modelled estimates produced by Portsmouth University)

60.0

50 51 50.0 46 47 44 43 40 40 38 39 39 39 40.0 37 38 38 38 35 34 35 36 31 31 32 33 30.0 28 22 22 20.0

10.0

Estimated % of 16-74 year-olds who smoke 0.0

d e n e e d n e e e n o i ire ir ire g el w u and o vi ale lto len p o l sh g sh sh rwell d w lbrid sd r e sgow sg isto lnga e yr wshir omon e yr yr tbri la la n Scot ast d e L th A Wishaw th G mcha E rathkelvst Ki A Hami u A u /Mi t a Cly th R th InverclydMo Coa st G n S u umbernauld ast r ast e Den E o C E o & S ter Shawlands N & E & Dr rie th k n d Eastern Glasgowth W o GlasgowGrea West End ou u et /Bearsde y and Levern Valley Air S g d eban So id n r a yd B sl Cl e ambuslangPaisle and C nni Renfrew & West Renfr A Maryhill/Woodside & N Glasgow Community

At a postcode sector level (Figuree 7.18) the differences between the ten areas with the highest prevalence and the ten areas with the lowest prevalence are much wider, showing on average at least a three-fold variation. While the areas of lowest prevalence have levels of smoking 15-20% lower than the Scottish average (35%), in the areas of highest prevalence the rates are at least 25% higher, and in some areas are estimated to be above 60%.

Figure 7.18

Estimated smoking prevalence (16-74 years of age), 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from estimates produced by Portsmouth University)

70 62 63 58 59 59 60 60 60 58 58 58

40 35

18 19 19 19 20 20 16 17 17 18 18

10 Estimated % of 16-74 year-olds who smoke 0

n W hill orn NE e W otland acolm use E anark ardinny iffnock Govan ilton Sc ; Mearns G ill; Th Houston umbreck essington Clarksto Kilm D Barl Parkhead N Parkhead S Ham - K Easterho Drumchapel Kirkhill rngad; Royston Drumchapel Easterhous Doonfoot; Alloway Ga rsden - Kilm Broom; Bearsden Bea

Bearsden - Castleh Postcode sector

201 Smoking attributable deaths The estimates of smoking attributable death rates presented here are subject to the same caveats about accuracy as the smoking prevalence estimates (from which they were in part derived) discussed in the previous section. Despite this, relative differences between communities are again likely to be reasonably robust. Figure 7.19 shows that Anniesland, Bearsden & Milngavie, Eastwood and Strathkelvin are the communities with the lowest rates, while – in contrast – in South West Glasgow, Maryhill, Woodside & North Glasgow, and Bridgeton & Dennistoun rates of death attributable to smoking are at least twice as high.

Figure 7.19

Smoking Attributable Deaths (ages 35+), 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles, 2004

900 816 800 734

700 647 599 600 558 520 527 492 493 509 500 462 465 473 477 421 429 434 400 387 391 368 375 400 346 309 325 300 239 244 200

ude rate per 100,000 population aged 35+ population ude rate per 100,000 100 Cr

e e d nd ell d nd w i hire hire hire nds aw y oun ood elvin o s s s rw a h l go apel gow t gavie tw nauld r milton r ridge l is c h sgow otland n r y y b he w er a Sc as t Kilbr be rewshire Lom A A W Glas Glas nnis Mil E f Ha Camglennv t as m Clydesdale h th Mot I t & Strathk as n E Cu out East Ayr Levern Valley S Nor E stern Gl d sgow Westth E h Wes and De rsde a Ea West Ren drie and Coat Greater Sha Gl ou out ton d ir S S Bea A ley an an ridge nd, w a Pais B l fre Clydebank and Drumc hill, Woodside & N.Glasgow ry nnies Ren Ma A Community

A great deal of caution should be exercised when inspecting the smoking attributable death rates at a postcode sector level given the previously mentioned caveats over the accuracy of these estimates, which are particularly pertinent for small areas. Nevertheless, as Figure 7.20 illustrates, it is clear that many of the most deprived parts of Glasgow have the highest rates of death attributable to smoking. In contrast the areas with the lowest rates are geographically dispersed but clearly more affluent and with less health problems in general.

202 Figure 7.20

Smoking Attributable Deaths (ages 35+), 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles, 2004

1400

1200 1119 1041 1063 1001 1001 1026 957 980 1000 914 922

800

600 400 400

193 196 198 214 214 200 153 <5 <5 <5 <5 cases cases cases cases 0 Crude rate per 100,000 population aged 35+ l n m s l tur uin on W ton lla hor on E head al Fr kst earns T acol onhi n cotland ar ; atland et lt C Ruchill S yss Bay Houston en l ; M l chinloch lm mi m C hil u i a e; Du e Gl e K Tow tl s; Barassie s; O Bridg H Dalmarnock Parkhead S lag W s n l a bal Vi r Easterhouse eenock Central d - C Gr ; Go aul en enzie S; A n n L Broom; Kirkhillsd ow ear nt B Cumber heso roon-Muirhead; Loa tc T u H Postcode sector

7.4 Obesity

Data from the most recent Scottish Health Survey (2003) estimate that more than half the adult female population of Greater Glasgow is overweight (55%), while the same is true of more than six out of ten adult males (63%). Furthermore, almost one in four females (24%) and more than one in five males (21.5%) were classed as obesex. These are similar to the figures for all Scotland (females: 60% overweight, 26% obese; males: 65% overweight, 22% obese). These data are summarised in Figure 7.21.

x Overweight – body mass index (BMI) greater than 25; obese – BMI greater than 30.

203 Figure 7.21

% of overweight & obese adults (aged 16+), Greater Glasgow and Scotland, 2003 Source: Scottish Health Survey

70 65.4 63.2 59.7 60 54.7

30 of adults (16+) 26

% 23.9 21.5 22.4 20

0 Males Females Males Females Greater Glasgow Scotland

Overweight Obese

Restricting thehe adult respondents in the survey to ages 16-64, we can show a trend in the levels of obesity from the 1995, 1998 and 2003 surveys. This is presented in Figure 7.22, showing a clear rise in levels of obesity for males and females.

Figure 7.22

% of adults (aged 16-64) classed as obese (BMI>30), Greater Glasgow, 1995, 1998 & 2003 Source: Scottish Health Surveys

21.9 20 19.8

16.4 15 14.8

of adults (16-64) 10 %

5 Males

Females 0 1995 1998 2003

As discussed in Chapter 9: Children and adolescents, childhood obesity has also reached worrying levels.

204 7.5 Diet

Detailed information on many aspects of diet is available from the Greater Glasgow Health and Well-being Survey4 and the 2003 Scottish Health Survey5. One illustrative example (from the Greater Glasgow survey) is presented here, namely fruit and vegetable consumption.

Figure 7.23 shows that one quarter of the population of Greater Glasgow does not eat any fresh fruit on a daily basis. However, this figure differs significantly between the three deprivation groupings used, ranging from just 11% in the least deprived areas (as defined by Carstairs deprivation6 categories 1 and 2) to 31% in the most deprived (categories 6 and 7).

Figure 7.23

Diet: % of respondents who on average eat no portions of fruit per day Source: NHSGG Health/Well-Being Survey, 2002

31.2

25 24.2

21.0 20

15 of respondents % 10.9 10

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Figure 7.24 shows similar figures for vegetables/salad (excluding potatoes). Overall, 13.5% of the population do not eat vegetables/salad daily. However, the figure is as low as 5% in the more affluent parts of Greater Glasgow, and as high as 17.5% in the most deprived areas.

205 Figure 7.24

Diet: % of respondents who on average eat no portions of vegetables (excl. potatoes) or salad per day Source: NHSGG Health/Well-Being Survey, 2002

18 17.5

14 13.5 12.1 12

of respondents 8 %

6 5.0

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

The minimum guideline for fruit and vegetable consumption is five or more portions of fresh fruit and vegetables per day. Figure 7.25 shows that overall, 34% of the Greater Glasgow population were meeting this target in 2002. However, there were significant differences between sub-categories of the population with the proportion meeting the target ranging from 29% (most deprived areas) to 42% (least deprived). Although not shown here, the overall figure in the 1999 survey was 25%: thus, there has been a significant increase over four years. However, separate analysis of the data for SIPxi and non-SIP areas showed that this increase only took place in non-SIP areas, potentially increasing the health gap between more and less affluent communities in Greater Glasgow.

Furthermore, it should be noted that the 2003 Scottish Health Survey suggests considerably fewer residents of Greater Glasgow are meeting this target (21%) than the Greater Glasgow survey found in 2002.

xi Social Inclusion Partnership.

206 Figure 7.25

Diet: % of respondents who on average eat five or more portions of fruit & vegetabes each day Source: NHSGG Health/Well-Being Survey, 2002

100

50 42.5

of respondents 40 37.1

% 34.1 28.9 30

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

7.6 Oral health

A more detailed analysis of oral health of children is contained in Chapter 9: Children and adolescents, but two questions asked of adults in the 1999 and 2002 Greater Glasgow Health and Well-being Surveys are of potential interest here.

At the time of the 2002 survey, one in three of the Greater Glasgow population had not visited a dentist in over 15 months, with statistically significant differences between the three deprivation groupings used: ranging from 23% in the least deprived areas to 38% in the most deprived (Figure 7.26). These figures were not significantly different to those recorded in the 1999 survey.

207 Figure 7.26

Oral health: % of respondents who had not been to the dentist in over 15 months Source: NHSGG Health/Well-Being Survey, 2002

40 38.4

35 33.1 30.7 30

25 23.1

20 of respondent % 15

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

A similar proportion of the population (33%) stated in 2002 that they brush their teeth less than twice a day (Figure 7.27). Again, this was not significantly different to the 1999 figures, but again there were significant differences between sub-categories of the population: 25% in the least deprived areas, 40% in the most deprived.

Figure 7.27

Oral health: % of respondents who brush their teeth less than twice a day Source: NHSGG Health/Well-Being Survey, 2002

40.3 40

35 33.2

30 26.5 25.7 25

20 of respondents % 15

0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

208 7.7 Sexual health

Only one indicator of sexual health is considered here: sexually transmitted infections (STIs). However, given current trends it is arguably one of the most important.

Figure 7.28 shows so-called acute STI rates for the Greater Glasgow area (and Scotland) between 1996 and 2004. Acute STIs include: infectious syphilis, gonorrhoea, chlamydia, genital herpes (first episode only), genital warts (first episode only), non-specific genital infections (non-chlamydial), trichomoniasis, HIV infection (newly diagnosed only), and ‘other acute STIs’xii.

Figure 7.28

Acute Sexually Transmitted Infection Rate s, Greater Glasgow & Scotland Source: ISD Scotland

900

800

700

600

500 Crude rate per 100,000 15-64 year-olds 400 Greater Glasgow

Scotland

300 1996 1997 1998 1999 2000 2001 2002 2003 2004

The numbers of acute STI diagnoses are expressed as a crude rate per 100,000 population aged 15-64. For Greater Glasgow, there has been a 93% increase over eight years. The equivalent figure for Scotland is 71%. In terms of actual numbers, the total number of recorded diagnoses within Greater Glasgow in 1996 was 2,100 and this had increased to over 4,000 by 2004. The total figure for all Scotland in 2004 was almost 19,000.

Note, however, that these figures may be influenced by proximity to genito-urinary medicine services, and it is possible that the higher rate of increase in Greater Glasgow reflects higher levels of screening in the area. Despite these caveats, the figures are clearly a cause for concern.

xii NB this group of diagnoses does not, therefore, include: other acquired syphilis, congenital syphilis, genital herpes recurrence, genital warts recurrence/reregistered.

209 7.8 Physical activity

Two aspects of physical activity are presented in this final section of the chapter: the proportion of Glaswegians meeting nationally set targets for physical exercise (from the Greater Glasgow Health and Well-being surveys), and the proportion of the population travelling to work or study by bike or on foot (from the 2001 Census).

Figure 7.29 shows that in 2002 just over a fifth of the population of Greater Glasgow met one of the minimum exercise targets, taking at least 20 minutes of vigorous exercise three or more times per week. It is notable that this figure did not differ significantly across the three deprivation groupings shown.

Figure 7.29

Exercise: % of respondents taking at least 20 minutes of vigorous exercise 3 or more times per week Source: NHSGG Health/Well-Being Survey, 2002

30.0

24.5 25.0 22.8 21.4 20.4 20.0

15.0 of respondents % 10.0

5.0

0.0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

However, over half (55%) the Greater Glasgow respondents met the less demanding target of taking either 20 minutes of vigorous exercise three or more times per week or 30 minutes of moderate exercise five or more times per week. These data are shown in Figure 7.30.

210 Figure 7.30

Exercise: % of respondents taking at least 20 minutes of vigorous exercise 3+ times per week or 30 minutes of moderate exercise 5+ times per week Source: NHSGG Health/Well-Being Survey, 2002

70.0

59.0 60.0 55.0 53.0 50.0 50.0

40.0

30.0 of respondents %

20.0

10.0

0.0 All (Greater Glasgow) 1-2 (least deprived) 3-5 6-7 (most deprived) Carstairs Deprivation Category

Figure 7.30 also shows that significantly more respondents (59%) in the most deprived areas were meeting this target. Furthermore, although not illustrated here, comparison with the 1999 survey shows that there was a significant increase in the proportion of the population living in SIP areas who were taking this level of exercise – from 48% to 61%. There was no significant increase for the rest of the population.

The 2003 Scottish Health Survey presents data on a more recent physical activity target (30 minutes or more moderate or vigorous activity at least five days a week). This showed that in Greater Glasgow 36% of adults (aged 16-74) met this target, which was significantly higher than the figure recorded in the 1998 Scottish Health Survey (28.5%)7.

Finally, Figure 7.31 shows the percentage of the population who travel to their place of work/study by bicycle, foot and car. This shows that in Glasgow considerably fewer individuals travel to work/study by car than is the case nationally (40% compared to the Scotland figure of 54%), and that more people regularly commute on foot or by bicycle. That said, we have already shown in Chapter 4: Economic factors that car ownership in Glasgow is rising, and, as discussed in the previous chapter, future projections in traffic volume show arguably unsustainable increases. Thus, this picture may change in the near future.

211 Figure 7.31

Travel to place of work or study* by bicycle/foot and car, 2001 Source: 2001 Census

70 bike/foot car 61 60 58 59 59 59 60 56 57 54 55 52 50

40 40

30 28 25 23 23 21 22 20 19 20 20 19 20 15 of population working/studying*

% 10

d e e e e e e e e n ity ir ir ire ir ir ir ir a l clyde sh sh wC nsh r wsh rksh rkshir yr nsh wsh cot o to e a a to e S r ve fr n Ayr A r fr sg In n a an th n la ba e ast L u ba e G n L n North Ayrshir R th E th R r So st st Du No ou st Du e S a Ea W E Council * Excludes those working/studying at home

212 Summary

A number of worrying trends are highlighted in this chapter: x Alcohol is a major cause for concern. There are estimated to be more than 13,500 ‘problem alcohol users’ resident within Glasgow City and, since the beginning of the 1990s, there has been a striking increase in numbers of alcohol related deaths and hospitalisations within both Scotland and the Greater Glasgow area. By 2003, 17% of all premature deaths among males in Greater Glasgow were related to alcohol, while liver cirrhosis mortality rates among males exceeded the maximum national figure in Western Europe. x The increase in the levels of obesity among adults in Greater Glasgow is also worrying. A fifth of males and almost a quarter of females are now estimated to be obese, with well over half classified as overweight. x In eight years (from 1996 to 2004), recorded rates in acute sexually transmitted infections have almost doubled. Although some of this increase may in part be due to better screening, this is an important problem in Glasgow (as it is elsewhere in Scotland). x Over the same eight-year period, drug related deaths in Greater Glasgow have risen by a third. There are estimated to be around 25,000 ‘problem drug users’ in the West of Scotland (of whom more than 11,000 live in Glasgow). x Better news is evident in terms of the overall downward trend in smoking. Nonetheless, it remains one of the commonest causes of preventable mortality and demonstrates profound inequalities in its distribution. x Survey results also suggest that further good news is provided by the number of people within the more deprived areas of Greater Glasgow who are taking regular exercise.

213 References

1 Hay G, Gannon M, McKeganey N. Estimating the number of children affected by parental substance misuse in Glasgow (University of Glasgow Centre for Drug Misuse Research report for Glasgow City Council Addiction Services). June 2005

2 NHS Health Scotland. Constituency Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/constituencyprofiles

3 Hay G, Gannon M, McKeganey N, Hutchinson S, Goldberg D. Estimating the National and Local Prevalence of Probl em Drug Misuse in Scotland. January 2005 http://www.drugmisuse.isdscotland.org/ publications/local/prevreport2004.pdf

4 Jones R, Borland E, Boyd A, Lorenzetti K, Scouller J, Carey L, Tannahill C. The Health and Well-being of the Greater Glasgow Populatio n; summary report. November 2003 http://www.show.scot.nhs.uk/gghb/PubsReps/Reports/health_promotion/health+wellb eing/health+wellbeing_city_nov03.pdf

5 Scottish Exec utive. The Scottish Health Survey 2003. http://www.scotland.gov.uk/Publications/2005/11/25145024/50251

6 Carstairs V, Morris R. Deprivation and Health in Scotland. Aberdeen: Aberdeen University Press, 1991

7 Scottish Executive. The Scottish Health Survey 1998. htpt ://www.show.scot.nhs.uk/scottishhealthsurvey/

214 Chapter 8: Pregnancy and childbirth ong associations between socioeconomic factors socioeconomic ong associations between (such households as lone parent r There is a strong trend toward women having childrenThere is a strong women at older ages.” trend toward ap (compared to Scotland) has reduced, Glasgow stillap (compared a higher than has Glasgow to has reduced, Scotland) average eenage pregnancies for 13-19 year olds have reduced nationallyreduced although and, olds have the year eenage for pregnancies 13-19 he West of Scotland, the with areas the breastfeedinghe West highest are and the levels lowest eenage rate. pregnancy “Six out of the ten areas with the highest teenage pregnancy rates in were all at least double the Scottish average.” Glasgow, “ “Maternity related emphasise the indicators importance of the interaction social, cultural and economic factors and healthbetween behaviours.” Summary T g t is a gap in theThere of ten years age of first of Scotland time mothers West across communities with motherstheir to communities likely have deprived in more first child at a much age. younger indicate trends that proportionately born being babies are and more to more However, older mothers almost 50% of births – in 2004 to mothers of age or were of 30 years older. groups,Despite nationally deprivation rates of smoking in reductions and across polarised remain verypregnancy between high rates in the parts deprived more of rates in the and much affluent more Glasgow lower areas. has a strongDeprivation with association birthweight, low with the most 20% deprived havingof areas double the birthweight low rate of the least 20% of areas. deprived been modest have theThere rises in breastfeeding and the last few years over of the at the Scottish average. breastfeeding is now level rateGreater in Glasgow within there large in breastfeeding variations are level: rates area at a small However, t both concentrated in Glasgow. uptake of primaryThe lowest and immunisation tends to be concentrated Glasgow, in uptake, withis associated of MMR, with thelower greater exception deprivation. St and children and maternity-related households) in workless indicators emphasise the importance of the factors and economic social, cultural interaction between and health behaviours. Guide to data presented in this chapter % of dependent children living in hous eholds where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 8: Pregnancy, childbirth and early years

The period of pregnancy and the early years of life are recognised as extremely important for child development. While immunisation has successfully reduced the impact of many once common diseases (and is still vitally important), increasing focus is now given to behavioural and socio-demographic factors that can affect the health of both mothers and babies e.g. smoking, alcohol, drug abuse, age and deprivation.

This chapter reports on a range of indicators relating to pregnancy and infant health. The topics covered are: teenage pregnancy, teenage abortions, age of first time mothers, smoking in pregnancy, low birthweight, breastfeeding and immunisation.

Infant deaths, which were reported on in two previous chapters (Chapter 2: A historical perspective on Glasgow’s population, and Chapter 3: Population and life expectancy) are also briefly summarised in terms of their relationship with deprivation. A final section comments on the strong associations between many of these indicators and their relationships with two socioeconomic factors: single parenthood and living in a workless household.

As with previous chapters, many of the comparison graphs are drawn from two main publications: NHS Health Scotland’s Community1 and Constituency profiles2. The data within these reports mainly relate to the period up to 2000-2002, but where possible these data are supplemented with more recent data in order to show up to date trends.

8.1 Teenage pregnancies and teenage abortions

Teenage pregnancy The first two Figures in this section display teenage pregnancy rates by ‘community’i and by postcode sector. Across West of Scotland communities in 2000-2002 there was a three-fold variation in the rate of teenage (age 13-19) pregnancies (Figure 8.1). In Eastwood and Anniesland, Bearsden & Milngavie, the annual average ratesii were 1.5 and 1.7 per 100 females (13-19), respectively, while the rates in eight other communities (from Motherwell to Maryhill, Woodside & North Glasgow) were at least three times greater, ranging from 5.1 to 6.4 per 100. In comparison, the Scottish average for this measure over the period was 4.3 per 100 females (13-19).

i These are primary care-based localities (mainly the old Local Healthcare Cooperative (LHCC) areas or, in some cases, the new Community Health (Care) Partnerships (CH(C)Ps)) with populations ranging from 20,000-140,000 people. For further details see ‘Preface to Chapters 2-12’. ii Rates shown are annual averages rather than three year totals, as used in the NHSHS Community Profiles.

217 Figure 8.1

Teenage pregancies (13 - 19 years): annual average rate per 100 females, 2000-2002, West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data) 8

7 6.4 5.9 6 5.6 5.6 5.3 5.3 5.5 5.1 4.9 5.0 5 4.6 4.6 4.7 4.4 4.3 4.2 4.2 3.8 3.8 3.9 3.9 e 4 3.7 3.1 3.1 2.8 3

1.7 2 1.5 Rate per 100 females aged 13 - 19

d ie le n e s e w w n w w o v ide nd o ire ir d ir ire aw u pel o o r h h h h h lley o a g ga s ridge s s a t s tw esda mo milt r b r r is ch s hkelvin o a ews Wis therwell lasgo V n la Scotland a L H Ay o G n n E Miln st Kilb fr hawlan t Inverclyde t e um a Clyd S s rth Ay M s rn GlasgoD r NG en/ Strat E uth Ay o e ever e d Cumbernauld Ea N L & s gow West End So ater n& r e nd o k & D r th W a East t uth East Glasgon Glas West Ren G irdrie & Coat e dside A So ba o d/Bea & Sou idg e o n d ew Br ly l/W Cambuslang & Rutherglen Paisley C il iesla nfr h n e y n R r A Ma Community

At a postcode sector level the ten areas with highest rates all had rates at least double the Scottish average (Figure 8.2)iii. Six out of ten of these areas were in Glasgow, three were in Paisley and one was in East Ayrshire.

Figure 8.2

Teenage pregancies (13 - 19 years): annual average rate per 100 females, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow

Source: NHSHS Community Health Profiles (from ISD Scotland data) 14

11.8 12

10.0 10.0 10.0 10 9.5 9.5 8.9 8.9 9.1 9.2

8 e 6 4.3 4 2.6 2.3

Rate per 100 females aged 13 - 19 2 0.7 <5<5 <5 <5 <5 <5 <5 0

k h p n n n l . nd c s od th o a rk ie E ls o o ort r t v a h a tla no c nlo lp ave law. b o n Largs u il h ton E P or art M ardinny t sing Go in h Sc ; D a s tlemilk G rmu G Howw tr uslie Park ock rhouse W s ; a ton S Ke Laig Camlac a C g Bridge Kn C ton - Kilm aste s Lu n n- Paisley Centra Ferg ill; E e e h sd n rad r to T Bea Al lie; Meigle; AuchengaBearsde lmor Ske Postcode sector

iii Note figures quoted as ‘<5’ relate to areas where there were less than five teenage pregnancies in the period 2000-2002.

218 Trends in teenage pregnancy rates across a selection of West of Scotland council areas between 1991-93 and 2001-03 (see Figure 8.3) show that, while the overall rate of teenage pregnancies has reduced nationally, Glasgow has maintained a higher rate. However, the rates for the two councils with the highest rates, Glasgow and East Ayrshire, have reduced to levels closer to the national rate.

Figure 8.3

Teenage Pregnancies (13-19) expressed as a rate per 100 females, 1991/92 - 2002/03 for selected West of Scotland Councils Source: ISD Scotland 7

6 Glasgow City

5 East Ayrshire

4 Scotland

South Lanarkshire 3 East Dunbartonshire

Rate per 100 women aged 13-19 per Rate 2 East Renfrewshire

0 1991/92 1992/93 1993/94 1994/95 1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03

* 2002/03 data are provisional

Teenage pregnancy rates have a strong association with deprivation. The Scottish Executive’s report on measuring inequalities3 showed that, nationally, the ratio of the rate of teenage pregnancies among 13-15 year olds between the most and least deprived quintiles was three to one; that is, on average, a 13-15 year old girl living in the 20% of most deprived areas would be three times more likely to have had a teenage pregnancy than a girl of the same age living in one of the 20% of least deprived areas.

Teenage abortions In the period 2000-2002, the average annual rate of teenage (13-19 years) abortions in Scotland was 1.3 per 100 females (13-19). Among Scottish Parliamentary Constituencies within Greater Glasgow, this rate varied from 0.8 per 100 in Dumbarton to 2.2 per 100 in Glasgow Shettleston, a rate which is 65% above the Scottish average (Figure 8.4). Over the period 1993/95-2000/02 there was a slight rise in the teenage abortion rate nationally (13.9%) and rises of varying amounts in most of the constituencies within Greater Glasgow. The largest rise was in Eastwood (+94%), although the actual rate remained below the Scottish average.

219 Figure 8.4

Average annual teenage (13-19) abortions expressed as a rate per 100 females, 2000-02, Scottish Parliamentary Constituencies within Greater Glasgow Source: ISD Scotland 2.5 2.2

2.0 1.8 1.8

1.5 1.5 1.4 1.3 1.3 1.3 1.4 1.2 1.1 1.0 1.0 1.0 0.9 0.8

0.5 Rate per 100 females aged 13-19

0.0

k d n rn on vie llo vin len u on rt a lan ryhill st rsden s a lng Po e Kel ngb llie tleston i w w i et Scotland umba Bea pr Eastwood w Cathcart ow Gova D d sgo Anni g sgo ow M S Sh n nd M go s g w a a la ow s la la ow Rutherg s o ow Bai w n G g G g nk s la G Gla s a a G lasg la lasgo kelvi Gl G Glasg G h G lydeb trat C S Constituency

8.2 Age of first time mother

In the period 1999-2001, the average age of first time mothers varied between 24.6 years and 29.8 years across West of Scotland communities (Figure 8.5). The youngest first time mothers lived in Clydebank & Drumchapel, Maryhill, Woodside & North Glasgow, Bridgeton & Dennistoun and South West Glasgow, while the areas with the oldest first time mothers were also in Greater Glasgow, within the generally more affluent communities of Greater Shawlands, Strathkelvin, Glasgow West End, Eastwood and Anniesland, Bearsden & Milngavie.

Figure 8.5

Average age of first-time mother; 1999-2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data)

29.7 29.8 30 28.6 27.6 27.8 28 27.2 26.8 26.5 26.4 26.4 26.5 26.6 26.6 26.1 26.2 26.3 25.6 26 25.3 25.5 25.5 25.6 24.9 25.1 25.1 24.6 24.6 24.8 Age 24

d l n e ll y e e s d d n e u w w d ge e w on e w nd ir ld le in o ie p o w ll h len ride nd lv o v tla t ly id s rg au shir e En o is isha r er milt Va mo r n la k t w ga n lasgo tb lasgo a lasgo o e r esda w w s st mcha W a Ayrshire th n L th e re a th e a Sc u G o G H r G u f W E Miln r st th Ayrshire Inverc C Mo n ve R Clyd n D Den e r r uth Ay e Stra o East e Le Cumb R East Kilb ow en/ & W N So g & t ter Sh g sd k n& rie & n s a r to th East nd e re las an e d a uth East la b y o s W G G e Sou Air S d idg le bu & d/Bea is m w n ly l/WoodsideBr & N Glasgow a a C P C fre Ren nniesla Maryhil A Community

220 A similar pattern is observed at a postcode sector level, but with an eight to ten year difference in the age of first time mothers observed between the areas with highest and lowest average ages (Figure 8.6). In Drumchapel, Ferguslie Park, and parts of the East of the city, the average age of first time mothers was between 21 and 22, while in Bearsden, Milngavie, Cathcart, Hyndland and Kelvinside the average age of new mothers was above 30.

Figure 8.6

Average age of first-time mother, 1999-2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from ISD Scotland data) 34

32.2 32.3 32 31.3 31.4 31.6 31.0 31.1 30.6 30.6 30.6

28 26.5 26 Age

24 22.5 22.6 22.0 22.3 21.6 22 21.4 21.4 21.5 21.0 21.2

k y l sil r ill n il nd NE s lop ock n h ton tla l el W on E azie o na shill rloch n i n ls e p t h it u fn rd a a co p use W P rla N oomh D if w tlemilk E o r Cathcart Alloway G o ug S s Ruc rh Ba B ; D o mcha a te High ot ; u Bridge C s fo Kilma ; D r avie - Ba ugton; - nd e rumcha D Ferguslie Park g L on n la D Ea o e D indale; Kelvinside d ton Miln v rs ynd a H Kel e Keys B - e vi Postcode sector ga Miln

There is a strong trend toward women having children at older ages. At a national level the percentage of births to women of 30 years or older has risen from 40% of all births in 1996 to 49% in 2004. While every West of Scotland council has shown an increase in the percentage of births to ‘older’ mothersiv, the actual proportions vary considerably between councils (Figure 8.7). In East Renfrewshire and East Dunbartonshire in 2004, two thirds of all births were to older mothers and, even in North Ayrshire, the council with the lowest proportion, 41% of births were to older mothers.

iv Defined here as mothers of 30 years or older.

221 Figure 8.7

Births to mothers aged 30 or older as a percentage of all births, 1996 vs 2004 West of Scotland council areas Source: ISD 80%

70% 1996 2004 p 66% 67%

58% 60% 56% 53% 51% 49% 49% 50% 46% 45% 44% 44% 44% 43% 41% 40% 41% 37% 39% 40% 37% 36% 37% 34% 31%

% of all births 30%

20%

10%

e e nd ity d ire ire ire la C hir h h rs rshire ow y y Scot g A artonshire nvercly narks narks th b I a las L La enfrewsh G East A h h R Nor rt South Ayrshire t Dun o out s N S East Renfrewshire We East Dunbartonshire Council P Figures for 2004 are provisional

At the other end of the maternal age spectrum, the percentage of births to mothers under 20 years has remained stable at 8%, nationally, over the same period. However, while in East Renfrewshire and East Dunbartonshire only 3% and 5% of births respectively are to mothers under 20, in West Dunbartonshire and Inverclyde the proportions are much higher, at 11% and 12% respectively.

Nationally, there is strong association between deprivation and the age of mother at the birth of her first child (see Figure 8.8). The distribution of maternal age at birth of first child shows a difference of approximately 12 years between the most deprived quintile and the least deprived. It is likely that Glasgow will have a similar pattern.

Figure 8.8

First Birth1 by Age of Mother and Deprivation Quintile, Year ending 31 March 2004p Scotland Source: ISD Scotland 600 1 - Least Deprived 2 500 3 4 5 - Most Deprived

400

300 Number

200

100

- 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 48 49 50 1 - Excludes home births and births at non-NHS hospitals. Age p - Provisional.

222 8.3 Smoking in pregnancy

Across the West of Scotland in the period 2000-2002, figures for maternal smoking (recorded at first hospital booking) ranged from 9% in Eastwood to 43% in Clydebank & Drumchapel (Figure 8.9). Four Greater Glasgow communities (Eastwood, Anniesland, Bearsden & Milngavie, Greater Shawlands and Strathkelvin) had the lowest maternal smoking rates in the West of Scotland, while four other Glasgow communities (South West Glasgow, Bridgeton & Dennistoun, Maryhill, Woodside & North Glasgow and Clydebank & Drumchapel) had the highest rates in the West of Scotland.

Figure 8.9

% Maternal smoking at hospital booking, 2000-02 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data)

50 45 43 39 40 38 36 33 34 35 32 30 30 31 32 29 29 29 30 27 27 27 28 25 25 25 23

% 25 21 21 19 20 16 15 9 10 5 0

d e d d w e e w w l n od ld n on ir ir ow a ow e ride u on len ilt wo E g sgo sgo toun gavie kelvin lb wshir rna m rclyde st m a bridge ish is n th e her l t lasg n Scotla ast Lo ve W Glasg E ra st Ki fre Ha Gla t a mb Clydesdale In st G st AyrshMotherwell rn G en/Mil S E u a a N Ren C outh Ayrshire & Rut E E & sd S North Ayrsh e th rie & Coa h West on & Dend k & Drumchap reater Shawlands lasgow We d Easte si n G G slang ou ir ut et S A y and Levern Valley o od le S idg bu s r o ew & West B /W fr Cam Pai ill Clydeba yh nniesland/Bear Ren ar A M Community

At a postcode sector level (see Figure 8.10), the differences in maternal smoking are considerable, with less than 10% of mothers smoking in the lowest maternal smoking areas to over 50% in the highest smoking areas – which are all characterised by deprivation, and multiple health and social problems.

223 Figure 8.10

% Maternal smoking at hospital booking, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from ISD Scotland data) 70 62 60 54 55 50 50 50 50 51 51 51 50

40 % 30 27

7 7 7 7 10 5 5 4 4 4 5

h n ck ay n c S ill W e o ton lm ton o W le fley g no w rlo sh lk ni i ff nnock a ood Ibrox ead N el NE i u oust Nit use apel W Fa h p arkst G lmaco ugals H Mearns lemi h Pe Scotland Cl m o - B ; sw c Ki e ill ht ark Kessin ig P Car rkh Cast rum en - ne; D gavi Kn Easterho D d o n Drumcha rs Doonfoot; Allo Mil Bea - Keyst Broom; Ki e

Milngavi Postcode sector

Trends in smoking in pregnancy over an eight-year period (1994-96 to 2000-02) show a modest reduction in maternal smoking at a national level, but reductions of at least 10% in nine West of Scotland communities (Figure 8.11).

Figure 8.11

% Maternal smoking at booking (totalled over 3 years), 1994-96 vs 2000-02 selected West of Scotland communities Source: NHSHS Community Profiles (from ISD Scotland data) 50.0 47.1 47.2

45.0 42.1 1994 - 1996 2000-2002 39.5 40.0 38.4 36.9 33.2 35.0 32.2 30.9 29.8 30.0 28.9 28.5 27.1 27.4 25.4 24.9 25.0 23.2 19.5 % Smoking 20.0

15.0 11.0 10.0 8.7

5.0

0.0 Scotland Eastwood Eastern Bridgeton and Maryhill, Airdrie and Greater Inverclyde Lomond Cumbernauld Glasgow Dennistoun Woodside and Coatbridge Shawlands North Glasgow Community

At a sector level a number of areas have shown a large percentage drop over the period (Figure 8.12).

224 Figure 8.12

% Maternal smoking at booking (totalled over 3 years), 1994-96 vs 2000-02 10 postcode sectors showing greatest reductions, West of Scotland Source: NHSHS Community Profiles (from ISD Scotland data) 50.0 1994 - 1996 2000 - 2002 45.1 45.0

40.0 39.1

35.0 32.7 29.5 30.0 28.9 27.1 27.8

25.0 21.9 22.0 20.5

% Smoking 19.4 20.0 16.9 15.7 15.6 15.0 15.0 12.6 9.3 9.9 10.0 7.9 4.8 5.1 5.0 3.6

0.0 Scotland Carmunnock Clarkston Kilmacolm Howwood Ayr - Kilmarnock Irvine; Blackhill Chryston Southcraigs; Harbour & W Dreghorn Fenwick Town Centre Postcode sector

Trends from 1995-2004 show that the rate of smoking in pregnancy has reduced by nearly a quarter in Greater Glasgow to 25%, a figure that is only just above the Scottish average. Over this period there have been reductions in all deprivation quintiles (see Figure 8.13). However, despite these reductions, the ratio of the rate of smoking in pregnancy between most deprived and least deprived areas has remained unchanged: mothers in the most deprived quintile are four times as likely to smoke as in the most affluent quintile.

Figure 8.13

% Maternal smoking at booking by deprivation, 1995-2004* NHS Greater Glasgow Source: ISD Scotland

35 5 (most deprived)

30 4

% 25

3 20

15 2

10 1 (least deprived) 5

1995 2003 2004 * 2004 data are provisional

225 However, it should be noted that recent research suggests that at least part of the reduction in smoking in pregnancy may be an artefact of changes in recording4.

8.4 Low birthweight babies

Across Scotland, 5.8% of babies were of low birthweight (<2500g) in the period 2000-2002v. Across West of Scotland communities, the percentage of low birthweight babies ranged from 3.6% in Anniesland, Bearsden & Milngavie to 9.2% in Bridgeton & Dennistoun (Figure 8.14).

Figure 8.14

Low birthweight (<2500g) live births as a percentage of all singleton births, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data) 10 9.2 8.8

8.0 8 7.7 7.7 7.0 7.0 6.6 6.6 6.7 6.3 6.5 6.1 6.2 5.8 5.8 5.8 5.9 6 5.3 5.4 5.4 4.9 4.6 % 4.3 4.3 4 3.6 3.8

le e ld n e e re s n d e w w y w a id u ir i d le a lle avie ood d sh ilton shir sh g h a gow g w s na kelvi r r rclyde r is otland e r h w e omond lasgo V lasgo c d Kilbr e awlan v L Ayrshir W nistoun S Miln ly t Ham fre GlasgowG rn Glas n / East s mb n st Ay In th t e nG e n C u Strat uth Ay e a Motherwell Ruthe Coatbridge r s v r D e Ea R rSh o e e e d C t E te N s So s a g& h East W dL n & ar e e lasgow West En th n East to W Gr G dside & Ne /Be uslan Airdrie & Sout ya o d & b Sou le ebank & Drumchapelo n w is la W Bridg s Cam Pa Clyd ill/ ie h Renfre Ann Mary Community

At a sector level, in four areas there were no low birthweight babies born between 2000 and 2002 and in other areas the numbers involved were less than five babies. In the ten areas with the highest rates, the percentage of low birthweight babies ranged from 12-16% of all live births (Figure 8.15).

v Note the definition used for this measure excludes twins and babies that are stillborn.

226 Figure 8.15

Low birthweight (<2500g) live births as a percentage of all singleton births, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from ISD Scotland data)

18 16.2 16.5 16 14.4 13.8 13.9 14 12.7 12.9 13.0 12.0 12.3 12

10 % 8 5.8 6

2 0.0 0.0 0.0 0.0 <5 <5 <5 <5 <5 <5 0

. ck rn . s re s n ie ie rk nd lop ort ide ton n h z nE la n lp e c nW Pa o t no lbu u tepp ar lmo rbals to t o n S o dd Gova la e Ke D Mil Sourlie a lie g Sc mu ; Meigle.. Ba ge Rucha s r n; Springs Stew Cam Woodside rhouse W id u a rlie; rg Brid C i gto nce; Cowc Br e u a F Fa L rr deston; G Easte ; erceton; a ds; P n Skelmorlie To Tr la d

Glenside Woo

Circus;

Park Postcode sector

At a national level there has been little change in the rate of low birthweight babies born over the last 30 years. At a community level there have been varying trends across the West of Scotland in the last ten years (see Figure 8.16). While the percentage of low birthweight babies dropped in Clydesdale (by 23.1%) and Motherwell (by 11.7%), the percentage of low birthweight babies rose by 20% or more in Eastern Glasgow, Inverclyde, Wishaw, Bridgeton & Dennistoun and Lomond.

Figure 8.16

Low birthweight (<2500g) live births as a percentage of all singleton births, 1990/92 - 2000/02, selected West of Scotland communities Source: NHSHS Community Profiles (from ISD Scotland data)

10 9.2 9 1990-92 2000-02 8.0 8 7.0 7.1 6.7 7 6.6 6.5 6.6 6.2 6.1 5.8 5.9 6 5.5 5.6 5.7 4.9 5.0 5.0

% 5 4.6 4.3 4 3.8 3.6

0 Scotland Clydesdale Motherwell Cumbernauld Anniesland, Cambuslang Eastern Inverclyde Wishaw Bridgeton Lomond Bearsden and Glasgow and and Rutherglen Dennistoun Milngavie Community

227 More recent data for 2004 show that West Dunbartonshire had the highest rate of low birthweight babies among West of Scotland councils, while South Ayrshire had the lowest rate (Figure 8.17).

Figure 8.17

Low birthweight (<2500g) live births as a percentage of all singleton live births, 2004 West of Scotland council areas Source: ISD Scotland 9 8.2 8 7.8 7.3 7.1 7 6.1 6.0 6.0 6 5.8 5.3 5.4 5.0 5.1 5 % 4

ire re re re re ire re ow h tland sg rsh nshire co la o wshi yrshi S G Ay arkshi re Ayrshi A arkshire h art h n of b nf Inverclyde bartonshi ut rt La n ity h Lan Re East Renfrews So t Dun No rth C t o Sou s East N Ea West Du Council

In terms of deprivation, nationally, the percentage of low birthweight babies born in the 20% least affluent areas was consistently twice that in the 20% most affluent areas over the period 1991-93 to 2000-02. Data for Greater Glasgow have a similar ratio.

8.5 Infant death

Trends in infant deaths and comparisons of infant death rates across the West of Scotland have been included in previous chapters (Chapters 2 and 3 respectively). In this brief section a short commentary on the relationship between infant deaths and deprivation is provided.

Nationally, there was a reasonably consistent pattern in the relationship between infant deaths and deprivation from 1991-93 to 1999-01. The rate of infant deaths for female infants in the most deprived 20% of areas was one and a half times the rate in the least deprived 20%. The inequality ratio for male infants was more variable but generally greater, varying from 1.6 to 2.1.

228 8.6 Breastfeeding

The highest breastfeeding rates in the West of Scotland (2000-02) were in Anniesland, Bearsden & Milngavie (57% of babies being breast fed at 6-8 weeks) and in six Greater Glasgow communities the rates were above the Scottish average of 34% (Figure 8.18). The lowest breastfeeding rates within a community were for Airdrie & Coatbridge (18%).

Figure 8.18

% breastfeeding at 6-8 weeks, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data) 60 57

50 50 46 48

38 40 36 34 33 33 31 31 32 28 29 % 30 26 26 24 25 26 23 23 21 21 22 19 20 20 18

l n e d n s d d w w ire ire l ire ire n dge o lton ow yde h uld le h vie tland l a and bri erwell ishaw istoun sg rc rsh erg Valley rsh kelvi st E co t h lasgo ami la h h wl lnga a W G nn Ayrs Ay rn Lomon S Glasg H G nve t ut lydesda Eastwoo Mi Co Mot rumchape I h s C hAy Sha rn D De est ut Strat r n/ & & ort CumbernEa East KilbrideRenfrewso e ow We e & W N g & R S de & N k n at sg ri Easte o la rd et an re dsi g West G G Ai eban South & South East Glasgow oo d sley and Leve y Brid i w nd/Bearsde ill/W Cl ambuslPa re sla C nf e ie R Maryh Ann Community

At a postcode sector level large differences in breastfeeding rates become apparent (see Figure 8.19). Breastfeeding rates range from less than 10% in the ten lowest rate areas, eight out of ten of which are in Glasgow, to above 65% in the areas with the highest rates, nine out of ten of which are in Greater Glasgow.

Figure 8.19

% breastfeeding at 6-8 weeks, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from ISD Scotland data)

90 78 80 70 68 68 70 65 65 66 66 66 66

50 % 40 34

8 8 999 9 10 10 6 6 6

l N E e E k k y h l e n W c r c hi N olm inn lo ead khill in N nhill ad ton E ty l no Pa c d m h c a e n r e a ar ill ar pe apel W i m ar oo Scotland khe dg C h l m ; Dunlop B H Kelv i c alma usl Ki n Br Parti Par Br m g Stevenston D - Kil Easterhouse rumcha Dru Fer Lugto gavie - EasterhouseD en n dale; Kelvinsid dland; Dow d n n s Mil vi r Hy Kel Bea Postcode sector 229 More recent data based on children born in 2004 show breastfeeding rates measured against the national target of 50% of mothers breastfeeding at six weeks (Figure 8.20). While East Renfrewshire (47.6%) and East Dunbartonshire (44.9%) are close to the target, North Lanarkshire is furthest away with only 23.2% of mothers breastfeeding at 6-8 weeks.

Figure 8.20

Breastfeeding rates recorded at the 6-8 week review: children born in 2004p West of Scotland council areas Source: ISD Scotland

National Target (50% at 6 weeks) 47.6 50 44.9

40 34.1 34.9 32.5 29.6 30.3 30 27.2 27.2 25.1 23.2 Percentage 20

f o de ire re re ire ire y y h t shire shi wsh ,Ci on yrshi rt Ayrs A rew re h f ow ba Invercl nf ort East Ren nbartonsh N South Ayrshire u Glasg Dun st Re North Lanarkshire a est South Lanarkshire E W East D p Data for 2004 are provisional Council Area

There has been a gradual rise in breastfeeding rates both nationally and in Greater Glasgow (see Figure 8.21), where rates have caught up with the Scottish average.

Figure 8.21

Breastfeeding rates recorded at the 6-8 week review, 1998-2004 NHS Greater Glasgow Source: ISD Scotland

25 % babies breastfed at 6-8 weeks breastfed % babies

Greater Glasgow Scotland 15 1998 1999 2000 2001 2002 2003 2004

Note: 2004 figures are provisional

230 Deprivation has an important association with the levels of breastfeeding. In 2002 a national comparison showed that the percentage of mothers from the 20% most deprived areas not breastfeeding was 1.7 times higher than in the 20% most affluent areas.

8.7 Immunisation

In this section we report separately on patterns and trends in childhood immunisation (excluding MMR) and MMR immunisation.

Childhood immunisation (excluding MMR) Immunisation uptake for antigens other than MMRvi varied widely across West of Scotland communities in 2000-02 with the lowest uptake concentrated in Greater Glasgow (Figure 8.22). The lowest rates of uptake were in Greater Shawlands and Maryhill, Woodside & North Glasgow (both below 90%), while the highest uptake rates across the West of Scotland were in East Kilbride and Clydesdale.

Figure 8.22

Immunisation Uptake (excluding MMR) Rates at 24 Months, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data)

100 98.0 98.0 97.7 97.8 97.9 97.9 98 97.3 97.3 97.3 97.4 97.4 97.6 96.8 96.9 96.9 97.0 97.1 96.4 96.5 96.0 96.1 96

93.8 94 93.0 92.0

% 92 91.0 89.9 90 89.4

w w l w e y e d ll n n e d e ow pe ire a g uld ir o e e o ir ire n id a avie h id a h o w ilt h lyde h r t End sgo h g r s w rgl s c rs mo s a c is tb yr e w r o ilb esdale lasgow e lasg l lasgo W e e L K d Scotland G G G A Ham fr v Ay t ennistounW t t n G rum Miln East n In s s s r d Coa Strathkelvin Mother e Cly e e D East Ayrshn evern Valle Cumbern outh Ea gow a nd L North nd Ruth t R S thEa nd a d s n and D u th W East a en ga e Greater Shawlands Glas k d rie So an d d W Sou b ars n e e Air d Bridgeto ly d, B Paisley an wa C n e Cambuslan nfr sla e R nie An Maryhill, Woodside and North Community

At a postcode sector level (see Figure 8.23), there were uptake rates of below 70% in two areas, Cowlairs and Pollokshaws and nine out of the ten lowest uptake areas were in Glasgow. At the other end of the spectrum, six sectors had 100% uptake.

vi Diphtheria, Pertussis, Tetanus, Polio and Hib (abbreviation of Haemophilus influenzae type b).

231 Figure 8.23

Immunisation Uptake (excluding MMR) Rates at 24 Months, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from ISD Scotland data)

99.4 99.4 99.5 99.7 100 100 100 100 100 100 100 96.4 86.6 84.2 85.5 86.2 81.3 81.9 83.4 80 72.0 68.6 64.7

60 %

l s ls n x . h k e E a tre ad o un er ill. rt m c and aws n e r tra o d a san o id n l h rb e Ib s s to ygle tst en SE anark ng o sha r C or o l L e r e mn ing a Scot Cowlair Go y h u r lloks ; it ownh ;T ck Cen Sc c C o C T d; Royston N; Cad n; Foreh Ard Eagl Sp P a ie no o w ston d e e Dumb e e iggs Rutherg ;Au N d lma r le ra Garng o Gr T P pb Holmst eig M isho B rlie; lmo e Sk Postcode sector

At a national level, the level of immunisation uptake (excluding MMR) has stood above 96% for the last five years with only minor fluctuations over the period. The trends in immunisation levels for Diphtheria, Pertussis, Tetanus, Polio and Hib have been similarly relatively stable for Greater Glasgow over the same period. For the main primary immunisations with the exception of MMR, immunisation rates tend to be lower in the most deprived areas (Figure 8.24).

Figure 8.24

Primary Immunisation Uptake rates at 12 months by deprivation category for Glasgow NHS Board, as at November 2003 Source: ISD 102 Dip Tet Pert Pol Hib MenC

100

% 94

86 1234567 Deprivation (1 least deprived - 7 most deprived)

232 MMR immunisation MMR immunisation uptake rates at 24 months varied between 82.6% and 93.3% in 2000-02 across West of Scotland communities with the six communities with the lowest immunisation uptake all being in Glasgow (Figure 8.25).

Figure 8.25

MMR Immunisation Uptake Rates at 24 Months, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data) 96

94 93.3 92.1 91.4 91.4 91.6 92 90.9 91.2 91.2 91.3 90.4 90.4 90.5 90.0 89.8 90.1 90 88.8 88.8 88.9 88.2 88.5 88.6 87.6 88 85.9

% 86 84.8 83.9 84.2 84 82.6 82

l w d w e in e ld e n le d w nd un o o p lley v u ir a ire la o g En g el a h avie d h well t s t s rshire k shir s g s woo rs isha er la s lasgow la y lasgow h w rn yr milto t y co e nVa t e e A a s W Lomond S G G mcha r t Kilbride fr H lyde A oth hG W t t ru th A e s nG n mb Inverclyde Ea th M rt s s D r v Stra e u d Miln C u o ow o Ea R East n o g Ea d N t C a and DennistN s h d Le s S h We t an n Easter e en n nd la e and Coatbridgek d Greater ShawlandsG n y a W ea Sout Sou a le d ars geto id Airdri is n e s eb a a d w Brid P e d, B Cly fr n n la Cambuslang and Rutherglen e s ill, Wood R h nie y r An Ma Community

At a postcode sector level (Figure 8.26), the uptake rates in some areas drop below 80% and in two areas, the City Centre and Cowlairs, the rates were below 70% (although in the former the actual numbers of children living in this area in the period was very small).

Figure 8.26

MMR Immunisation Uptake Rates at 24 Months; 2000-2002; Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Health Profiles (from ISD Scotland data)

100 94.8 94.8 94.9 94.9 95.0 95.2 95.7 95.7 95.9 96.0 90.0

77.8 78.0 78.9 80 74.6 76.4 76.4 70.6 70.7 65.6 66.9

60 %

d e s k l s s tr ls il E n w h nN dE ill.. W e a rk S ck a h ill h nhead ti rdinny rton re h C ks lie Par Pa r he Stepp a Scotlan y Cowlairs Kelvin N g ergle rr Fo lls it llo n; Gorba us Tow Pa th Newmain mb ; Be C o rg nin u Kilma Ba u n Po R D to Fe Kin n - e Irvine; Dreghornlms radest d o T lly; Dally; Turnberry s H ear B Old Da Postcode sector

233 Recent national trends indicate that MMR immunisation uptake rates at 24 months (which dropped between 2000 and 2001 from 93.2% to 88.5% and dropped further to 86.8% in 2003) are starting to rise again – up to 88.3% in 2004. The same pattern is apparent in Greater Glasgow, which, while having a lower uptake rate than the national average, has shown an increase in the most recent year of published figures (87.1% uptake in 2004, a rise of 1.1% on the previous year). Lanarkshire, Ayrshire & Arran and Argyll & Clyde NHS Board areas all show similar increases in uptake in 2004.

There is no clear pattern of uptake of MMR by deprivation.

8.8 Associations between maternal and early years indicators and related socioeconomic factors

An analysis of the associations between a range of maternity/child related indicatorsvii from NHS Health Scotland’s Community Profiles produced some notable, if unsurprising, results. The following is a summary of the main results, which are based on a set of postcode sector level correlation analyses of the aforementioned indicators: x There is a strong correlation between the average age of first time mothers and breastfeeding rates at 6-8 weeks. As average maternal age increases the percentage of mothers’ breastfeeding increases. x There is a highly significant negative correlation between age of first time mothers and smoking during pregnancy: the lower the average age of a first time mother, the higher the probability of smoking during pregnancy. x Lone parent households are correlated with age of first time mothers: as the average age of a first time mother increases the percentage of lone parent households decreases. x There is a high correlation between teenage pregnancy rates and smoking during pregnancy: the higher the rate of teenage pregnancy, the higher the proportion of mothers smoking during pregnancy. x A positive correlation is shown between lone parent households and smoking during pregnancy: as the percentage of mothers smoking at hospital booking increases, so too does the percentage of lone parent households in that sector. x There is also a negative correlation between smoking during pregnancy and breastfeeding: the higher the breastfeeding rates, the lower the percentage of mothers who smoke during pregnancy.

vii Annual birth rate, average age of first time mothers, teenage pregnancy rate, low birthweight babies, smoking during pregnancy, breastfeeding, lone parent households and children in workless households.

234 x There is a strong positive correlation between teenage pregnancy rates and lone parent households. x There is, perhaps not surprisingly, an extremely high, significant positive correlation between lone parent households and children in workless households. Given this correlation, it is predictable that children in workless households display the same set of associations as lone parent households with other maternal and early years indicators. x For example, children in workless households (and lone parent households) display a strong negative correlation with breastfeeding rates. As the percentage of children in workless households increases, the percentage of mothers who are breastfeeding at 6-8 weeks decreases.

The analysis described was carried out for postcode sectors across Scotland, but there is no reason to believe that the associations described are not valid for the Glasgow area. The strong associations between lone parent households and children in workless households and maternity related indicators emphasise the importance of the interaction between social, cultural and economic factors and health behaviours.

235 Summary x Teenage pregnancies for 13-19 year olds have reduced nationally and, although the gap (compared to Scotland) has narrowed, Glasgow still has a higher than average teenage pregnancy rate. Much higher teenage pregnancies rates tend to occur in more deprived areas. x There is a gap of ten years in the age of first time mothers across West of Scotland communities. Trends indicate that proportionately more and more babies are being born to older mothers – in 2004 almost 50% of births were to mothers of 30 years of age or older. Conversely, however, there has been no reduction in the percentage of births to mothers under 20 years of age, which is 8% nationally, but varies widely across the West of Scotland. Deprivation and age of mother at first birth have a strong association, with a difference of approximately 12 years in the age for starting a family between the most and least deprived quintile. x Despite reductions nationally and across deprivation groups, rates of smoking in pregnancy remain polarised between very high rates in the more deprived parts of Glasgow and much lower rates in the more affluent areas. x Over a 30-year period there has been little change in the rate of low birthweight babies born nationally. Deprivation has a strong association with low birthweight, with the most deprived 20% of areas having double the low birthweight rate of the least deprived 20% of areas. x There are large variations in breastfeeding rates especially at a small area level, with the areas with the highest and the lowest levels breastfeeding both concentrated in Glasgow. There have been modest rises in breastfeeding over the last few years and the breastfeeding rate in Greater Glasgow is now at the level of the Scottish average. x The lowest uptake of primary immunisation tends to be concentrated in Glasgow, and lower uptake, with the exception of MMR, is associated with greater deprivation. With the exception of MMR, primary immunisation uptake has remained relatively stable for the last five years. The MMR uptake rate, which was affected by the controversy over the safety of this form of immunisation, dropped between 2000 and 2001, but has shown recent signs of recovery. x The strong associations between socio-economic factors (such as lone parent households and children in workless households) and maternity-related indicators emphasise the importance of the interaction between social, cultural and economic factors and health behaviours.

236 References

1 NHS Health Scotland. Community Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/communityprofiles

2 NHS Health Scotland. Constituency Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/constituencyprofiles

3 Scottish Executive. Inequalities in Health – Report of the Measuring Inequalities in Health Working Group. 2003 http://www.scotland.gov.uk/Publications/2004/03/19045/34233

4 Judge K, Bauld L. Health inequality targets in Scotland: Smoking during pregnancy (internal report). Glasgow: University of Glasgow, 2006

237

Chapter 9: Children and adolescents of Scotland between 1999 and 2003. 1999 of Scotland between kless households vary from 58% to 64%.” drugs. the decreasing, Although are opposite suggest is true trends smoking levels r st es of road traffices of road casualties among children fell significantly and the in Glasgow t ke There has been a marked increase in teenage alcohol There has been a marked 989/91 and 1999/2001.” 989/91 elated/attributable hospitalisations over a ten year period between between period a ten year elated/attributable hospitalisations over ising. he percentage of five year-olds without dental decay rose to 51% nation- he percentage year-olds without of five dental decay rose to 51% “In the for most which been published – 2003/04 recent year data have – t and to 42% in Greater Glasgow.” ally, “ r 1 “Just over one in twenty children are estimated twenty one in in Glasgow to be living “Just over with at least parent who has a substance one misuse problem.” “In the ten areas rates, with the the lowest percentage of children in workless households ranges from 2% to in the 4%, while ten areas with the highest the rates, percentages all of which of children are in Glasgow, in wo Summary It is estimated that than more there with living children 6,000 were in Glasgow a parent with a substance in 2003. problem misuse children 2,500 currently after are looked theIn Glasgow, by local authority – and thanmore are afterthat double councils. Rates of Scotland looked are all the by West r on a child of Scotland are children protection register. in theAlmost West 1,000 in households living were of Scotland children in the West than more 100,000 In 2001, in employment. neitherwhere was parent Significant drink and of Scotland smoke, proportions the across of adolescents West ta of alcohol. One fifth of pre-school children either are or obese. overweight throughout Greater The dental health children of However, improving. is slowly 40% and 70% of children between aged teeth.Glasgow decayed five have Ra We Guide to data presented in this chapter % of dependent children living in hous eholds where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 9: Children and adolescents

This chapter considers a number of indicators relevant to the health of children and adolescents in Glasgow and the West of Scotland. Some of the data presented in the previous chapter (Chapter 8: Pregnancy, childbirth and early years) is also clearly relevant to this topic (e.g. teenage pregnancies, teenage abortions).

The chapter is divided into two sections. First, we consider information relating to the circumstances in which children in Glasgow and the West of Scotland live and are brought up (their ‘social environment’: this includes children of substance misusers, children looked after by a local authority, child protection register data and children in workless households). Second, we examine a number of indicators which could be classified as ‘behavioural’ in nature. These include obesity, alcohol, smoking and drug-taking, and dental health. Clearly, however, this division is artificial, as many of these behavioural factors are obviously influenced by the environment in which children are raised and some will relate to the behavioural influences of the parents rather than the children. The distinction is employed merely to enable better structuring of the chapter.

9.1 Children’s social environment

Children affected by parental substance misuse The figures presented here are estimates derived by the University of Glasgow Centre for Drugs Misuse Research in a report commissioned by Glasgow City Council Addictions Team1. They are reproduced here with the kind permission of the Centre and the City Council. However, it should be emphasised that the figures are statistically modelled estimates derived from a number of different data sources. It is extremely difficult to gauge the accuracy of the findings and, as with any modelled estimates, the information should be interpreted with caution.i

The report by the Centre for Drugs Misuse Research calculated, for Glasgow in 2003, estimates of the total numbers and proportions of children with parents with ‘problem drug’ or ‘problem alcohol’ use, including estimates of children living with parents with substance misuse problems. A summary of the work shows that:

i Drugs misuse figures were calculated through combining data from a national drugs misuse prevalence report (published in 2005 and referenced within Chapter 7: Behaviour), and the Drug Outcomes Research in Scotland (DORIS) study (see www.gla.ac.uk/centres/drugmisuse/DORIS.html). The sample size for Glasgow in the latter study was only 240. Alcohol figures were derived from Glasgow City Council social enquiry reports and the same national drugs misuse report: the former allowed calculation of the ratio of problem drug users to problem alcohol users, which was then applied to the latter. Information on the numbers of children was again derived from the fairly small DORIS cohort. 241 x An estimated 9,940 children in Glasgow have a ‘problem alcohol use father’; 7,600 have a ‘problem drug use father’; 3,360 have a mother with drugs misuse problems; 3,640 have a mother with alcohol misuse problems. These categories, illustrated in Figure 9.1, are not mutually exclusive. However, the majority of children do not live with these parents.

Figure 9.1

Estimated numbers of children with problem drug and problem alcohol use mother or father, Glasgow City, 2003 Source: University of Glasgow Centre for Drugs Misuse Research

12000

9,937 10000

8000 7,602

6000 Number of children 4000 3,639 3,358

2000

0 problem drug user mother problem alcohol user mother problem drug user father problem alcohol user father

x The total, estimated, number of children living with a ‘problem drug use’ parent in Glasgow is almost 3,500 (3.1% of all children aged 0-15). The breakdown (shown as percentages of all children) by each council social work action team area is presented in Figure 9.2. The equivalent figures for children with a ‘problem alcohol use’ parent are shown in Figure 9.3. The total figure in this category is just under 3,800 (3.4% of children in Glasgow).

242 Figure 9.2

Children living with a 'problem drug use' parent Percentage of all children aged 0-15, Glasgow City, 2003 Source: University of Glasgow Centre for Drugs Misuse Research

Glasgow City: 3.1% 5.3 (3,492 children) 5

4 3.5 3.1 3.1 2.9 3 2.8 2.7 2.7 2.6 2.6 of all children (0-15)

% 2

0 Glasgow City South East North East West North West Greater Pollok North South South West East Glasgow City Council Social Work Area Action Team

Figure 9.3

Children living with a 'problem alcohol use parent' Percentage of all children aged 0-15, Glasgow City, 2003 Source: University of Glasgow Centre for Drugs Misuse Research

6 5.7

Glasgow City: 3.4% (3,781 children ) 5

4 3.8

3.4 3.4 3.1 3.0 2.9 2.9 3 2.8 2.8 of all children (0-15)

% 2

0 Glasgow City South East North East West North West Greater Pollok North South South West East Glasgow City Council Social Work Area Action Team

In all, more than 6,000 children in Glasgow are estimated to be living with at least one parent who has a substance misuse problem (Figure 9.4). This equates to just over one in twenty children in Glasgow (5.5%).

243 Figure 9.4

Estimated numbers of children living with a parent with substance misuse problem, Glasgow City, 2003 Source: University of Glasgow Centre for Drugs Misuse Research

7,000

6,142 6,000

5,000

4,000 3,781 3,492

3,000 Number of children

2,000

1,000

0 living with either parent who is a problem drug user living with either parent who is a problem alcohol living with either parent with a substance misuse user problem

These figures are considered further at the end of the chapter.

Looked after children In 2004, more than 11,500 children in Scotland were being looked after by a local authorityii. Just under half of these children were being looked after within a West of Scotland council area, with the figure for Glasgow at just under 2,500 (Figure 9.5).

ii Note that, as with the other indicators presented in this report, a full definition of looked after children is included in Appendix 1. 244 Figure 9.5

Numbers of looked after children, West of Scotland council areas 2004 Source: Care Scotland

3000

Scotland: 11,675 children West of Scotland: 5,590 children 2500 2,420

2000

1500

Number of children 1000

595 465 500 425 430 300 330 215 225 90 95 0

e e e y ir ire ir ir it h shire sh rshire rshire n w kshire ws rksh e ar e a fr Ay Ay n fr arto Inverclyde h artonsh st a an b ut b L Ren o Ea L Ren Glasgow C S North Ayrshire th th Dun st Dun u r st Ea st So No Ea We Council

Glasgow stands out as havingng the highest rates not only within the West of Scotland but across the whole country. The rate of 20.8 per 1,000 children is almost twice the national figure of 10.9 per 1,000 and is well in excess of the overall figure for the West of Scotland (12.3). The lowest and highest rates among the other West of Scotland councils in 2004 were 3.7 per 1,000 in East Dunbartonshire and 14.8 per 1,000 in West Dunbartonshire. This is illustrated in Figure 9.6.

Figure 9.6

Looked after children - rate per 1,000 0-17 year-olds, 2004 West of Scotland council areas Source: Care Scotland

25.0

20.8 20.0

14.8 15.0 14.0 12.7 12.3 12.0 12.5 10.9 10.0 10.0 8.1 6.5 4.5

Rate per 1,000 0-17 year-olds 5.0 3.7

0.0

d e e e e e e e e nd ir ir ire ire hir tla tlan shir shir sh sh sh o w City k ksh rclyd c o r yr wshir on Sco S rtonshir ews ar a Ayr ve A e Ayr t fr n fr ar of n an th In st n th b t lasg L u r G Re h Ea Re rt So No Dun Wes Dunba outh La st East S No st Ea We Council

245 Rates have increased slowly but consistently over the past few years. Across the whole country, rates rose from 9.5 in 1998 to 10.9 in 2004, and in Glasgow the rate increased from 18.2 to 20.0. This is an increase of about 14% which is similar to the national figure. These trends are illustrated in Figure 9.7 but note that these are expressed as three year rolling averages (so differ slightly from the annual data presented above).

Recording discrepancies make it difficult to obtain an accurate breakdown of the most common reasons for children being looked after. An analysis of Glasgow City Council Social Work Department’s ‘CareFirst’ system in April 2005 showed that of the 2,500 children in care, around 13% were recorded as being in care as a result of ‘child protection orders’. These may have been issued for a variety of different reasons. Despite this caveat, we can estimate that at least 30% of children are looked after because of lack of parental care/desertion/abandonment, and at least 20% as a result of drug and/or alcohol abuse by the carer. Other reasons are listed in Figure 9.8 but, once again, these figures should be interpreted, and reported, with caution.

Figure 9.7

Looked after children - rate per 1000, three year rolling average, 1998 - 2004 Glasgow and West of Scotland council areas Source: Care Scotland

25.0

20.0

15.0

10.0 Rate per 1000 children aged 0-17 5.0

0.0 1998 - 2000 1999 - 2001 2000 - 2002 2001 - 2003 2002 - 2004

Scotland West of Scotland Glasgow City

246 Figure 9.8

Looked after children, Glasgow City Council, April 2005: reason for being looked after Source: Glasgow City Council CareFirst

Lack of parental 31.4 care/desertion/abandonment

Drug/alcohol misuse by carer 20.8

Child Protection 12.8

School non-attendance/exclusion 8.4

Deteriorating relationship with carer/s 6.0

Outwith parental control 5.7

Other miscellaneous reasons 4.7

Mental health problems of carer/s 4.3

Domestic Violence 3.1

Offending behaviour 2.9

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 % of looked after children

Child protection register The total number of children placed on the child protection register in Scotland in 2004 was 2,440. Of these, 925 were resident in the West of Scotland, with 420 resident within Glasgow City Council boundaries. Figure 9.9 presents these numbers as a rate comparable across the different parts of the West of Scotland and, as can be seen, the figure for Glasgow (4.2 per 1,000 children aged 0-15) stands out as easily the highest. The equivalent figures across the other West of Scotland councils range from 0.5 (East Dunbartonshire) to 2.6 (Renfrewshire). The overall figure for all the West of Scotland council areas was 2.3 per 1,000.

247 Figure 9.9

Children placed on child protection register (rate per 1,000), 2004 Source: Care Scotland

4.5 4.2 4.0

3.5

3.0 2.6 2.6 2.5 2.3 2.4 2.1 2.0 1.7 1.7 1.5 1.6 1.5 1.0 Rate per 1,000 0-15 year-olds 1.0 0.8 0.5 0.5

0.0

d d e e e e e e e n ity r ir ir ire ir ire a yde l tlan C shir shi sh ksh rcl sh ksh cot co w n w r n r yr S rto re Ayrshir a ve Ayrshir A f S sgo arto frewsh a ba nf th an In b n l n e u L n ast e st o G u th u E R e D So r North D W st ast R No st a E e South Lana E W Council

As with looked after children,ildren, the trend is generally upward. In Glasgow, although there has been some fluctuation, the rate has increased from 2.7 in 1998 to 4.2 in 2004, with a particularly noticeable increase taking place in the last year of the analysis. The Scottish and West of Scotland figures have also increased. Trends for these three areas are illustrated in Figure 9.10 – note that these are presented as three year rolling averages and so the point prevalences differ slightly from above.

Figure 9.10

Children placed on child protection register Rate per 1000, three year rolling average, 1998 - 2004 Source: Care Scotland

3.5

3.0

2.5

2.0

1.5

1.0 Rate per 1000 children aged 0-15

0.5

0.0 1998 - 2000 1999 - 2001 2000 - 2002 2001 - 2003 2002 - 2004

Scotland West of Scotland Glasgow City

248 Children in workless households Although there are individual exceptions, the proportion of children in a population living in workless households can be used as a proxy for children living in poverty. Census data reveals that in 2001, almost one in five children (18%) in Scotland lived in households where neither parent was in employment. As shown in Figure 9.11, however, the pattern across West of Scotland ‘communities’iii, 2 illustrates striking differences. While in Eastwood and Anniesland, Bearsden & Milngavie only 6% and 7% of children, respectively, lived in workless households in 2001, the figure in Maryhill, Woodside & North Glasgow was 47%, and for Bridgeton & Dennistoun one in two children (50%) fell into this category. The polarity of life circumstances for children in Greater Glasgow is further emphasised by the fact that, comparing across the West of Scotland, Glasgow communities occupy the eight highest ranking positions, all of which had 25% or more of children living in workless households. In contrast, three Greater Glasgow communities had the lowest proportions of children living in such circumstances. Note that the overall figure for Glasgow (not shown in Figure 9.11) is 36%.

Figure 9.11

Dependent children living in households where no-one is in employment, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from 2001 Census data)

50 50 47

40 37 33 33 33 29 30 28 23 23 24 24 22 23 20 21 21 18 17 18 20 16 14 16 12 11 10 6 7 Percentage of all dependent children of Percentage

in de nd and ood ond ly haw hire gow gow gow toun shire rshire c s rs t E ilbride y las las lasgow as cotl ilngavie Lom er n Valley Wi es S astw ydesdale Hamilton oatbridge Gl E Inv er Motherwell W n G ennis Strathkelv enfrew Cl umbernauld C N D East K outh Ay orth A ter C East Ayrshire N S as & Drumchapel lasgow E ide & West R G Greater Shawlandsouth East G outh West G ey and Lev Airdrie & S S dgeton & & debank oods i sl mbuslang & Rutherglen land/Bearsden/M ai l/W Br P Ca Cly enfrew nnies R A Maryhil Community

At a postcode sector level (Figure 9.12) the differences become even starker. In the ten areas with the lowest rates, the percentage of children in workless households ranges from 2% to 4%, while in the ten areas with the highest rates, all of which are in Glasgow, the percentages of children in workless households vary from 58% to 64%.

Dependent children living in households where no-one is in employment, 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from 2001 Census data)

70 64 64 60 60 60 61 61 61 60 58 58

20 18

Percentage of all dependent children of Percentage 10 4 4 4 4 4 4 2 2 3 3 0

h k k E ll k and ton N noc Ibrox otl arloc lloway uchi nhead tonhill arkston ous ar sington R l head S Sc H Giffnoc dgeton E Cl ilmardinny ilm es ark ri ie - B K Tow almarnoc ; Auchinloch sterhouse W Hami P D B rumchapel e S oonfoot; A D Ea D Milngav Tradeston; Gorbals earsden - K Lenzi room; Kirkhill; Mearns earsden - K B B B Postcode sector

9.2 Behavioural factors

Pre-school overweight and obese children Measurements of height and weight taken during 2001 allow us to estimate the proportion of overweight and obese pre-school children in Scotlandiv.

Figure 9.13 shows that, nationally, in 2001, 21% of pre-school children born in 1998 were classified as overweight or obese. Across the West of Scotland communities, the figures varied from 16% in Anniesland, Bearsden & Milngavie to 25% in both Bridgeton & Dennistoun and in Cambuslang & Rutherglen. No information was available below community level.

iv Data collected by ISD Scotland’s Child Health Surveillance System at the 39-42 month review of children born in 1998. Covers ten out of the 15 Scottish NHS Boards. Proportion of overweight/obese children based on calculation, and ranking, of body mass index (BMI): overweight defined as children at or above the 85th centile; obese defined as at or above the 95th centile. 250 Figure 9.13

% of pre-school children born in 1998 classed as overweight or obese, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Health Profiles (from ISD Scotland data)

25 25 24 25 25 23 22 22 22 21 21 21 22 22 20 20 20 21 21 19 19 19 20 18 19 17 17 17 16

% 15

d d s e e e e y l e e ll n w n w ir w l w ld e and vie lvin o nd lton lle pe rid u w le l sgo sh sgo a b r rg ga a ke st E la ishaw mi asgo il e ln l stwoo th e w yr a la omond ch l he Scot G a a W Ayrshir rnVa G L m berna th t E ra W A H u lydesda st K u /Mi th Inverclydst C st G a m Mo R n St w N Glasg rSh u eve Dr e u o & Ea L ern E C e te So North Ayrshir st th East a d k & n & Dennistounng & arsde sid re n Ea n a e ou Glasg G a sl /B S od y a Airdrie & Coatbridge u d o eb South W n isle a /W a lyd Bridgeto sl P C Camb nie n Renfrew & West Renfrewshire A Maryhill Community

More recent data on children in Greater Glasgow born in 2001, and reviewed in 2004/05, show a similar picture, with an estimated 20% of children assessed as overweight or obese, including 8% who were classed as obese3.

Dental health of children At a national and NHS Board level the SHBDEPv, and latterly the NDIPvi, surveys have been used to monitor trends in the dental health of five year-olds since 1987/88. This is illustrated for Scotland and Greater Glasgow in Figure 9.14.

v Scottish Health Boards’ Dental Epidemiological Programme. vi National Dental Inspection Programme. 251 Figure 9.14

Percentage of 5 year-olds with no decayed/missing/filled teeth ('zero caries'), Scotland & Greater Glasgow 1987/99 - 2003/04 Source: NDIP; SHBDEP

with no dental caries 20 %

0 1987/88 1989/90 1991/92 1993/94 1995/96 1997/98 1999/00 2001/02 2002/03 2003/04

Scotland Greater Glasgow

The percentage of five year olds with no dental decay (‘zero caries’ experiencevii) fluctuated between 1987/88 and 2002/03 but showed little real change on a national basis. However, in the most recent year for which data have been published – 2003/04 – the percentage of five year olds without dental decay rose to 51% nationally, and to 42% in Greater Glasgow.

Although such an increase is obviously welcome, this still means that in Greater Glasgow almost six out of ten five year olds have experienced some level of dental decay. Figure 9.15 shows this figure broken down by LHCC areaviii within the city. As can be seen, the proportion of primary one school children with ‘obvious or advanced decay’ix varies from 38% in the more affluent Anniesland, Bearsden & Milngavie LHCC area, to 75% in the more deprived Drumchapel area.

vii Defined as no decayed, missing or filled teeth. viii Local Health Care Cooperative. LHCCs have now been replaced by the new Community Health Partnerships (CHPs) (Community Health and Care Partnerships (CHCPs) within Glasgow). ix As defined by NDIP risk levels 2 or 3: risk level 2 – “obvious evidence of decay experience and/or poor oral hygiene”; risk level 3 – “obvious advanced and/or widespread current decay”. 252 Figure 9.15

Dental decay: % of 5 year-old children with obvious/advanced decay (risk level 2-3) by LHCC area, Greater Glasgow, 2003-04 Source: NDIP

80 74 74 70 68 68 70 70 65 62 64 59 58 60 58 52 48 50 43 37

% 40

k n od in w ds w el ow len lv n an o p g a b tou sg m ke sgo e is dside stwo a la wl n o th a yd o mcha Ea C ra G Bridgeton Glasgow u t Sh Cl n Glasg st ter Gla S ast t r Den ill W e Dr E G ste yh W h a North Glasgow r Grea t E a ou Glasgow West End M outh S S

Anniesland/Bearsden/Milngavie LHCC area

It is known that the most common reason for admission to hospital among children is for dental problems4,5. Within Scotland, between 1999 and 2002, there were almost 51,500 acute hospital admissions for dental related problems among children aged 0- 15 years, almost 13,000 per year on average. Of that national four-year figure of 51,500, more than half of these dental admissionsissions (just over 27,000) took place within a West of Scotland community, including almost 11,000 within Greater Glasgow.

Figure 9.16 shows that proportionally (i.e. as a rate per 100 children) East Ayrshire and Maryhill, Woodside & North Glasgow recorded the highest rates among West of Scotland communities (around 10.5 per 100 children over the four-year period), with Eastwood and Anniesland, Bearsden & Milngavie having the lowest (2.1 and 3.0 respectively). Trends at a community level (for Greater Glasgow communities only) are shown between two points of time (1991-94 and 1999-2002) in Figure 9.17. Although, nationally, there has been a slight increase (from 4.7 to 5.2 per 100 over four years), no clear pattern in trends is evident across the communities.

253 Figure 9.16

Admissions to hospital among children for dental related conditions, four year total 1999-2002, expressed as crude rate per 100 children, West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from ISD Scotland data)

12.0 10.4 10.5 9.5 10.0 9.0 8.6 8.0 8.2 8.3 7.7 8.0

6.0 6.2 5.6 5.8 5.8 5.9 6.0 5.3 5.2 5.2 5.4 4.8 5.0 4.4 4.0 3.6 4.0 3.0 3.3 2.1 2.0 Crude rate per 100 0-15 year-olds 0.0

l d e s l n ld n e w n d w e o vi ide ire vin nd ow to ire o ir o a dale nd r l we idge au il apel ou gow w g la lb sh E r r sg n sgo sh st sh n i ishaw st r m ch as mon st l w W thke e the tb e a yr l o Scotland a K o Camgle a b H Ayrshir m Gla A L Glasg Ea /Mi Inverclyde M m u h n Clydes ast enfrew Stra w W Dr rn ut st G N ast Ayr e rSh E o e e t R East GlaCu North & ste E rsd at s sgo h S n & Denni a re e drie & Co ut nk Ea side & G W Gla ir o a Be A S od d/ idgeto South W o n deb r a y B /W sl Paisley and Levern Valley Cl ie nn Renfrew & A Maryhill Community

Figure 9.17

Admissions to hospital among children for dental related conditions, 4- year totals 1991-94 and 1999-2002, expressed as crude rate per 100 children, Greater Glasgow Communities Source: NHSHS Community Profiles (from ISD Scotland data)

12.0 Maryhill/Woodside & N Glasgow

South West Glasgow

10.0 Bridgeton & Dennistoun

Eastern Glasgow

8.0 Clydebank & Drumchapel

South East Glasgow

6.0 Camglen

Scotland

4.0 Glasgow West End

Crude rate per 100 0-15 year-olds Strathkelvin

2.0 Greater Shawlands

Anniesland/Bearsden/Milngavie

0.0 Eastwood 1991-1994 1999-2002

Adolescent smoking, drinking and drug-taking Analysis of the 2002 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) gives an indication as to the current levels of smoking, drinking and drug- taking among adolescents (defined as 13 and 15 year olds).

254 Smoking Nationally, 14% of 13 and 15 year olds were classed as being ‘regular smokers’ in the 2002 survey. At 9%, the proportion in Glasgow (both Greater Glasgow and Glasgow City) was lower than the national figure, while other areas in the West of Scotland had significantly higher rates e.g. 17% in North Ayrshirex (Figure 9.18).

Figure 9.18

Proportion of 13 and 15 year-olds classed as 'regular smokers', 2002 Greater Glasgow and West of Scotland council areas Source: SALSUS

18 17 16 16 14 14 14 14 13 13

12 11 10 10 99 9

8 of 13-15 year-olds

% 6

2 N/A 0

e e e e e nd ity ir ir ir ire r a ow tl C sh shire sh sh sg w n ksh n rclyd kshi o w yr r Sco re A arto na arto nve nar nf b a I a ter Gla ast L b L Glasg Re E h n Renfrewshire u th South Ayrshire North Ayrshire Dun ut D r Grea ast st o st E S e No Ea W Council

Generally, significantly higher rates of smoking were recorded among 13 and 15 year old girls than boys e.g. 11% of girls compared to 7% of boys in Greater Glasgow (Figure 9.19).

Local trends in smoking rates among 13 and 15 year olds are not available from SALSUS. However, national trends (which may also be reflected at a local level) show a decrease in smoking prevalence among 15 year olds since 1996: for boys the prevalence rate dropped from 30% to 15%, and for girls from 30% to 24% (however, the latter is not statistically significant). Rates for both sexes remained flat between 2000 and 2004.6

x For the three examples given (Glasgow City, Greater Glasgow and North Ayrshire), statistical significance levels (reported in the 2002 SALSUS local reports) were calculated separately for the two ages (13 and 15). Glasgow City and Greater Glasgow had significantly lower rates for pupils aged 15 (not 13), and similarly, North Ayrshire had significantly higher rates among pupils of that age only. 255 Figure 9.19

Proportion of 13 and 15 year-olds classed as 'regular smokers', by gender, 2002 Greater Glasgow and West of Scotland council areas Source: SALSUS

25 Boys Girls 21 20 19 18 17 16 16 16 15 15 12 12 11 11 11 11 11 11 11 10 10 10 9 8 of 13-15 year-olds 7 7

% 6 5

N/A 0

d e e e n ity ir ire ire ire ire a ow l sg sh shire a wC w n rksh cot l e a tonsh S fr Ayrshir n Ayrsh r Ayrsh sgo arto st th Inverclyd h ter G b r ut Gla Ren n o o Renfrewshire u Ea th La N st D u Dunba S Grea orth Lanarkshire Ea st So N Ea West Council

Drugs Nationally, 15% of 13 and 15 year olds reported having taken drugs in the month prior to the survey, ranging from 12% in Glasgow to 21% in North Ayrshire (Figure 9.20), figures which were, respectively, significantly lower and higher than the national estimatesxi. Within Glasgow, the rate was slightly higher among boys (Figure 9.21).

Figure 9.20

Proportion of 13 and 15 year-olds who had taken drugs in the last month, 2002 Greater Glasgow and West of Scotland council areas Source: SALSUS

21 20 17 17 17 17 16 15 15 14 13 13 12 12

10 of 13-15 year-olds %

N/A 0

e e e e e nd ity ir ir ir ir ire a ow C tl sg sh sh sh clyd w w yr yr r rksh kshire o e ar Sco r A A na n nf artonshire th Inve a a ter Gla ast b u Glasg Re L L Renfrewshire E th th North Ayrshire Dun So r u Grea ast E st No So Ea West Dunbartonsh Council

xi In this instance, significance levels relate to 15 year olds only. 256 Figure 9.21

Proportion of 13 and 15 year-olds who had taken drugs in the last month, by gender, 2002, Greater Glasgow and West of Scotland council areas Source: SALSUS

30 28 Boys Girls

19 19 20 18 18 17 16 16 16 15 15 15 15 15 14 14 14 15 13 12 12 12 12 10 10

of 13-15 year-olds 10 %

N/A 0

w e e e e nd o ir ire ire r ire la g yd t s rshire sh cl shi w City wshir nsh yr r ksh k e to ar Sco Ay r A ve n nar Ayrsh frewshire rGla st a h In a a h n te ut L L a Glasgo Ea nb o h nbartonshire ort Re re Du S ut Du N G o East Renfr ast North S E West Council

Data on drug use has only been collected in SALSUS since 1998 so, even at a national level, trends (which have been fairly flat) are limited.

Alcohol The majority of 13 and 15 year olds across Scotland (including Glasgow and the West of Scotland) have tried alcohol (Figure 9.22), and around one in three were reported in the survey as having drunk alcohol in the previous week (Scotland: 35%; Glasgow City and Greater Glasgow: 29% and 30% respectively (both significantly lower than the national figure) – Figure 9.23), with little difference evident between the sexes (Figure 9.24).

257 Figure 9.22

Proportion of 13 and 15 year-olds who have ever had an alcoholic drink, 2002 Greater Glasgow and West of Scotland council areas Source: SALSUS

100

90 78 78 80 80 80 76 76 76 77 77 73 74 70 70

40 of 13-15 year-olds

% 30

10 N/A 0

d y e e e e e n it ir ir ire ire ir ire a l sh nsh w rksh cot to e S r fr Ayrsh Ayrshir frewsh Inverclyd na n st a e Glasgow C Ren L Ea th North R st r South Ayrshire Greater Glasgow st Dunba a Ea No South Lanarkshire E West Dunbartonsh Council

Figure 9.23

Proportion of 13 and 15 year-olds who had drunk alcohol during the last week, 2002, Greater Glasgow and West of Scotland council areas Source: SALSUS

40 36 36 36 35 34 35 33 33 31 30 30 29 30 28

15 of 13-15 year-olds % 10

N/A 0

e e e e e nd ity ire r ir ir a ow tl C sh shire shi sh sg w n n rclyd ksh o w rkshir r yr Sco re ve A arto arto na na er Gla b b nf In a a t n e L L ast Glasg h E Renfrewshire u th North Ayrshire South Ayrshire D Dun ut r Grea st st ast R o e E S No W Ea Council

258 Figure 9.24

Proportion of 13 and 15 year-olds who had drunk alcohol during the last week, by gender, 2002, Greater Glasgow and West of Scotland council areas Source: SALSUS

45 Boys Girls 39 40 38 36 36 34 35 35 35 34 34 35 32 32 33 33 33 30 2929 29 3030 30 29 30 26 25

of 13-15 year-olds 15 % 10

5 N/A 0

e e e e e r ir ow City yd sg shire shire nshi nsh rkshir yr yr ow to to a Ayrshir Scotland sg r r frewshire frewshire er Gla a ba ba n Invercl st n t l n n G h Lan Ea outh A Re rt North A S st Re o Grea st Du st Du a e a E South LanarkshireN W E Council

Again, trends for local areas are not available. However, the national trend showed increasing levels of alcohol drinking among 13 and 15 year olds of both sexes between 1990 and 2004..

Summaries of the SALSUS figures on smoking, alcohol and drugs use for the Glasgow area are presented in Figures 9.25 and 9.26.

Figure 9.25

Smoking, alcohol and drug use among 13 and 15 year-olds, Scotland, Greater Glasgow & Glasgow City, 2002 Source: SALSUS

35 35

30 30 29

of 13-15 year-olds 14 15 13 % 12

10 9 9

0 Regular smoker drunk alcohol in past week taken drugs in past month

Scotland Greater Glasgow Glasgow City

259 Figure 9.26

Smoking, alcohol and drug use among 13 and 15 year-olds in Greater Glasgow, by gender, 2002 Source: SALSUS

35 boys girls 30 30 29

15 15

of 13-15 year-olds 12

% 11 10 7

0 Regular smoker drunk alcohol in past week taken drugs in past month

Teenage alcohol hospitalisation Rates of acute hospitalisation among teenagers (ages 13-19) for alcohol related and attributable causes (1999-2001) were included in the 2004 Constituency Health and Well-being Profiles. A summary chart for the West of Scotland parliamentary constituencies is shown in Figure 9.27. The graph shows a three-fold difference between the constituency with the lowest rates, Strathkelvin & Bearsden (0.4 hospital stays per 100 population), and the constituency with the highest, Glasgow Springburn (1.2 per 100). Note that these figures only include teenagers actually admitted to hospital, and do not reflect those attendances at Accident and Emergency which do not result in an inpatient admission.

260 Figure 9.27

Teenage alcohol related/attributable hospitalisations, 1999-2001 West of Scotland and Greater Glasgow constituencies Average annual crude rate per 100 pop aged 13-19, Source: NHSHS Constituency Profiles (from ISD Scotland data)

1.4 1.2 1.2 1.1 1.0 1.0 1.0 1.0 0.9 0.9 0.8 0.8 0.8 0.9 0.8 0.8 0.8 0.8 0.7 0.7 0.7 0.7 0.7 0.7 0.6 0.6 0.6 0.6 0.6 0.5 0.5 0.5 0.5 0.5 0.4 0.4 0.5 0.4

0.2 Crude rate per 100 pop aged 13-19 0.0

n d e w ill n n ill h n h y n r a nd o o rt o t yr r land sh a rt yh o llok A u shi ilsyth sh ll yst clyde r outh rglen o ou b ilbride w Southesdale e esl r r a North e N liest S arsde stwoo e n K i e y S ing Scot e a K r d d d Shotts Wi B ve mba th wP w Govan r B E st nf n d d nn In u wM m u Bail on Valleo d ilto Cly n D o a isle ame o sgow KelvinEa e a e an a d ow Cathcart aisley h la R am i ll an wA n Pa P lasgo g uld sg ingh in G H a G n Glasg vin an n ck a Glasg n sgow Sp l ank and Milngavie r Airdr erwe North lasgo o Gla unn u la West e h n n Glasgow b G tbridgee and Ch C Glasgow R C GlasgowG Shettleston thke m e a u Mot ilto r Clydeb C m Coa Gr Kilmarnock and Loudounumnock and D St a H C

Carrick, Parliamentary Constituency

In terms of actual numbers of admissions, the rate in Strathkelvin & Bearsden represents an average of 33 hospital stays per year, while there were an average of 71 in Glasgow Springburn.

There has been a marked increase in admissions over a ten-year period between 1989/91 and 1999/01. For all Scotland, admissions increased by around 22% over the period, with more notable rises evident in some areas of Glasgow and the West of Scotland e.g. Glasgow Rutherglen (60% increase), Carrick, Cumnock & Doon Valley (80% increase).

Road traffic casualties The final section in this chapter examines briefly road traffic casualties among children. Figure 9.28 shows child road accident casualties by local authority area for the time period 1999-2003. Note, however, that a number of caveats (explained in full in the appendices) around this data should be borne in mind, not least the fact that casualties have been assigned to a council area in which an accident occurred (although clearly not all casualties will have necessarily come from that area).

261 Figure 9.28

Child (under 16) casualties of road accidents per 10,000 population, 1999 vs 2003 West of Scotland council areas Source: Scottish Executive

50.0 47 43 45.0 1999 2003 40.0 37 36 37 35 35 34 35.0 33 33 32 32 31 30 31 29 29 28 30.0 27 27 25 24 25.0 22 21 20.0 18 15 15.0 Crude rate per 10,000 pop 10.0

5.0

0.0

d d y e e e e e n it ire ire ir ir a yde tl tlan cl sh shire wC r rshire ksh w n co o rkshir r e Sco S ve Ay na frewsh na Ayrshir fr th Ayrshir In st a artonsh n a arto of u b e b Glasg L R L st Ea h th North Ren e So ut Dun r Dun W o ast S st No E st We Ea Council

This Figure shows that over the period there was a reduction in the rate of child road accident casualties in the majority of the West of Scotland council areas with the exception of South Ayrshire where the rate rose slightly. The rate of child road accident casualties in the West of Scotland as a whole (29 per 10,000 in 2003, representing a total of 1,194 casualties) is slightly higher than the Scottish average (25.5 per 10,000). However, great variations in rates are evident across the different council areas. Glasgow had the highest rate of child casualties in both 1999 and 2003, although the rate decreased by 25% over this period to 35.3 per 10,000 (representing 376 casualties). Despite this drop, the rate of child casualties in Glasgow was still double that in East Renfrewshire and East Dunbartonshire.

262 Summary x We know that the circumstances in which children are raised can have a major bearing on their future health and well-being. Recent studies have shown, for example, that children in care are more likely to go on to experience considerable problems and challenges in later life7. Given that, this chapter highlights areas of considerable concern, such as:

o The estimated 6,000+ children in Glasgow living with a parent with a substance misuse problem.

o In Glasgow, 2,500 children are looked after by the local authority – and twice that number are looked after across all the West of Scotland council areas.

o Almost 1,000 children in the West of Scotland are on a child protection register.

o There is a significant number of children living in households where neither parent is in employment: in 2001, well over 100,000 West of Scotland children fell into this category. x These are big numbers for only one part of a small country. Furthermore, the proportions of children who are looked after and who are on child protection registers are increasing, and while we have no trend data on the estimated numbers affected by parental substance problems, the fact that levels of drug and (especially) alcohol related harm are rising, means that it is unlikely that the proportion of children affected by these problems will diminish in the near future. x Further bad news in terms of children’s health is provided by the trend in teenage alcohol related hospitalisation, and in the levels of alcohol consumption, and drug- taking, by adolescents. x The rising level of adult obesity was highlighted as a major concern in Chapter 7: Behaviour. To add to this, the fact that an estimated one fifth of pre-school children (i.e. three to four year olds) are either overweight or obese should clearly have important policy implications. Indeed, although no Glasgow/West of Scotland specific data are available, recently released, national figures estimate that over one third of primary seven pupils are overweight, one in five are obese and more than one in ten are classed as ‘severely obese’. x However, some more positive evidence around the health of children can be glimpsed in the national decrease in rates of smoking among adolescents (especially among boys), as it is likely that this decline is also true of the West of Scotland. x Better news is also provided by evidence that the dental health of children is slowly improving – although the fact that even in the more affluent parts of Greater Glasgow almost four out of ten children have ‘obvious or advanced decay’ suggests there is no room for complacency.

263 x The decrease in road traffic casualties among children is also welcome. Although casualty rates in Glasgow remain the highest in the West of Scotland, the 33% decrease in the five-year period between 1999 and 2003 can be seen as a success story.

264 References

2 NHS Health Scotland. Community Health and Well-being Profiles. 2004 http://www.scotpho.org.uk/communityprofiles

3 ISD Scotland. Obesity statistics – children. http://www.isdscotland.org/isd/info3.jsp?pContentID=3640&p_applic=CCC&p_servi ce=Content.show& www.isdscotland.org/isd/files/childhood_obesity.xls

4 Scottish Executive. Towards Better Oral Health in Children. 2002 http://www.scotland.gov.uk/consultations/health/ccoh-00.asp

5 ISD Scotland. Morbidity statistics – children. http://www.isdscotland.org/isd/info3.jsp?pContentID=1781&p_applic=CCC&p_servi ce=Content.show& http://www.isdscotland.org/isd/info3.jsp?pContentID=2044&p_applic=CCC&p_servi ce=Content.show&

6 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) National Report. 2004 http://www.drugmisuse.isdscotland.org/publications/abstracts/salsus.htm

7 Scottish Executive. The Report from the Working Group on the Throughcare and Aftercare of Looked After Children in Scotland. Edinburgh: The Stationery Office, 2002

265

Chapter 10: Health and function king age population.” r the 2001 census, almost census, reported four one in of Greater Glasgow residents that the they 2001 hese benefits in 2000, while in the highest rate – areas – all in Glasgow to 49% of thehe rates of adults claiming these benefitsranged from 31% he high numbers of people not in thehe high numbers of people not in market due to employment disability could be one “Glasgow communities appear to be at either“Glasgow end of the of spectrum of limiting long-term illness.” prevalence “In the ten areas rate with the of adults claiming Incapacity Benefit lowest only 2% to claiming 4% of adults were Allowance Disability or Severe t t wo “Some of the are the communities in and around Glasgow ‘healthiest’ in Scotland.” Summary At of suffered About 15% a limiting long-term from illness, healthdisability. or problem statedGlaswegians that theirhealth good”. “not was Scotland, huge of the in variation rates of suchthe and recorded Glasgow West Across true can be seen. The same is also self assessed measures of a number of different indicators of health, benefits which function and disability government from derived are systems. incorporateThe boundaries both of Greater Glasgow the ‘unhealthiest’, and ‘healthiest’, such within areas by Scotland, as measured indicators. In the almost 2000, one fifth year the of age working of Greater population Glasgow classified than(more as being unable to 85,000 adults) were due to work illness or then Since Effective therate has fallen, solutions to reduce but onlydisability. slightly. t in Glasgow. for drivers healthof the improvement key Guide to data presented in this chapter % of dependent children living in households where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 10: Health and function

This chapter examines a selection of indicators grouped under the broad heading of ‘health and function’. This concept is included in many current models of health and is defined in terms of issues such as disability, the need for care/support, and the ability to carry out activities of daily living.

Two sets of indicators are presented in an attempt to describe the varying patterns of health and function across Glasgow and the West of Scotland. These are: self-assessed measures from the Census, and data derived from government benefits systems. The latter are slightly problematic because of changes in eligibility criteria over time. However, although individual indicators may suffer from specific weaknesses and caveats, the presentation of all these data together provides a reasonable insight into the overall patterns of health and function across the West of Scotland.

10.1 Self assessed measures

Limiting long-term illness According to the 2001 Census, 20% of the population in Scotland stated that they suffered from a ‘limiting long-term illness, health problem or disability which limits their daily activities or the work they can do’i. This represented a considerable rise from the figure of 15% reported in the 1991 Census. Whether there has been a real change in the number of people suffering such problems, or whether the rise is in part because the public is more willing to ‘admit’ to such problems, has been subject to debate. Nevertheless, this is an important indicator of overall and relative health status.

At 24%, the 2001 figure for the Greater Glasgow area was higher than that of Scotland as a whole. Figure 10.1 shows the variation in levels of limiting long-term illness (LLI) across the West of Scotland ‘communities’ii. This shows that Greater Glasgow communities appear at either end of the spectrum of prevalence: the lowest rates occur in Anniesland, Bearsden & Milngavie (15%), Eastwood (15%) and Strathkelvin (18%), while the highest rates occur in South West Glasgow (28%), Eastern Glasgow (28%), Maryhill, Woodside & North Glasgow (30%) and Bridgeton & Dennistoun (30%).

i This definition includes problems due to old age. Full definition of this, and other indictors presented in this chapter, are included in Appendix 1. ii These are primary care-based localities (mainly the old Local Healthcare Cooperative (LHCC) areas or, in some cases, the new Community Health (Care) Partnerships (CH(C)Ps)) with populations ranging from 20,000-140,000 people. For further details see ‘Preface to Chapters 2-12’.

269 Figure 10.1

% of population with a limiting long-term illness, health problem or disability, 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from 2001 Census data)

30 30 30 28 28 25 26 24 25 23 23 24 24 22 22 22 21 21 22 22 22 20 20 19 20 20 18 18

15 15 15 % of population 10

ld e e e ll e n w vin ide r ire nd r e on g pel o un l E nds w ilt g o br shi sh shire la shaw s l nau r er asgow i asgow asgow ist hke Ki er ew est am l hergle cha l l la n Scotland astwood at Lomond ydesdal n Valley aw Ayrshi verclyde H atbrid t W E tr h Ayr l In o S ast C rth Ay Sh Moth st G Ru st G rn G NG E out ever ow W e e Cumb No er East Ea & & Drum st Renfr S d L W e asg eat rie & C ng k th East ide & an l r rd s G G i ou d geton & Den ey South A S d sl oo ri ydeban /W B Pai Cl l nfrew & W Cambusla e nniesland/Bearsden/Milngavie R A Maryhil Community

At a postcode sector level, differences in LLI between areas are more marked.arked. In the ten areas with the lowest levels, the rates range from 10% to 13% of the population, while in the ten highest rate areas the figures range from 36% to 41%. As can be seen in Figure 10.2, the latter are all areas of known deprivation and multiple social and health problems.

Figure 10.2

% of population with a limiting long-term illness, health problem or disability 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from 2001 Census data)

45 41 41 41 41 39 40 38 38 36 37 37 35

25 20 20

% of population 15 13 11 12 12 12 12 12 10 11 11 10

n d n . ill e tur on ns S ds i on E ral and a r ui Est t yne t l ll hor nhill hea ad an ddr nock al on u a l kst s Bay ea uch l i rnt en cot il ar M ins R at R ar C S ll; T H Houston l ys ; len Fr a m get C ll rkhe O l id Ca ck C ehi ; Dow G M a s; r Parkhouse l d khi ; P l Da B llage; D Wem r i ast Ki ber rba eeno C ; o o r - ndlan Cl G Hy - n; G room e rsden B ow bernauld V ea m B ilngavi sont Cu M che ut H Postcode sector

270 Self-assessed health Self-assessed health – also collected in the 2001 Census – is a similar indicator of general health status. The pattern of people stating that their health was ‘not good’ across the West of Scotland communities is comparable to that just shown for limiting long-term illness. The lowest rates of people describing their health as poor were in Anniesland, Bearsden & Milngavie (7%), Eastwood (7%), and Strathkelvin (9%), while the highest rates occurred in South West Glasgow (16%), Eastern Glasgow (17%), Maryhill, Woodside & North Glasgow (19%) and Bridgeton & Dennistoun (20%). The figure for all Scotland was 10%. These are shown in Figure 10.3.

Figure 10.3

% of population who rated their health 'not good', 2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from 2001 Census data)

22 19 20 19 18 16 17 16 14 14 14 14 14 13 12 13 13 13 11 12 12 11 11 10 11 10 10 10 10 10 9 9

8 % of population 7 7 6

l e ld y d e w w ide ire e el ton len land ood w il g oun w lbr sh nau all lands shaw sgo st ngavie i V i bridg asgow asgo il er am her W l la l ni Scot athkelvin Ayr Lomond ydesdal b other H at G /M East r l Inverclyde ut en St C um M Shaw R NG D en East K outh orth Ayrshire r & &Co ern & East AyrshireC N Levern East GlasgowWest G & S d ie ast e asgow West En eate r th h id on an r ang u E s Gl G usl Aird So out d/Bearsd ey b S ood idget n sl r am /W B Pai C Clydebank & Drumchapel ll iesla Renfrew & West Renfrewshire aryhi Ann M Community

Note that no comparable question was asked in the 1991 census.

At a postcode sector level (Figure 10.4), the contrast between areas is more pronounced. In the ten areas in which the population assessed its health most positively in 2001, only 5% to 6% of people claimed that their health was ‘not good’. In the areas with poorest self-assessed health, the rates of poor self-assessed health ranged from 20% to 28% of the population; in other words between one in five people to one in four people in these populations stated their health was ‘not good’. These ten areas are all in Glasgow and in areas of relative deprivation.

271 Figure 10.4

% of population who rated their health 'not good', 2001 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from 2001 Census data)

30 28 26 26 25 24 24 25 25 23 23 22

% of population 10

5 6 666 5 5 5 5 5 5

d n n n S s ll ns on tur d an nhill ui Bay a chi l ksto hor a ar Fr ll nock ad onhill nock ust u ington lt r Calton ntyne eton E l;T yss ar Ru ar g Scot l len Ho m ss khe mi C Clar ill; Me l e ar ehi ; Dow h G Ki Parkhouse l k Parkhead N P Ha Dalma Brid nd Wem llage; D ast i rbals; Oatlan ;Kir den - K -C ndla m rs Hy en roo ea sd B B bernauld V ear ntown; Go B m so Cu

Hutche Postcode sector

Note that the overall figure for Greater Glasgow in 2001 was 14% of the total population. At a council level the figure for Glasgow City was 15.6%, almost double the figures for Edinburgh (8.1%) and Aberdeen (8.5%).

10.2 Benefits data

Adults unable to work due to illness/disability This indicator, based on claimants of Incapacity Benefit or Severe Disability Allowanceiii, is important for several reasons. It can be tracked on an annual basis and identifies working age adults who are unable to work for health reasons. In Scotland in 2000, over 320,000 adults (10.6% of the working age population) were claiming Incapacity Benefit or Severe Disability Allowance. This figure was three times that of those claiming unemployment benefit. In Glasgow during the year 2000, almost one in five of the working age population was categorised as unable to work for this reason. This indicator is also important as it shows a strong correlation with other health measures such as life expectancy and mortality.

Across the West of Scotland communities, the pattern in the rates of adults unable to work due to illness or disability in 2000 was very similar to those seen for LLI and poor self assessed health. The lowest rates were observed in Anniesland, Bearsden & Milngavie and Eastwood (both 5%), with the highest rates in South West Glasgow (20%), Eastern Glasgow (21%), Maryhill, Woodside & North Glasgow (24%) and Bridgeton & Dennistoun (25%). These data are shown in Figure 10.5 below.

iii See definition in Appendix 1.

272 Figure 10.5

% of adults of working age unable to work due to illness/disability, 2000 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from DWP data)

25 25 24

20 21 20 17 17 17 16 15 15 15 15 15 13 13 12 12 11 11 11 12 11 10 9 9 10 8

% of working age population 5 5 5

e e n re d re re ld n n w od vi ds to e a o yde gl apel idge oun lbrid shi nau rshire an cl erwell r st ngavi i hkel omon yr wl ch lasgow tb lasgow lasgow il t L er amil h ther Wish Scotland a Ayrshi ydesdale rewshi b ha H G oa G nni M Eastw tr h nf Inver n e n/ S ast A Cl um S vern Valley Mot C r D East K out e ast & e E C North Ay ter & Drum E & sde S and Ru ie West G n lasgow Westea End nk h East o ear r ng rdr B G G a i out ey and L South A S dget l ri nd/ ydeba ew & West Re busl B r Pais Cl iesla am hill/Woodside & N Glasgow enf C R ry Ann Ma Community

At a small area level (Figure 10.6), the contrast between areas with lowest and highest rates of adults on these benefits is striking. In the ten lowest rate areas, only 2% to 4% of adults were claiming these benefits in 2000, while in the highest rate areas – all in Glasgow – the rates of adults claimingng these benefits ranged from 31% to 49% of the working age population.

Figure 10.6

% of adults of working age unable to work due to illness/disability, 2000 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from DWP data)

49 50 44 42 40 37 35 32 32 33 31 32 30

% of working age population 11 10 4 4 3 3 3 3 4 4 4 4

ll n n n ur S n ck nd ui or hu nny o nds d to r arns loch i nock lk W yne nhi F Th d kst ff Ibrox tla i nt rno ; ullat m Cal a en ll ar lar Gi D a e khea Scotla l - Bar lm C ; O Car idgeton E m G ill; Me e stl ar al d; Dowanhill h lehi Ki s; Parkhead N a P Hamilto Br D n k - C ast illage bal ngavi V ; Kir -C il d yndla m M Helensburgh; R l H n earsden nau wn; Gor Broo sde B er o ear B Cumb

Hutchesont Postcode sector

273 Figure 10.7 shows that since 2000, there has been no change in the national proportion of working age adults unable to work for this reason, while the figure for Glasgow has decreased, but only slightly: from 19% in 2000 to 17% in 2004.

Figure 10.7

Adults unable to work due to illness/disability Incapacity benefit/severe disability allowance claimants, 2000-2004 Source: DWP

40.0

Glasgow City 35.0 Scotland

30.0

25.0

20.0

15.0 of working age population

% 10.0

5.0

0.0 2000 2001 2002 2003 2004

These figures are considered further at the end of the chapter.

Disability Living Allowance – mobility component Disability Living Allowance is payable to people who are disabled and who have personal care needs, mobility needs, or both. The pattern in the rates of adults claiming the mobility component of this benefit is similar to the patterns seen for Incapacity Benefit / Severe Disability Allowance, limiting long-term illness and self- assessed health. The lowest rates are observed in Anniesland, Bearsden & Milngavie and Eastwood (both around 2%), while the highest rates are in Bridgeton & Dennistoun, South West Glasgow (both 8%), Eastern Glasgow and Maryhill, Woodside & North Glasgow (all above 8%) (Figure 10.8).

274 Figure 10.8

% of adults claiming Disability Living Allowance - Mobility Component (18-64 years), 1999 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from DWP data)

10 9.2 9 8.6 8.3 8.3 8 7.1 6.7 7 6.3 6.4 6.5 5.9 6 5.3 5.4 5.5 5.5 5.1 5.2 5.2 4.8

% 5 4.5 4.5 4.3 4.5 4.1 4.2 4 3.4

3 2.0 2.2 2

l d e e le ld re e e nd ley ire ow el ton aw ood ond h w idg apel w lbrid shire lands nau shi s er r sgow ngavi i om yr yr yrshir lasg erglen ch lasgow a il L er n Val A A h h atb amil Wish Scotlan ast athkelvin ydesda b rew ot ut o H nnistoun G M E tr West E haw Inverclyde e n S Cl um ver enf rth M R C D en/ East K rS R o ast G & d te C East N E & Drum South A d Le h n & asgow ea rie o Easter ears l r an rd nk uth West Glasgow B G G West out i o S A dget S odside & N Gl sley i o and/ buslang and ydeba Br Pai rew & m Cl l/W esl ni enf Ca R aryhil An M Community

At a small area level (Figure 10.9) there is a ten-fold difference in rates between the ten areas with lowest claimant rates (1% to 2% of adults claiming this benefit) and the ten areas with highest claimant rates (12% to 19%). The latter are all areas of known deprivation and multiple social and healthealth problems.

Figure 10.9

% of adults claiming Disability Living Allowance - Mobility Component, 1999 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from DWP data)

20 18.6 18 17.3

16 15.0 15.0 13.7 13.8 13.9 14 12.3 12.6 12.7 12

% 10

6 4.5 4 1.5 1.6 2 1.1 1.2 1.3 1.3 1.3 1.3 1.3 1.5

s e orn E kston nock alton Nitshill iltonhill C arnock Scotland len Fruin Giff gh Possil Carntyne G lmardinny Clar myss Bay Parkhead N Hi Parkhead S Ham Parkhous Bridgeton Ki vie - Barloch We Dalm astlehill; Th ndland; Dowanhill rsden - Kessington Milnga Hy room; Kirkhill; Mearn Bearsden - B Bea

Bearsden - C Postcode sector

275 Blue badge holders Blue badge parking permits are issued to recipients of some disability related benefits, and to other ‘permanently and substantially disabled’ individualsiv. It is thus a useful (if, obviously, not comprehensive) proxy for levels of some forms of disability in the population.

Over 220,000 blue badge parking permits were on issue as at March 2004, of which almost 100,000 had been issued to individuals resident in the West of Scotland, and more than 23,000 to Glasgow inhabitants. The full breakdown for each West of Scotland local authority area is shown in Figure 10.10. Note, however, that it is unclear to what extent the variation in rates across the country is attributable to need, greater uptake, different council practices or just to differences in age structure.

Figure 10.10

Blue badges - total number on issue at March 2004, West of Scotland council areas Source: Scottish Executive - Scottish Transport Statistics 2004

25000 23,243 Scotland: 223,995 West of Scotland: 93,970

20000

15,524 15000 13,694

10,602 10000 Total number

6,420 6,892 5,217 4,330 5000 3,817 2,974 1,257

e e e e e r ir re i yde i ir sh cl rshire n r nsh kshire rksh to ar rto ve r frewsh Ay Ayrshir n na In th Ayrshir n st a a ba u e n R L L u Ea North th th Glasgow City D So u r st st Dunba East Renfrewshire e a So No W E Council

Figure 10.11 shows the total number of blue badges on issue in 2004 expressed as a crude rate per 100 population aged 17 and above. Proportionally, North Ayrshire has the highest figures, with a rate of almost 10 per 100 population, while the area with the lowest rate is East Renfrewshire (1.8 per 100 population). The rate for Glasgow is 4.9 per 100 population.

iv Badges are issued automatically to recipients of mobility (and other) allowances and issued on discretionary basis to people with a permanent and substantial disability who are unable or nearly unable to walk. Full definitions are listed in Appendix 1.

276 Figure 10.11

Blue badges on issue at March 2004 - crude rate per 100 population aged 17+, West of Scotland council areas Source: Scottish Executive - Scottish Transport Statistics 2004

12.0

9.8 10.0

8.0 7.2

6.1 5.7 5.8 6.0 5.5 5.6 5.6 4.9 5.1

Council 4.7 4.1 4.0

1.8 2.0

0.0

e e e e e e nd ir ire ir r and l tla sh sh w w kshire rkshi e e ar Scot r fr n na sgow City nf a Inverclyd a of Sco la G Re Ren L L st th th East Ayrshir North Ayrshir e u South Ayrshire r W ast E So No West Dunbartonsh East Dunbartonshire Crude rate per 100 pop aged 17+

A clear upward trend for badge issues can be seen between 1998 and 2004 (Figure 10.12), with, for example, the rate for the West of Scotland having increased by approximately 30% over that period.

Figure 10.12

Issues of Orange/Blue Badges, 1998-2004 Crude rates per 100 population aged 17+ Source: Scottish Executive Transport Division

6.0

5.0

4.0

3.0

2.0 Crude rate per 100 population aged 17+ 1.0

0.0 1998 1999 2000 2001 2002 2003 2004

Scotland West of Scotland Glasgow City

277 Attendance Allowance The last indicator considered in this section is Attendance Allowance. This is a benefit for people over the age of 65 who have physical or mental health needs of sufficient severity that they require a great deal of help with personal care or supervision.

The pattern of rates of claimants of Attendance Allowance across West of Scotland communities is again similar to the patterns seen for other disability related indicators presented in this chapter. Figure 10.13 shows that the lowest rates are observed in Anniesland, Bearsden & Milngavie (12%) and Eastwood (13%), while the highest rates are in Maryhill, Woodside & North Glasgow (23%), Eastern Glasgow (24%) and Bridgeton & Dennistoun (25%).

Figure 10.13

% of elderly population (65 + years) claiming Attendance Allowance, 1999 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from DWP data)

25 25 23 24 21 21 20 21 21 21 19 19 19 20 20 19 19 17 17 16 16 17 15 14 15 15 15 14 13 12

10 % of population aged 65+

in el ide ire ire ds ood well glen gow gavie rshire clyde alley cotland iln her S Kilbr Lomond ver rewshire Wishaw Hamilton Eastw In mbernauld rumchap Strathkelv Clydesdale Mot N Glas East East AyrshCu North Ayrsh South Ay West Glasgow gow West End and Levern V Eastern Glasgow outh East Glasgow Greater Shawlan Glas S South Airdrie & Coatbridge buslang and Ruther Bridgeton & Dennistoun Paisley Clydebank & D Cam Renfrew & West Renf aryhill/Woodside & Anniesland/Bearsden/M M Community

In the ten areas with lowest claimant rates at a postcode sector level, 7-11% of the elderly population were claimants, while in the ten areas with the highest claimant rates, 28-34% of the elderly were claiming Attendance Allowance (Figure 10.14).

278 Figure 10.14

% of elderly population (65 + years) claiming Attendance Allowance, 1999 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from DWP data)

35 34 32 33 31 31 29 29 29 30 28 29

20 15 15 11 11 9 9 9 10 10 10 8 8 9 % of population aged 65+ 7

h ll e n on on ns on m N o S E and rt r ut sW lock yr n rk N rk S lt d N l e col onhi ad N a kst ea So gg lt ant e a cot M am i l elvi P Ca S ; ie ilma chinloch h B K khea apel Clar n u t am ng Eaglesham r K ar gh ar ch - West lbi H i Parkh P rkhill shopbri G inni um en Ki ;H Kinning P K r Bi S D sd sden - Kessingt e r enzie S; A ear oom; Ki L yr B r Bea nt Bishopbriggs N; Cadder B la B

Troon-Muirhead; Loans; Barassie Postcode sector

279 Summary x In one sense these indicators merely reinforce what we already know: that the poorer parts of Glasgow have poorer health and higher levels of disability. However, what it again highlights is the fact that Glasgow is not one homogenous population. Just as there are many areas of poor health, there are other areas that are much healthier than the Scottish average and, indeed, some of the communities in and around Glasgow are the ‘healthiest’ in Scotland. x It is also clear that differences in health between these areas are to a large extent mirrored by differences in health behaviour, educational attainment, employment, income and overall deprivation. x The extent to which areas have changed over time in terms of their absolute and relative levels of health and disability is difficult to determine from these data but would be worthy of further study. We can be reasonably sure, however, that at least over the last ten to fifteen years many of these areas will have remained in the same relative positions. x The proportion of the working age population unable to work due to illness and disability is striking. More than 10% of the working age population across Scotland fall into this category, with the proportion in some areas of Glasgow having been more than 40% in 2000. Across the Glasgow communities, more than 85,000 adults fall into this category. Obviously, there are issues to be considered with this indicator. In the past it has suited governments to have people classified as ‘sick’ rather than ‘unemployed’, and there are still suggestions today that some claimants prefer to continue receiving sickness/disability related benefits rather than other unemployment related payments, given eligibility and other criteria associated with the latter. Furthermore, at the time of writing, the UK government is proposing significant changes to the Incapacity Benefit system which will have a major effect on some claimants. x Nonetheless, and despite these historic and ongoing issues, it is clear that effective solutions to reduce the high numbers of people outwith the employment market due to disability, could be one of the key drivers for health improvement in Glasgow. As discussed in Chapter 3: Population and life expectancy, Glasgow as a whole has a relatively low dependency ratio with a relatively high proportion of working age adults. However, with such a high proportion of this section of the population not in the employment market due to disability, the advantages of this relatively large working aged population are largely lost. There would clearly be economic and health gains from bringing this ‘lost’ sector of the population back into meaningful employment.

280 Chapter 11: Illness and disease est Central Scotland’s relatively poor levels of life expectancy are of life expectancy est poor levels Central Scotland’s relatively of the A gap has thuscountry. the emerged and between rates in Greater Glasgow w estimates of of primary-care overview a helpful provide disease prevalence based st ear period analysed (1991/93 – 2000/02) and this increase is mirrored in (1991/93 analysed ear period The trend in cancer deaths is downward: across Scotland between 1990- across Scotland between The trend in cancer deaths is downward: ears. eflected in the fact that around one fifth of the population die before their he past 25 years. However, Glasgow’s rate of decrease has not matched rate of decrease that Glasgow’s of the However, he past years. 25 he total of the numbers affected population Greater Glasgow particular by conditions, “Rates of admission to hospital for diabetes more than doubled in the ten y partsmany of Glasgow.” “ of and this level 10%, 92 and 2000-02 deaths dropped from by all cancers communities.” decrease is mirrored in a number of Glasgow “W r 65th birthday.” t areas. deprived and confirm more in evident the higher levels Important of hospital types admission, such as diabetes, been increasing have of admission to hospital for deliberate in levels, and variations The levels, significantly. self harm striking,are as is the long-term suicides among men. in trend been significant accident casualties in recent have in ratesThere road of reductions y Deaths heart over from than more in Greater Glasgow have halved stroke disease and t re Scotland. one fifthAround of Scotland die before of the their population of the 65th West birthday. In the figures areas, much deprived are more higher (especially among men), and alcohol is one of the death. main causes of premature Summary Ne Guide to data presented in this chapter % of dependent children living in households where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 11: Illness and disease

This chapter highlights a number of key points in relation to patterns and trends in morbidity and mortality in the West of Scotland and, particularly, Glasgow. However, no attempt has been made to present a detailed description of all the main illnesses affecting the population. This information is available elsewhere. Rather, the purpose of this chapter is to highlight some important trends and present some relatively new information on elements of disease prevalence.

The chapter is divided into five sections: an analysis of disease prevalence in Greater Glasgow (as measured at a primary care level); an examination of a handful of relevant hospital admission based indictors; road accident casualties among all ages; trends in a small number of cause-specific mortality rates; and premature mortality.

Note that several of the indicators discussed in other chapters are also relevant here: for example, levels of disability (in Chapter 10: Health and function), child road accident casualties (in Chapter 9: Children and adolescents) and alcohol related deaths (Chapter 7: Behaviour).

11.1 Estimates of disease prevalence at a primary care level

The figures presented in this section are taken from the QOF (Quality and Outcomes Framework) data first published by ISD Scotland in summer 2005. The data – collated as part of the system to remunerate GPs within the new General Medical Service (GMS) contract1 – include, for each practice, the total number of patients recorded on each of eleven separate disease registers. Participation in the scheme is, however, voluntary, and the data presented here for the NHS Greater Glasgow area covers 210 out of the 215 Greater Glasgow practicesi.

There are two important points to note with regard to these data: x Given the five missing GP practices, the figures will be an underestimate of the true disease prevalence of each disease category. Other important caveats are listed in Appendix 1. x The data are currently not available by age or sex. Thus, where crude rates are presented, they do not take into account the age/sex structures of the populations. Variations in rates could, therefore, be a consequence of, for example, larger proportions of elderly patients within a practice population.

All data should, therefore, be interpreted with caution.

i Nationally, 99% of practices submitted data – only 14 out of 1038 failing to do so. However, five of those 14 were in the Greater Glasgow area (three within South West Glasgow, one in the West End of Glasgow, and one in the Bridgeton & Dennistoun area).

283 Figure 11.1 shows the total number of patients recorded on nine of the disease registers in the 210 NHS Greater Glasgow practices. This allows us to see that, for example, more than 105,000 patients in Greater Glasgow have been diagnosed with hypertension, 47,500 patients have been diagnosed with asthma, and around 40,000 with coronary heart disease (CHD). There are also about 30,000 diagnosed diabetics (aged 17+), 22,500 patients with chronic obstructive pulmonary disease (COPD), over 7000 patients with epilepsy (aged 16+), and more than 5,000 patients with severe and long-term mental health problemsii.

Figure 11.1

Selected disease prevalence in Greater Glasgow, 2005 Numbers of patients on GP disease registers (210 out of 215 practices) Source: ISD Scotland (QMAS Database as at May 2005)

120,000

106,463

100,000

80,000

60,000 47,469 41,621 40,000 Total number of patients 29,627 22,544 21,300 20,000 16,936

7,128 5,364

0 Hypertension Asthma CHD Diabetes COPD Hypothyroidism Stroke & TIA* Epilepsy Severe mental health problems Disease Register * TIA - Transient Ischaemic Attack

Figures 11.2 to 11.8 show the breakdown of these figures across different practices within Greater Glasgow. Please note that the data are presented by location of the practice, not the location (residence) of the patient. As discussed above, these are crude, unstandardised rates, and should be interpreted with caution.

It can be noted that: x Despite the many caveats listed above, a familiar pattern is evident in the majority of these graphs in terms of (a) the enormous variation in rates across Greater Glasgow, and (b) the more deprived parts of the city being associated with the highest prevalence rates for many conditions. x For example, we see that for asthma (Figure 11.2), about one in ten patients served by GP practices within parts of Drumchapel have been diagnosed as suffering from this condition, whereas for patients within the more affluent Hillhead area – only two or three miles distance from Drumchapel – the figure is less than two in a hundred. x In areas with the highest rates of diagnosed hypertension (Figure 11.3), almost one in five of the practice population have been diagnosed, compared to just 3.5% in the area with the lowest figure (Hillhead). ii Patients with severe and long-term mental health problems: numbers are restricted to those undergoing regular follow-up.

284 x Similar, or greater, variations in rates are seen for all conditions (e.g. coronary heart disease (Figure 11.4), chronic obstructive pulmonary disease (Figure 11.5), stroke (Figure 11.8) x Although relating to much smaller numbers of patients, the crude rate of diagnosed epilepsy (Figure 11.6) among adults is also much higher in practices based within more deprived areas (e.g. Drumchapel, Calton, Hutchesontown), with a ten-fold variation in rates between these areas and those with the lowest rates. x Diabetes (Figure 11.7) among adults shows a different picture, however, with high rates recorded in some affluent, as well as more deprived, areas. This may be affected by, for example, some practice populations having higher proportions of elderly patients and/or members of minority ethnic populations (some of which are known to experience higher levels of diabetes).

Figure 11.2

Asthma: crude (unstandardised) prevalence rates by GP Practice, 2005 Comparison of 10 practices with highest rates and 10 with lowest rates, Greater Glasgow* Source: ISD Scotland (QMAS Database as at May 2005)

14.0

12.0 11.5

10.0 9.0 8.3 7.9 8.0 8.2 8.0 7.1 7.2 7.3 7.5

5.4 6.0 5.0

4.0 2.9 3.0 3.1 3.1 3.2 3.2 3.2 3.2 1.8 1.8 2.0 Crude rate per 100 practice population 0.0

d ill ie S n s E ill E h r ark r S N h W N ea nds n d g ou nd l n l l NE sgow h la a d n sp la ke ley E se la ill d w Ri tst g w rn lto pe H o in a Carmyle Yo a Scotland G o Do usla Shieldhall hape rhou Scotstoun b Sco K Sh ch W d; ; Dougalstonm ic; Da Hami ste m s; n a r a reater la C rumchaperu da d Drumc E D D G Drumry; Linnvale n wad n Hyn ort Du - Keystone Car P

ilngavie M Postcode sector of GP Practice * Includes 210 out of the 215 practices in the NHSGG area

285 Figure 11.3

Hypertension: crude (unstandardised) prevalence rates by GP Practice, 2005 Comparison of 10 practices with highest rates and 10 with lowest rates, Greater Glasgow* Source: ISD Scotland (QMAS Database as at May 2005)

25.0

19.2 20.0 18.6 18.8 18.9 19.0 17.5 17.7 17.9 18.1 16.8

15.0

11.5 11.3

10.0

5.8 5.9 6.1 6.1 6.1 6.1 5.1 5.2 4.4 5.0 3.5 Crude rate per 100 practice population

0.0

d w d ill ill d S E ill s o h W ve se el on r N ir ea n n ro ch i drie l S a tlan lh a e g u ald d yst ke co il Yorkhill w n R khou head S n Ri pe ro o Hagh wlands S Glasg H r a b Y Cowl Yoker S r elvi Woodside Battlef Kingspark rdo ch o ha e ; Do K Pa Park a S at d uthergl C m ; R e R u r lan Dr G d Hyn rmulloch Ba Postcode sector of GP Practice * Includes 210 out of the 215 practices in the NHSGG area

Figure 11.4

Coronary heart disease: crude (unstandardised) prevalence rates by GP Practice 2005; Comparison of 10 practices with highest rates and 10 with lowest rates, Greater Glasgow* Source: ISD Scotland (QMAS Database as at May 2005)

9.0 8.5 8.2 7.8 7.8 8.0 7.6 7.7 7.7 7.2 7.0 7.1 7.0

6.0

5.0 4.6 4.4

4.0

3.0 1.9 1.7 1.7 1.7 1.8 1.8 1.9 1.9 2.0 1.5 0.9

Crude rate per 100 practice population 1.0

0.0

ill l ill s s e n l e n S h hil ve d n d hil o W N rie o n r lt ld d len d n n r a a side si n tyn a a d lhead g l e d tstoun d n ton ryg il wa ngrove Yorkh n d ilto r C na Ri H vi o M co larksto a ge o Scotland Dowa lvi o n C m C d rd rkhe To r Glasgow ; Do Woo S Woo a e d d; Kel Ke W H Pa ie; at n n wto Bri Ca d e a as; e a l d N m Gr d dla n l u o Hyn Hyn D P ort P Postcode sector of GP Practice * Includes 210 out of the 215 practices in the NHSGG area

286 Figure 11.5

COPD: crude (unstandardised) prevalence rates by GP Practice, 2005 Comparison of 10 practices with highest rates and 10 with lowest rates, Greater Glasgow* Source: ISD Scotland (QMAS Database as at May 2005)

10.0 8.8 9.0 8.0 8.0 6.9 7.0 6.6 6.1 6.2 5.8 5.9 5.9 6.0 5.7

5.0

4.0

3.0 2.4 1.9 2.0

Crude rate per 100 practice population 1.0 0.4 0.5 0.2 0.2 0.3 0.4 0.4 0.4 0.4 0.4 0.0

d w n k l s S E ill n o o ad r hil d on on W a rk S e a n t n l ald alton l S e rkst sp lan yst n e l ltonh cot Pa g d gspark o C Cal g i S Glasg g Hillh in in Hillhead geton W d ap m r Cla K Dowa K d r Woodsidea e in a d; Bri C uther H at n s; Woo R e Kinn a rumch r Newton Mearns d Easterhouse W D G dla n u Hyn D Bearsden - Kessingtonort P Barmulloch; Robro Postcode sector of GP Practice * Includes 210 out of the 215 practices in the NHSGG area

Figure 11.6

Epilepsy (age 16+): crude (unstandardised) prevalence rates by GP Practice, 2005 Comparison of 10 practices with highest rates and 10 with lowest rates, Greater Glasgow* Source: ISD Scotland (QMAS Database as at May 2005)

2.5

2.1 2.0

1.5 1.4 1.4 1.5 1.4 1.3 1.3 1.3 1.3 1.3

1.0 0.7 0.8

0.5 0.3 0.3 0.3 0.3 0.3 0.3 0.2 0.2 0.2 0.3

0.0 Crude rate per 100 practice population aged 15+ d w d l ill d n N n n o a h a ps la n p sg te el NE la illhe wanhil illhe alston S Calton pel NE iltonhill Calton p cot H H g apel SE a S G Dowa Clarkston Clarksto m Carntyne esontow ; Shawlands ch ch m Parkhead Ha m ch nd; Do nd u u eater a a r das; Woodlandsl D Drumcha Dr Hut Gr n Drumry; Linnvale ystone; Dou Hynd Hyndl e K Port Du

ilngavie - M Postcode sector of GP Practice * Includes 210 out of the 215 practices in the NHSGG area

287 Figure 11.7

Diabetes (age 17+): crude (unstandardised) prevalence rates by GP Practice, 2005 Comparison of 10 practices with highest rates and 10 with lowest rates, Greater Glasgow* Source: ISD Scotland (QMAS Database as at May 2005)

12.0 10.2 10.0 8.1 8.0 6.9 6.6 6.7 5.9 5.9 6.0 5.4 5.5 5.6

3.8 3.8 4.0 2.2 2.2 2.3 2.4 2.5 1.7 1.9 2.0 2.0 1.3 1.4

0.0

w ill l ill l e e S s d S Crude rate per 100 practice population aged 15+ l S h ve h ark d g d S k n ro c si ld n en ea field r sgo a g sp d nva a a d lh la illhead w n Ru o in d tle H o o on sl ca Hil Mearns at Scotland D Dowanhil lvi lvingrove ClarkstonDowanhil d u rG ; ; King W ar b obroystonw on B te d; Ke Ke ry; L m R Parkhea t ning Pa a n nd m C a Co in e u ew r la land C N K G dla Dr loch; ds; yn n H Hynd Hynd rmul dla a o B o W

ircus; C rk Pa Postcode sector of GP Practice * Includes 210 out of the 215 practices in the NHSGG area

Figure 11.8

Stroke/TIA*: crude (unstandardised) prevalence rates by GP Practice, 2005 Comparison of 10 practices with highest rates and 10 with lowest rates, Greater Glasgow** Source: ISD Scotland (QMAS Database as at May 2005)

6.0

5.0 4.7

4.0 3.7 3.7 3.8 3.3 3.4 3.1 3.2 3.2 3.2 3.0

2.0 1.8 1.8

0.8 1.0 0.7 0.7 0.7 0.7 0.8

Crude rate per 100 practice population 0.5 0.5 0.4 0.4

0.0

w d k k n ill S N n o a ps r r u W S and rk S p use n oss ld l a o ad a earns illhe illhead orkh cr e rntyne n cot M Ste Y iltonhill oker o S Glasg H H ergle Toll rkh Yoker S Ca m Y d ing P BattlefieldKingspa Kingspa Scotsto h ; Torygle r Parkh n; Pa Ha ie a o d C Rut a reater Newton Kinn G olm P Shettlest * Transient Ischaemic Attack ** Includes 210 out of the 215 practices in the NHSGG area Postcode sector of GP Practice

The caveats surrounding this information are significant as the data have important limitations. Nevertheless, the data provide us with a useful overview of the extent to which the population of Greater Glasgow is affected by some common conditions.

288 11.2 Hospital admissions data

Some of the most common reasons for hospital admission (e.g. heart disease, cancer, stroke) are discussed elsewhere in this chapter. Here, four reasons for admission are considered: diabetes, ‘external’ causes, deliberate self harm, and psychiatric admissions. Diabetes is included on account of its increasing prevalence in recent years. The term ‘external causes’ covers a number of reasons for hospital admission including road accidents, assaults, falls, drowning and poisonings. It is important because research has shown that a number of the causes included in this broad grouping are contributing to the rising trend in death rates among young men in Scotland2, and because of the association between high rates of admission for these reasons and deprivation. Deliberate self harm is one such ‘external’ cause and, alongside psychiatric admissions, allows us insight (albeit extremely limited) into patterns of mental ill-health in Glasgow and the West of Scotland.

Diabetesiii Figure 11.9 shows the average annual age-standardised rates for admissions to hospital for diabetes in each Greater Glasgow and West of Scotland ‘community’iv. At this community level, there is more than a four-fold variation across the areas. At a small area level (Figure 11.10), the rate in the postcode sector with the highest rates is around twenty five times that of the area with the lowest – although, as always with such small area analysis, one should bear in mind that rates are based on a relatively small number of actual events.

iii As with all data presented in this chapter, a full definition of this indicator is included in Appendix 1. iv These are primary care-based localities (mainly the old Local Healthcare Cooperative (LHCC) areas or, in some cases, the new Community Health (Care) Partnerships (CH(C)Ps)) with populations ranging from 20,000-140,000 people. For further details see ‘Preface to Chapters 2-12’.

289 Figure 11.9

Diabetes: average annual age-standardised hospitalisation rates, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from ISD Scotland data)

1400.0

1200.0 1141

1000.0 890 822 770 785 800.0 723 680 686 624 627 642 559 560 564 600.0 530 523 472 434 445 381 400 403 342 366 400.0 300 315 263 200.0

0.0 Age standardised rates per 100,000 population l d e e e d n n e ld e w e e n s w n vi d od n ale aw e u un o ir ge a o ilto h l o lvi d tla w sd clyd sgow sh and g ilbri st E erg r a ist l co iln K st e am h l n yr thke lasgo S H Lomond Wis berna Ayrshir n Ayrshir A a /M st Ea Inve G e Glasg h tr oatbri n Clyde Motherwell Rut m th D st t C e Ea enfrewshire w W u u r ast S R o & C & Ea E sd West Glasgow g So n No r nd Levern Valley n th a a th a Eastern to u reater Shaw u Glasg sl e irdrie & Be u g So A G d/ So ebank & Drumchap b d n isley lyd m Bri Pa C ill/Woodside & N G iesla Ca n yh Renfrew & West An Mar Community

Figure 11.10

Diabetes: average annual age-standardised hospitalisation rates, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from ISD Scotland data)

2500.0 2119 2000.0

1578 1614 1642 1500.0 1338 1223 1140 1145 1163 1179

1000.0

530 500.0 160 162 177 180 196 199 220 221 222 87 0.0 Age standardised rates per 100,000 population d ll d n l e e n ch i a go s o h nny ale ssi u d rl i ld S n o si llhe a sd ysto u g cotla skine E wan n illhead b lornock kh iltonhill n S r o Ralston Hi u bro H th r m ri -Ba E a Ba ardon Lo tr High Po Pa Sp d; D C Ro S Ha avie n g ch; loch N; iln dla and; Isle of Arran llo M yn u ields; Bellahouston H earsden - Kilmard Bearsden - KessingtonB arm Kirkintil ksh Holy Isl B Pollo Postcode sector

290 More striking still is the trend over ten years in rates of admission to hospital for diabetes. Nationally, rates more than doubled over the ten year period analysed. In terms of actual numbers, this equates to an increase from an average of 17,000 admissions per year at the beginning of the 1990s to around 40,000 admissions per year a decade later. As can be seen from Figure 11.11, this increase is mirrored in many parts of Greater Glasgow including Maryhill, Woodside & North Glasgow (the community with the highest rate of admission in Scotland, and where the rate also increased by almost 100% over the ten years), with some areas experiencing even steeper increases over the period (e.g. Greater Shawlands, where rates rose more than three-fold). Trends for postcode sectors (Figure 11.12) appear to show a widening gap between the small areas with the lowest rates of admission and those with the highest.

Figure 11.11

Diabetes: average annual age-standardised hospitalisation rates, Greater Glasgow communities 1991/93 - 2000/02 Source: NHSHS Community Profiles (from ISD Scotland data)

1,400.0 Maryhill/Woodside & N Glasgow

Greater Shawlands 1,200.0 Strathkelvin

South East Glasgow 1,000.0 Bridgeton & Dennistoun

800.0 Eastern Glasgow

Cambuslang & Rutherglen 600.0 Scotland

Glasgow West End 400.0 Eastwood Age standardised rate per 100,000 pop Clydebank & Drumchapel 200.0 South West Glasgow

0.0 Anniesland/Bearsden/Milngavie 1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002

Figure 11.12

Diabetes: average annual age-standardised hospitalisation rates, 1991/93 - 2000/02 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from ISD Scotland data)

2500 Hamiltonhill Parkhouse Balornock High Possil 2000 Pollokshields; Bellahouston Strathbungo Kirkintilloch N; Hillhead Patna; Dalmellington…. 1500 Carnwadric; Darnley E Cowlairs Scotland Lounsdale 1000 Cardonald S Hillhead Holy Island; Isle of Arran Bearsden - Kilmardinny

Age standardised rate per 100,000 pop 500 Ralston Bearsden - Kessington Hyndland; Dowanhill 0 Erskine E 1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002 Milngavie - Barloch

291 ‘External’ causes At a community level (Figure 11.13), a two and a half-fold variation in hospitalisation rates for ‘external’ causes is evident across the West of Scotland, with the rates in Bridgeton & Dennistoun also about 60% higher than the national figure. At a small area level (Figure 11.14), the variation is more extreme: in the period 2000-02, the postcode sector with the highest rates (Calton) experienced admissions to hospital for this reason at around three times the national rate, and about six times the rate of the small area with the lowest figure, (Newton Mearns).

Figure 11.13

'External' causes: average annual age-standardised hospitalisation rates, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from ISD Scotland data)

4000.0

3500.0 3307

3000.0

2500.0 2038 2000.0

1500.0 1285

1000.0

500.0

0.0 Age standardised rates per 100,000 population d e d d ll n e e n e y e e n od ire n e ir ir w w w un vi aw yd lle o o o tla a aul sh ilto h rgl apel a sh g rn st E erwe rcl bridg sg ist co n stwo e w h am t he ch V yr la lasgo S il a re e Lomond Wis t m n Ayrsh E rathkelvin H nve u u r A Glasg G enn /M nf Mot I Coa R th Ayrshir th n n St Clydesdale w W u Dr ve r ast st r D e East Kilbride Re o o E a Cumb & & N E ste & sd ie So a n r r ng & nd Le th a d a nk a u E th West Glasgowto Glasg Greater Shawlands ir sl a u e Be A u So g d/ So d n deb y aisley Bri frew & West Cl P ill/Woodside & N G iesla Camb n yh Ren An Mar Community

Figure 11.14

'External' causes: average annual age-standardised hospitalisation rates, 2000-2002 Comparison of 10 small areas with highest rates and 10 with lowest rates, West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from ISD Scotland data)

7000.0 5996 6000.0 5770 4969 5000.0 4476 4228 4304 4406 3979 3980 4050 4000.0

3000.0 2038 2000.0 1034 1055 1098 1136 1144 1144 1195 1200 1208 1209 1000.0

0.0

l r s k Age standardised rates per 100,000 population il r E n ton ck ny de sie rd a tre ck ton land o nh in p a n n va o fn d P Ibrox e o rn if wa rd on e iltonhill use W et Go Cal ssing G o a e o C g Scot l;Mearns m Cam Clarkston id e D t L wn r alma K Kil s N; Ca n rgusli Ham o B D - - g i en - Westertonn g Fe eston; Gorbals e en ri Easterh WT dland; ilton Of -Sa d rsd pb M E n Trad arsd Hyn a o e Bearsd e sh B i rid ur a Broom; Kirkhil Be B b o il rb K Ha ast E yr - A Postcode sector

292 Over recent years, there has been a generally upward trend in admissions to hospital for this reason. Nationally, rates increased by around 12% between 1990-92 and 2000-02, and similar (and in some cases, greater) rises were evident within most Greater Glasgow communities (Figure 11.15). Interestingly, one of the few areas to buck this trend and show a decrease in rates for admission to hospital for this reason over the period was Bridgeton & Dennistoun, the community with the highest admission rate in Scotland.

At a small area level, however, Figure 11.16 shows the gap between the sectors with the highest rates, and those with the lowest rates, to be widening.

Figure 11.15

'External' causes: average annual age-standardised hospitalisation rates, Greater Glasgow communities 1991/93 - 2000/02 Source: NHSHS Community Profiles (from ISD Scotland data)

4,400.0 Bridgeton & Dennistoun

Maryhill/Woodside & N 3,900.0 Glasgow South West Glasgow

3,400.0 Eastern Glasgow

South East Glasgow 2,900.0 Clydebank & Drumchapel

2,400.0 Cambuslang & Rutherglen

Greater Shawlands 1,900.0 Scotland

1,400.0 Glasgow West End Age standardised rate per 100,000 pop Strathkelvin 900.0 Eastwood

400.0 Anniesland/Bearsden/Milngavie 1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002

Figure 11.16

'External' causes: avg annual age-standardised hospitalisation rates, 1991/93 - 2000/02 Comparison of 10 small areas with highest rates and 10 with lowest rates West of Scotland and Greater Glasgow Source: NHSHS Community Profiles (from ISD Scotland data)

8000 Dalmarnock Tradeston; Gorbals

7000 Govan Bridgeton E Ayr - Harbour and W Town Centre 6000 Ibrox Easterhouse W 5000 Hamiltonhill Ferguslie Park Garngad; Royston 4000 Scotland Clarkston 3000 East Kilbride E - Saint Leonards Milton Of Campsie Bishopbriggs N; Cadder 2000

Age standardised rate per 100,000 pop Bearsden - Kilmardinny Hyndland; Dowanhill 1000 Giffnock Bearsden - Kessington

0 Bearsden - Westerton 1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002 Broom; Kirkhill; Mearns

293 Deliberate self harm Deliberate self harm is another indicator which must be interpreted cautiously. As with all hospital based data, rates of admission to hospital for this reason can be affected by proximity to hospital services. Also, there have been inconsistencies, historically, in the manner in which some of these admissions have been coded in hospitals. Despite these caveats, it is a valuable measure of this type of morbidity, and Figure 11.17 shows huge variation in hospitalisation rates for deliberate self harm across the West of Scotland: a five-fold difference between East Kilbride (the community with the lowest rates) and Maryhill, Woodside & North Glasgow (the highest).

Figure 11.17

Deliberate self harm: average annual age-standardised hospitalisation rates, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from ISD Scotland data)

600.0 526 500.0 475 446 447 422 423 392 401 400.0 367 374 348 357 327 334 335 313 312 324 291 300.0 262 262 273 238 211 200.0 145 121 105 100.0

0.0 Age standardised rates per 100,000 population l e d n le ld d e w s l e y n w re e w vi a ow d lle i ir o a ilto glen au En yd n rwe a ou apel g sd r n sg la e st isha sh sh sg n stwoo r st rcl tbridg i ch yr yr la cotland il a am the ewshire e e Lomond th n W A S H Glasgow r haw o rn V n /M E rathkelvin nf Inve e st A n St st Clyde e w W S M Coa ve D rth a N G East Kilbridee e o ern Glasgo & Drum o Cumb st & & E & sd W East Gla ie South Ayrshire n N e r ng & Ru h eater r o d a th a ut Ea d nd Le nk si u Glasg o r a et a d Be S Gr Ai g o d/ So id o n r aisley B P Clydeb l/W iesla Cambusl n ryhil Renfrew & West R a An M Community

Note that the rates presented in Figure 11.17 equate to more than 6,700 hospital stays on average per year across the West of Scotland.

Variation at the small area level is even more marked. However, given the relatively small number of events at this level, it is not shown here. Trends cannot be shown due to coding discrepancies prior to the mid 1990sv.

Trends in rates of suicide for the Greater Glasgow area are discussed in section 11.4 (mortality).

v See Appendix 1 for more details.

294 Psychiatric hospital admissions Figure 11.18 shows, by West of Scotland community, age-standardised rates for first admissions to hospital as a psychiatric inpatient. The highest rates of admission were recorded within the Maryhill, Woodside & North Glasgow community: between 2000 and 2002 the average annual hospitalisation rate within that community was twice that of the country as a whole, and three times the rate of the community with the lowest rate of admission, Eastwood. Note that the relatively high rates within the Paisley & Levern Valley community are probably influenced by the proximity of Dykebar Hospital in Paisley. Other areas may be similarly affected.

Figure 11.18

First psychiatric hospital admissions, average annual age-standardised rates 1999-2001 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from ISD Scotland data)

400.0 373

350.0 322 311 299 300.0 275 264 267 250.0 230 234 235 217 218 226 200 209 192 189 196 200.0 177 180 181 184 152 159 141 145 150.0 120

100.0

50.0

0.0 Age standardised rates per 100,000 population e n ld n ll d e s e e w e d w y w od vi ide e ge n d ir o ir o e un o o a lvi r l o n haw En o w au rg rid a sh sg sh sg apel sg g ilb rn erwe b m a st ist cotland st iln thke esdale e he h o wl yr l e la ch n la S a d t Hamiltonat L a Ayrshir Wis rew verclyde n Ea /M tr u o G f In e n Cly R Mot C th Ayrshir st A rn st G D N G e S East K u r Sh a w W e Drum Cumb & te E Ren o & & & sd g So a North ste n e r n e a st o d a a E e nk nd Levern Vall si sl irdrie & W Glasg a a et d Be u A Gr South East Glasgow g o d/ b South W d o n w & isley m e Bri Clydeb Pa l/W iesla Ca n ryhil Renfr a An M Community

Trends at a community level are relatively flat but with no sign of the gap between ‘high’ and ‘low’ areas being narrowed (Figure 11.19).

Figure 11.19

First psychiatric hospital admissions: average annual age-standardised rates, Greater Glasgow communities 1990/92 - 1999/01 Source: ISD Scotland/NHS Health Scotland

450.0 Maryhill/Woodside & N Glasgow Bridgeton & Dennistoun 400.0 Clydebank & Drumchapel 350.0 South West Glasgow

300.0 Glasgow West End

South East Glasgow 250.0 Eastern Glasgow

200.0 Greater Shawlands

150.0 Scotland

Cambuslang & Rutherglen 100.0 Strathkelvin Age standardised rate per 100,000 population

50.0 Anniesland/Bearsden/Milngavie

0.0 Eastwood 1990 - 1992 1993 - 1995 1996 - 1998 1999 - 2001

295 Given the relatively small number of events recorded at a postcode sector level, this particular indicator is not presented here at a small area level.

11.3 Road accident casualties

Road accident casualties among children were discussed in Chapter 9: Children and adolescents. This section briefly considers trends in adult road accident casualty rates, taken from the 2004 constituency profiles3.

Figure 11.20 shows, by West of Scotland parliamentary constituency, road accident casualty rates (for all ages) per 10,000 population for 1991 compared to 2002. Nationally, rates fell by 25% over this ten year period. A similar decrease was evident across the West of Scotland constituencies, with the 1991 figure of almost 11,000 casualties falling to around 8,100 in 2002. As Figure 11.20 shows, this decrease was matched, and in some cases bettered, by the majority of the West of Scotland constituency areas, with notable falls in rates visible in Eastwood (50%), Paisley South (41%) and West Renfrewshire (39%), while rates in five of the Glasgow constituencies fell by more than 30%.

Figure 11.20

Road accident casualties (all ages), 1991 vs. 2002 West of Scotland and Greater Glasgow constituencies Source: Transport Statistics, Scottish Executive

160

140 1991 2002 120

100

Rate per 10,000 population Rate per 10,000 20

l l n th rt n n h il re h ts rn n n le yth e uth le vie lok h i hil t u to ton s d a Ayr l ls h lyde o s va da il lbride hca rg wood sland g o l alley ry h b s K i rs t ishaw So e t e n e rc V e les Kelvin cotland a W e h il e y Sout d tt S t K e t w P frews e & S Chry ley North w Go y s B m Eas M o n sl e o a a hame Nort Inv i ri ais Dumbarton Cl E & ow Ca h g & a gow Ma e& sg sgow in amiltong Sou g k & lasg k P rd P a v s in ow Ru ow Annigow Baillieston tRe c ow Springg rnauld & l H a n g g a G nin s o Ai g d Gla Gl e e n s s b n n Glas s ri sgow She k Gl therwell & a a e on NorthWe & Be ock & Doon a a th o Glas d Cu t n Gl M Cu Gl Gl y oatb Gl Cumb ra Cl Kilmarnock &mil Loudoun Gre C St Ha

Carrick, Cum

Parliamentary constituency

Figure 11.20 also shows that in 2002 the highest rates of road accident casualty were in the Glasgow Kelvin constituency, with a rate almost three times the national average. However it should be borne in mind that the Glasgow Kelvin constituency boundaries include the city centre and, given its high traffic volumes, this is likely to distort the residence-based rate presented. The rates of casualties for other constituencies with extensive road networks and/or above average traffic volumes may be similarly inflated for these reasons.

296 Despite these caveats it is noticeable that the casualty rates in a number of the more deprived constituencies (e.g. Glasgow Shettleston, Glasgow Springburn and Glasgow Maryhill) are above average, while rates are much lower than the national average in the affluent suburbs of West Renfrewshire and Eastwood. Interestingly, some of these deprived constituencies with high casualty rates also tend to have the lowest rates of car ownership, while the opposite is true of the more affluent constituencies: for example, while 68% of households do not have access to a car or a van in Glasgow Shettleston, the figure in Eastwood is only 20%.

11.4 Mortality

This section briefly considers trends in mortality for the three leading causes – heart disease, stroke and cancer – as well as suicide. Note that deaths due to liver cirrhosis and, more broadly, all alcohol related mortality, are discussed in Chapter 7: Behaviour.

Heart disease As is well known, heart disease is one of the three main causes of death in Scotland. Figure 11.21 shows, for Scotland and Greater Glasgow, age-standardised rates in ischemic heart disease for males aged 15 to 74 between 1976 and 2001.

Figure 11.21

Ischaemic Heart Disease: age standardised death rates, males (15-74) Greater Glasgow and Scotland, 1976-2001 Source: GRO(S)

500

400

300

200 Rate per 100,00 population per year 100

0 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Greater Glasgow Scotland

This shows that rates in Scotland, and in Greater Glasgow, have more than halved since the mid 1970s. Despite this good news, however, Figure 11.21 also shows that at the beginning of the period the rates for Greater Glasgow were identical to those of the country as a whole, but since then a gap between the two sets of rates has emerged. A similar picture can be seen for females.

297 Figure 11.22 shows that rates in heart disease mortality have also decreased across all the Greater Glasgow communitiesvi. Across the ten year period presented, rates in Scotland fell by about one third, and a similar level of reduction is visible across most Greater Glasgow communities. This chart also shows that, as with so many other indicators, considerable variations in rates persist across these different areas.

Figure 11.22

Heart disease: average annual age-standardised death rates, Greater Glasgow communities, 1991/93 - 2000/02 Source: NHSHS Community Profiles (from GRO(S) data)

350.0 Bridgeton & Dennistoun

Maryhill/Woodside & N Glasgow 300.0 Eastern Glasgow

South West Glasgow 250.0 South East Glasgow

200.0 Clydebank & Drumchapel

Greater Shawlands

150.0 Cambuslang & Rutherglen

Glasgow West End 100.0 Scotland Age standardised rate per 100,000 pop Strathkelvin 50.0 Eastwood

0.0 Anniesland/Bearsden/Milngavie 1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002

Cerebrovascular disease Deaths from strokes (cerebrovascular disease) in Greater Glasgow show a similar long term trend to ischemic heart disease. Figure 11.23 shows, again for males aged 15 to 74 and again for Greater Glasgow and Scotland, mortality rates from stroke over a 25- year period. Although mortality rates have fallen dramatically over the period, a widening gap between the rates in Greater Glasgow and Scotland is again visible. A similar, though slightly less pronounced, gap is also seen in the equivalent trend for female deaths.

vi Note that there are major differences in the definitions and calculation methods relating to the figures presented in Figures 11.21 and 11.22 and thus the rates in the two sets of graphs are not directly comparable. All definitions are included in Appendix 1.

298 Figure 11.23

Cerebrovascular Disease: age standardised death rates, males (15-74) Greater Glasgow and Scotland, 1976-2001 Source: GRO(S)

120

100

40 Rate per 100,00 population per year

0 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Greater Glasgow Scotland

Suicide Suicide remains the leading cause of death among young men in Scotland4. Figure 11.24 shows a 25-year trend in age-standardised rates of suicide among men in Greater Glasgow and Scotland. As can be seen, rates have more than doubled in Greater Glasgow over the period, and as with stroke and heart disease, there is evidence of a widening gap between the Greater Glasgow rates and those of Scotland, particularly in the last decade.

Figure 11.24

Suicide: age standardised death rates, males (15-74) Greater Glasgow and Scotland, 1976-2001 Source: GRO(S)

10 Rate per 100,00 population per year

0 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Greater Glasgow Scotland

299 Cancer The final cause of death discussed here is cancer. Figure 11.25 shows the average annual age-standardised cancer mortality rate across the various Greater Glasgow and West of Scotland communities in the period 2000-02. A similar, and predictable, pattern of variation is evident (lower rates in the more affluent communities, higher rates in the more deprived), although there is slightly less variation than in the equivalent data for heart disease mortality. The trend in cancer deaths is also downward: across Scotland between 1990-92 and 2000-02 deaths from all cancers dropped by 10%, and this level of decrease is mirrored in a number of Greater Glasgow communities (Figure 11.26).

Figure 11.25

Cancer: average annual age-standardised death rates, 2000-2002 West of Scotland and Greater Glasgow communities Source: NHSHS Community Profiles (from GRO(S) data)

250.0 221 215 217 221

200.0 185 189 191 191 179 179 179 184 171 173 175 176 177 166 164 167 157 163 151 155 155 143 150.0 132

100.0

50.0

0.0 Age standardised rates per 100,000 population e e e e d d n n e l e n od le n w e e w o vi rid a o lley to nds l yd aw p o a o a il a rwell a ou w g b naul m m e sh sg st cotland st n esd yrshire r o V wl erg ch tbridg la il Kil Ayrshir Ayrshir A e L a ewshire h vercl th Wi S rathkelvinlyd Glasg Ha r m nni Ea /M st th th nf In ru e n a u St C r st vern e Rut Mo Coa D e E East a e r Sh R & N G No Cumb E L e & & rsd So d at g ie a th e n k & D r th West Glasgow u an a n rd Easternu Glasgowside Be y Gr sl Glasgow West Endba i d So e A So d/ sle ridgeton & n i mbu yd B Pa a Cl l/Woo iesla C n ryhil Renfrew & West a An M Community

Figure 11.26

Cancer: average annual age-standardised death rates, Greater Glasgow communities, 1991/93 - 2000/02 Source: NHSHS Community Profiles (from GRO(S) data)

300.0 Bridgeton & Dennistoun

Maryhill/Woodside & N Glasgow 250.0 South West Glasgow

Eastern Glasgow

200.0 Clydebank & Drumchapel

Glasgow West End

150.0 Cambuslang & Rutherglen

Greater Shawlands

100.0 South East Glasgow

Scotland Age standardised rate per 100,000 pop 50.0 Strathkelvin Anniesland/Bearsden/Milngavie

Eastwood 0.0 1991 - 1993 1994 - 1996 1997 - 1999 2000 - 2002

300 Focussing on one of the most common forms of cancer, the final two Figures in this section show long-term trends in lung cancer mortality. Figure 11.27 presents age- standardised rates for males aged 15-74, and Figure 11.28 presents the equivalent figure for females.

Figure 11.27

Lung cancer: age standardised death rates, males (15-74) Greater Glasgow and Scotland, 1976-2001 Source: GRO(S)

200

175

150

125

100

75 e per 100,00 population per year

Rat 50

0 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Greater Glasgow Scotland

Figure 11.28

Lung cancer: age standardised death rates, females (15-74) Greater Glasgow and Scotland, 1976-2001 Source: GRO(S)

Rate per 100,00 population per year 20

0 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Greater Glasgow Scotland

301 These Figures show two contrasting patterns. Although in both cases the rates for Greater Glasgow are well in excess of the national figures (and in fact are the highest of all the health board areas) the rates for males have been falling over the whole period, whereas the trend for females has seen a consistent rise, with a fall in rates only visible over the last four years. This reflects the fact that, historically, women in Scotland started smoking later than men, and it is hoped that this decline in mortality rates will now continue, and a similar pattern to that seen for males will emerge.

11.5 Premature mortality

This final section of the chapter looks briefly at premature mortality in Scotland and some of the West of Scotland communities. For the purposes of simplicity, premature mortality is defined simply as deaths under the age of 65. Clearly, to examine this issue in more detail, a more sophisticated definition would be required. However, for the overview presented here, our simpler definition suffices.

Examination of premature mortality for the years 2001-2003 shows that: x More than one fifth (21%) of all deaths in Scotland occur under the age of 65. x For males the figure is yet more striking: more than a quarter of males die before their 65th birthday (27%). For females the figure is 15%. x Across Greater Glasgow and the West of Scotland, the overall figures are very similar to those for the country as a whole. However, this masks considerable variation across the communities of the West of Scotland. For example, in Bridgeton & Dennistoun one third of all deaths occur in people under-65, and for males that figure rises to 42% (the figure for females is 20%). In contrast, only 15% of all deaths in the more affluent Eastwood community were in people under 65 (19.5% of male deaths, 12% of females). This is illustrated in Figure 11.29vii.

vii Note that these proportions do not take account of the age structure of the population, and thus could be influenced by higher than average under-65 populations in any of the communities.

302 Figure 11.29

Percentage of all male and female deaths under the age of 65, 2001-2003 West of Scotland and Greater Glasgow communities Source: NHSHS (from GRO(S) data)

50.0 44 45.0 Male Female

ature (<65) 40.0 35 33 33 33 33 35.0 32 32 31 31 31 31 30 30 29 29 28 28 30.0 27 26 26 26 24 24 25.0 22 20 19 19 19 19 20 20.0 17 18 18 17 18 17 16 15 15 15 15 16 15 15 15 13 13 12 15.0 12 12 10 10.0 5.0 0.0 of all deaths which were prem % w el w ll y ld s e e in e e p e le u nd d g ire ale len vie yde w l d lv g sgo cl sgo r E brid sd r ga istoun r e bri milton wshir ke l e e n omond Wishaw th lasgow wlan t a e th ln Gla ve L rnVa berna G a H Ayrsh a yd th In Gla h h r u Eastwood/Mi Den rn Mo m Coa rt Cl R n N eve u St East Ki & & L C ow West & o Renfr East Ayrshir e & Drumcha ste West N South Ayrshire n k th East Glasgow d h sg rie ng & o Ea n d arsde et dsid ut Gla Greater S West e g o Sou y a o Air usla /B o eban S d d isle n Brid /W a ew & mb a ill Cly P Ca sl ie ryh enfr n a R n M A Community

This begs the question as to whether the causes of premature death are different from the causes of death for all ages. An analysis of the ten most commonly occurring single causes of death between 2001 and 2003 shows the follo wing: x In Scotland, the ten most common causes of death for the total population all relate to the three main ‘killers’ (heart disease, cancer, stroke) as well as diseases such as chronic obstructive pulmonary disease (not shown). In Greater Glasgow, the picture is similar, but with one important difference: the seventh most commonly recorded principal cause of death in the period was alcoholic liver disease (2.7% of all deaths, numbering 860 over four years). x However, the picture for the ten most common reasons for premature mortality (<65) is different. Figure 11.30 shows this for all Scotland (note that alcohol related conditions are now more prominent), while Figure 11.31 shows the same breakdown for Greater Glasgow: this shows that the single most common reason for premature death between 2001 and 2003 was alcoholic liver disease (9% of all premature deaths; 674 over the four-year period).

303 Figure 11.30

10 Most frequently occurring principal causes of death, 2001-2003, Age <65, Scotland Source: GRO(S)

Acute myocardial infarction 8.5

Malignant neoplasm of bronchus and lung 7.9

Chronic ischaemic heart disease 6.6

Alcoholic liver disease 6.1

Malignant neoplasm of breast 3.6

Other chronic obstructive pulmonary 2.5 disease Mental and behavioural disorders due to 2.3 use of alcohol Intent self-harm by hanging strangulation 2.3 and suffocation

Malignant neoplasm of oesophagus 1.7

Malignant neoplasm without specification 1.6 of site

0.0 1.0 2.03.04.05.06.07.08.09.0 % of all deaths under 65

Figure 11.31

10 Most frequently occurring principal causes of death, 2001-2003, Age <65, Greater Glasgow Source: GRO(S)

Alcoholic liver disease 9.0

Malignant neoplasm of bronchus and lung 8.1

Acute myocardial infarction 7.8

Chronic ischaemic heart disease 6.9

Other chronic obstructive pulmonary 3.1 disease

Malignant neoplasm of breast 2.7

Mental and behavioural disorders due to 2.4 use of opioids Mental and behavioural disorders due to 2.2 use of alcohol Intent self-harm by hanging strangulation 2.1 and suffocation

Pneumonia, organism unspecified 1.8

0.0 1.0 2.03.04.05.06.07.08.09.010.0 % of all deaths under 65

304 x Considerable differences in causes of premature mortality can be seen across the different West of Scotland communities. Figures 11.32 and 11.33 show the most frequently occurring causes of premature death in Eastwood (an area with one of the lowest proportions of premature deaths) and Bridgeton & Dennistoun (the area with the highest). Although in the former area, alcoholic liver disease does feature, the total number of premature deaths is so small in this area that, in fact, this only equates to around 20 deaths over three years. In contrast, by far the most common cause of premature mortality in Bridgeton & Dennistoun was alcoholic liver disease (14% of all premature deaths, and equating to 90 deaths over the period), while alcohol and drugs also feature prominently.viii

Figure 11.32

10 Most frequently occurring principal causes of death, 2001-2003, Age <65, Eastwood Source: GRO(S)

Malignant neoplasm of breast 8.6

Malignant neoplasm of bronchus and lung 7.2

Alcoholic liver disease 6.9

Acute myocardial infarction 6.9

Chronic ischaemic heart disease 6.6

Malignant neoplasm of colon 3.0

Subarachnoid haemorrhage 2.3

Mental and behavioural disorders due to 2.3 use of opioids

Malignant neoplasm of brain 2.3

Malignant neoplasm of oesophagus 2.3

0.0 1.0 2.03.04.05.06.07.08.09.0 % of all deaths under 65

viii It should be noted that a number of homeless hostels have operated in the Bridgeton & Dennistoun area in the time period covered. However, a separate analysis was run excluding, where possible, all deaths in known hostels and although this reduced the total number of deaths slightly, it did not alter the overall pattern presented in Figure 11.33.

305 Figure 11.33

10 Most frequently occurring principal causes of death, 2001-2003, Age <65, Bridgeton & Dennistoun Source: NHSHS (from GRO(S) data)

Alcoholic liver disease 13.6

Acute myocardial infarction 7.7

Chronic ischaemic heart disease 7.1

Malignant neoplasm of bronchus and lung 5.1

Mental and behavioural disorders due to 3.8 use of opioids Other chronic obstructive pulmonary 3.3 disease Mental and behavioural disorders due to 3.3 use of alcohol

Pneumonia, organism unspecified 2.0

Mental & behav'l disorders due 2.0 multiple/psychoact drug use Malignant neoplasm without specification 1.7 of site

0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 % of all deaths under 65

The considered wisdom in relation to mortality and deprivation in Scotland is that people in deprived areas die of the same things as people in more affluent areas, only they do so a number of years earlier5. This may be true when looking at very broad categories of disease; however, it is not borne out by examination of individual causes of death. There are important differences in the causes of premature deaths compared to all deaths, with the influence of suicide, drugs and, especially, alcohol much more prominent. Premature mortality, and therefore, these types of cause of death, is much more common in deprived areas.

306 Summary

This chapter has highlighted a number of important points with regard to illness and disease in the West of Scotland (with a particular emphasis on Greater Glasgow): x Estimates of primary care-based disease prevalence, although limited and with significant caveats, provide us with an overview of the total numbers of the Greater Glasgow population affected by particular conditions. They also confirm the higher levels of these conditions in more deprived areas. x Important types of hospital admission, such as diabetes, have been increasing significantly. The levels, and variations in levels, of admission to hospital as a result of deliberate self harm are also striking, as is the long term trend in suicides among men. x Better news is provided by the decrease in road accident casualties and, particularly, the decline in rates of death from heart disease and stroke. However, the gaps that have emerged between Greater Glasgow and the rest of the country in mortality rates for the latter two causes, and for suicides, are of concern. x The West of Scotland’s relatively poor levels of life expectancy are reflected in the fact that around one fifth of the population die before their 65th birthday. The figures for male deaths are of greatest concern: a quarter of male deaths are premature, rising to over 40% in Bridgeton & Dennistoun, and over a third in other deprived areas. x Finally, the influence of alcohol as a cause of premature mortality is further evidence of the worrying trend in alcohol related harm discussed in Chapter 7: Behaviour.

307 References

1 The NHS Confederation, British Medical Association. New GMS Contract: February 2003 – Investing in General Practice. 2003 http://www.bma.org.uk/ap.nsf/Content/investinggp

2 McLoone P. Increasing mortality among adults in Scotland 1981 to 1999. European Journal Of Public Health 2003; 13: 230-234

3 NHS Health Scotland. Constituency Health and Well-being Profiles 2004 http://www.scotpho.org.uk/constituencyprofiles

4 Scottish Executive. Health in Scotland 2002. Edinburgh: The Stationery Office, 2003 http://www.scotland.gov.uk/Publications/2003/06/17181/22128

5 Chalmers J, Capewell S. Deprivation, disease and death in Scotland: graphical display of survival of a cohort. BMJ 2001; 323: 967-968

308 Chapter 12: Past and future trends ddressing and reducing will remain health-damaging a behaviours ears.” The increasing projections impact of alcohol is undeniable: simple of The issue for Glasgow is thatThe issue for greater Glasgow been reductions in disease have While parts of Glasgow have prospered withWhile parts have and greater of Glasgow employment “ better paid middle-class jobs, in other parts and low ‘worklessness’ income are commonplace.” “ relatively health has become worse and so Glasgow’s elsewhere achieved toin comparison other UK cities.” “Estimates suggest not only live of life that expectancy Glaswegians shorter but succumb to in life.” earlier disease and illness lives, “ alcohol related deaths based on recent trends suggest that the number of alcohol related twenty deaths double in the in Greater could next Glasgow y “A major challenge.” Guide to data presented in this chapter % of dependent children living in households where no-one is in employment; 2001; Wes t of S c otland and Glas gow com m unities Source: NH SHS Community Profiles (from 2001 Cens us data) All the charts which present data at a ‘community’, or postcode 60 50 sector level, employ the following colour scheme: 50 47 communities/sectors within Greater Glasgow are shaded dark 40 37 33 33 33 29 red; other West of Scotland areas are shaded light blue. Where 30 28 23 23 24 24 22 23 20 21 21 20 18 17 18 16 16 possible, the same colour scheme has been incorporated into 14 12 11 other charts employing different geographical breakdowns 10 6 7

(e.g. in charts by council area, Glasgow City is shaded dark red; 0 the other West of Scotland council areas are coloured light blue).

See Preface to Chapters 2-12 for more details. Community Chapter 12: Past and future trends

In preceding chapters, past and future trends for a number of demographic, economic and health indicators have been described. In this chapter, we aim to synthesise these observations in order to demonstrate important linkages, for instance between the economy and health, to show where current trends may lead and to highlight major issues requiring action.

In terms of population changes there are a number of trends which have exerted important influences on the city and surrounding areas: x Since the mid-1970s the death rate in the city has exceeded the birth rate. Without a rise in the birth rate or inward migration, Glasgow’s population is likely to drop further; x Glasgow’s ethnic minority population has risen in recent years (to 5.5% in 2001) and looks set to increase further, particularly taking into account the recent rise in the asylum seeker and refugee population; x Glasgow has a low dependency ratio – the ratio of the young and old to the working age population – in comparison to other West of Scotland councils and to Scotland and is predicted to retain this relatively low ratio until at least 2024. In comparison, the dependency ratio for every other West of Scotland council is predicted to rise as populations grow older; x While populations in most areas will fall, household numbers are predicted to rise. In Glasgow, it is predicted single adults will account for 49% of all households in the next ten years, while lone parent households may rise to make up almost one in two of households with children.

Demographic changes have already driven service changes. For example, the drop in the school age population has led to amalgamations of schools across Glasgow. However, it is in the working age population that the health of Glasgow as a city and the overall health of its population will be determined. Glasgow’s current low dependency ratio gives the city, theoretically, a healthy economic employment base. However, this does not take account of people of working age who are not working or are unable to work due to incapacity, of which Glasgow has a high proportion.

A number of trends related to the economy are also notable: x There are now more women than men in employment in Glasgow and part-time work has grown to represent more than a quarter of all jobs; x The service sector has grown to become the most important sector of Glasgow’s economy, while manufacturing employment has shrunk; x One of the results of these changes is that the proportion of middle class jobs in Glasgow has doubled over a twenty year period; x Income for those in work has risen in recent years, both nationally and in Glasgow; x There has been an overall trend towards greater numbers of households with access to a car.

311 However these overall changes do not tell the whole story. Among those in employment, income inequalities have widened in recent years with those in the best paid occupations having gained more, relatively, and far more, absolutely, in terms of pay. In Glasgow, 85,000 people (19% of the Scottish total) are without work due to unemployment, illness or disability and 28% of the city’s population (over 160,000 people) is defined as living in income deprivation. Although there are no trends for these measures, it seems unlikely that either of these figures has changed significantly in recent years.

In addition, house prices have risen hugely in the last ten years, and in Glasgow average house prices have caught up with the Scottish average. However, prices have now reached a level in many areas where affordability has become a very real issue, especially for those on lower incomes.

Participation in higher education, a marker for future employability in the knowledge economy, has risen, but only modestly in recent years. The proportions of young people from deprived areas reaching university has increased, but there has not been an appreciable narrowing of the gap in participation rates between affluent and deprived communities.

In summary, while parts of Glasgow have prospered with greater employment and better-paid middle-class jobs, in other parts ‘worklessness’ and low income are commonplace.

Turning to health, despite Glasgow’s current poor position relative to other parts of Scotland and the UK, there have been successes. Infant mortality has reduced dramatically – perhaps to a level where further significant reductions may be much harder to achieve – and overall mortality, and that related to specific chronic diseases (heart disease, stroke and cancer), has fallen. The issue for Glasgow is that greater reductions have been achieved elsewhere and so Glasgow’s health has become relatively worse in comparison to other UK cities.

Estimates of life expectancy suggest that Glaswegians not only live shorter lives, but also succumb to disease and illness earlier in life. Future trends are difficult to predict. However, a simple linear extrapolation of current life expectancy trends in the West of Scotland suggests that, while life expectancy for both men and women will increase, the increases will be greater in the more affluent areas of East Dunbartonshire and East Renfrewshire compared to Glasgow. Figure 12.1 shows that the gap in male life expectancy across West of Scotland councils, which was eight years in 2001-03, is forecast to widen to ten years by 2011-13.

312 Figure 12.1

Male Life Expectancy at Birth (years); West of Scotland Council Areas vs Scotland; Trend: 1991-1993 to 2001-2003; Projections: 2002-2004 to 2011-2013 Source: Office for National Statistics & Health Scotland

82.0

80.2 80.0

78.0 77.2

75.6 76.0

73.5 74.0

72.0 Life Expectancy at birth at Expectancy Life 70.2 70.0 69.1

68.0

66.0 1991- 1992- 1993- 1994- 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Council

Scotland Glasgow City East Dunbartonshire

Trends in health behaviour will have an impact on future disease and mortality levels. Smoking levels, while still high, have reduced in recent years and may drop further depending on the success of the imminent legislation to control smoking in public places together with other local strategies. However, other behavioural trends are less promising. Obesity levels have risen to the extent that in Greater Glasgow a fifth of males and almost a quarter of females are now estimated to be obese, with well over half classified as overweight. Trends in hospitalisation for diabetes, much of which is associated with obesity, have risen dramatically in recent years.

Another major concern relates to alcohol. While accurate information on consumption is difficult to obtain, the increasing impact of alcohol is undeniable. There are estimated to be more than 13,500 ‘problem alcohol users’ resident within Glasgow City, and since the beginning of the 1990s, there has been a striking increase in numbers of alcohol related deaths and hospitalisations within both Scotland and the Greater Glasgow area. Simple projections of alcohol related deaths based on recent trends suggest that the number of alcohol related deaths in Greater Glasgow could double in the next twenty years (Figure 12.2).

313 Figure 12.2

Alcohol related mortality, Greater Glasgow: deaths 1980-2003 and projections 2004- 2027 Source: GROS/NHSHS

1200

1000

800

600

400

Total number of deaths/predicted deaths 200

4 6 2 4 6 2 2 4 6 80 82 8 8 94 98 00 0 0 0 1 18 20 2 2 2 9 9 9 9 0 0 0 0 1 1 19 19 1988 1990 1992 1 1996 1 2 2 20 20 2008 2010 20 2014 2016 2 2 20 20 20

The impact of illicit drugs should not be overlooked either. Between 1996 and 2004, drug related deaths in Greater Glasgow rose by a third. There are estimated to be around 25,000 problem drug users in the West of Scotland, of whom more than 11,000 live in Glasgow.

Two other sets of trends are also worthy of consideration. The physical environment chapter showed that despite improvements in overall house conditions and dramatic decreases in levels of overcrowding, housing-related problems persist for considerable numbers of residents of Greater Glasgow and the West of Scotland. Furthermore, the arguably unsustainable predicted rise in traffic volume clearly merits consideration in any future plan for the city.

Finally, children are the future of any city. Thus, the relatively high number of children being brought up in potentially problematic environments (e.g. as children of substance misusers, in care, in workless households) is a concern, as are the worrying levels of childhood obesity, poor dental health and potentially harmful behaviours (smoking, drinking, drug taking) that have also been presented in this report.

The evidence from this overview is that future demographic and health-related trends for Glasgow are likely to be challenging. Also, the health of Glasgow’s economy is vital to the health of Glasgow. Efforts to raise income levels among those on the lowest incomes, to reduce the city’s ‘workless’ population and to improve skills and education levels could be protective for health, and help prevent further widening of health inequalities. Addressing and reducing health-damaging behaviours will remain a major challenge.

314 Chapter 13: Summary and discussion

Chapter 13: Summary

This final section of the report summarises the main themes that have emerged from the preceding chapters. An accompanying discussion paper will be published to encourage consideration of the implications of these findings for national and local policy and practice. The key question in this regard is whether current approaches will manage to address the challenges highlighted and sustain the improvements achieved. If not, what other approaches need to be considered?

13.1 Summary of report

Summary of Chapters 2-12 The historical analysis of Glasgow highlighted the extraordinary growth, and recent decline, in the size of the city’s population; the declining birth and death rates; the huge advances in public health (illustrated by the fall in infant mortality and improvements in life expectancy); and the persistence of health inequalities across the city.

Glasgow’s current population is characterised by a comparatively high proportion of working age adults, and much higher levels of pensionable women compared to men. Future trends show a further decline in the population as a whole but increases in the overall numbers of households, and especially single adult and lone parent households. For example, in ten years’ time the latter are expected to make up half of all the households with children in Glasgow.

Life expectancy in Glasgow currently stands at 69 years for males and 76 for females, but huge variation exists across different areas (e.g. for males, a fifteen year gap between communities in Greater Glasgow). The gap in life expectancy between the least and most affluent parts of Glasgow has widened noticeably over the last 20 years.

The economy of Glasgow has changed considerably in recent times. It is now one dominated by the service sector, employing more women than men, and where the proportion of ‘middle class’ jobs has doubled in 20 years. Although unemployment levels have decreased, 30% of the working age population are economically inactive, and almost the same proportion of the total population lives in ‘income deprivation’. Income inequalities are increasing.

The analysis of issues relating to the social environment has shown that Glasgow is a city where deprivation/affluence clearly matters, whether it is in relation to educational attainment, the chances of being a lone parent, or likelihood of being affected by crime. And, while for some measures of social capital Glasgow’s profile is quite positive (e.g. in terms of trust, low levels of isolation, high levels of satisfaction with the local area), other measures, particularly levels of violent crime, domestic abuse and imprisonment, highlight issues of major concern that require concerted attention.

317 Examination of the physical environment of Greater Glasgow and the West of Scotland has shown that despite improvements in overall housing conditions and dramatic decreases in levels of overcrowding, housing-related problems persist for many people. Other environmental concerns include the arguably unsustainable predicted rise in traffic volume, and a number of issues around ‘environmental justice’.

Behavioural factors of concern include the worrying rise in levels of alcohol related harm, obesity, sexually transmitted infections, and drug related deaths. In contrast, the prevalence of cigarette smoking is falling, although inequalities in prevalence persist and are a major cause of the inequalities in life expectancy seen across Greater Glasgow.

An examination of issues around pregnancy and childbirth shows that despite recent improvements, Glasgow still has relatively high rates of teenage pregnancies and of smoking in pregnancy, and low rates of breastfeeding. Deprivation has a notable negative impact on all of the above, and is also associated with much younger ages of first-time mothers.

The relatively high number of children being brought up in potentially problematic environments (e.g. as children of substance misusers, in care, in workless households) is a concern. Worrying levels of childhood obesity, poor dental health and potentially harmful behaviours are also issues that require a clear strategic response.

Analysis of indicators relevant to health and function emphasises the high levels of ill-health and disability in Glasgow and the West of Scotland. For example, one in four of the population of Greater Glasgow suffers from a long-term limiting illness. This clearly has a major impact on the area’s economy: just under one fifth of the working age population of Greater Glasgow are classified as unable to work due to illness or disability. The relationships between health and employment are increasingly being recognised: health improvement will be an important cornerstone for future economic development.

Finally, an analysis of some specific aspects of illness and disease highlights further areas of concern: for example, upward trends in diabetes and suicide; levels of deliberate self-harm; the impact of alcohol on premature mortality. Better news is evident in the decrease in road accident casualties and falling rates of deaths from heart disease and stroke – although the latter is tempered by the fact that in Greater Glasgow the rates of decrease in both have not matched those of the rest of the country, resulting in an emergent gap between Glasgow and elsewhere.

318 Overall, what does this report tells us? The data presented in this report confirm that Glasgow has undergone significant change over the last 20-30 years. As recently as the 1970s Glasgow was an industrial and manufacturing city. The economic depression of that period destroyed many of these jobs and it has taken time for the city’s economy to recover. The social class and employment profiles of the city’s population have changed significantly since then. Economic regeneration has been accompanied by physical regeneration, at least for many parts of the city. Glasgow is now a predominantly ‘middle class’ city with a strong emphasis on service industries and consumerism. While all this has been happening, improvements have been seen in overall life expectancy and in falling death rates from major diseases like heart disease and cancer. This transformation has not happened by accident. Much of it reflects the successful policy initiatives implemented by the city’s leaders over these decades.

Yet, despite this progress many intractable problems remain and some new problems have arisen. Chief amongst these are:

1. marked inequalities between the most advantaged and least advantaged areas; 2. high levels of worklessness caused in no small measure by high levels of invalidity; 3. rising epidemics of obesity, alcohol related harm, health problems related to drug addiction, some mental health problems and sexually transmitted infections.

This is the central paradox. Glasgow is a city that has undergone profound change and considerable regeneration – but commensurate improvements in its health have not yet followed. And although these health problems are not unique to Glasgow, this report has shown that they are particularly profound and seemingly resistant to change in this part of the country, especially in less affluent communities.

There will be no simple solutions to the problems faced by Glasgow. Certainly, there will be no single initiative that will turn round such a complex set of problems with such deep roots in history. One of the key messages of this report is that for health to improve a large number of the determinants of health will have to be changed. Our response to Glasgow’s health problems needs to take account of all the data in this report and the many insights yielded. The response will have to come from individuals, organisations, communities and government. It will require a willingness to learn from past approaches, to reflect honestly on the implications of current trends, and to be open to different ways forward. An initial discussion of the range of possible approaches to addressing the issues highlighted in this report is being prepared as an accompanying discussion document to be published by the Glasgow Centre for Population Health.

In moving from analysis to action, the next challenge is to engage as wide a constituency as possible in debating this report and in using these data to inform their work and their lives. If you would like to contribute to this process please visit www.gcph.co.uk/involved.htm. In addition comments may be submitted by email to [email protected] or by post to the Glasgow Centre for Population Health, Level 6, 39 St Vincent Place, Glasgow G1 2ER.

319

Appendix 1: Definitions and sources

This Table includes definitions, notes and sources for each Table and Figure presented in the report. With some exceptions, the Table does not include details of time period, or geography at which the data is presented as these are displayed in each chart’s title.

In some cases ‘source’ indicates the source of original raw data sets, which were then manipulated by NHS Health Scotland to provide required measures (e.g. standardised rates).

Figure Description/Notes Source No. 2.1 Glasgow’s population, 1801-2004. Reports of Medical Officer of Health, It is worth noting that the boundaries of Glasgow were extended on Glasgow (1898, numerous occasions over the period covered. From 1996 onward, the 1925,1926,1972); population figures are for Glasgow City Council. Registrar General of Scotland's Annual Reports (1973-2004) 2.2 Births and births per 1,000 population in Glasgow; 1855-2004. “ ” 2.3 Deaths and deaths per 1,000 population in Glasgow; 1855-2004. “ ” 2.4 Infant deaths (under one year) per 1,000 live births in Glasgow; 1855-2004. “ ” Table Infant mortality and mortality from all causes for Glasgow and four other Report of Medical 2.1 UK cities, 1901. Officer of Health, Glasgow (1901) 2.5 Death and birth rates per 1,000 population in Glasgow; 1855-2004. Reports of Medical Officer of Health, Glasgow (1898, 1925,1926,1972); Registrar General of Scotland's Annual Reports (1973-2004) 2.6 Population density in Glasgow's Sanitary Districts, 1901. Report of Medical Officer of Health, Glasgow (1901) 2.7 Birth rates in Glasgow's Sanitary Districts, 1901. “ ” 2.8 Infant death rates in Glasgow's Sanitary Districts, 1901. “ ” 2.9 Death rates in Glasgow's Sanitary Districts, 1901. “ ” 2.10 Expected future years of life at ten by size of house and by gender for Report of the Medical Glasgow. Calculated on the basis of 1911 Census and deaths between Oct Officer of Health, 1909 and Sept 1912. Glasgow, 1925 (p34) 2.11 Overcrowding in Glasgow in 1921 - percentage of occupants living more Report of the Medical than three per room of all occupants by size of house. Officer of Health, Glasgow, 1925 (p190); original source 1921 Census 2.12 Expected future years of life at birth by gender for Glasgow; 1821-27 to Report of the Medical 2001-03. Officer of Health, Glasgow, 1925; Office for National Statistics, 2004

3.1 – Population density (persons per sq. km), male population age structure and General Register 3.3 female population age structure for West of Scotland council areas. Age Office for Scotland categories shown are: ‘Under 16’: 0-15; ‘working age’: 16-64 years for men (GRO(S)) and 16-59 years for women; ‘pensionable age’: 65 years and older for men and 60 years and older for women. 3.4 – Population under 16 years. Includes those resident in communal NHSHS Community 3.5 establishments and asylum seekers. Profiles (from 2001 Census data)

i Figure Description/Notes Source No. 3.6 – Population 16-64 years. Includes those resident in communal establishments “ ” 3.7 and asylum seekers. 3.8 – Population 65 years and over. Includes those resident in communal “ ” 3.9 establishments and asylum seekers. 3.10- Population dependency ratios. Definition applied: 100 x (‘Population under GRO(S); NHSHS 3.12 16 years’ + ‘Population of 65 years or more’) / ‘Population aged 16-64’. Community Profiles (from 2001 Census data) Table Components of population change (births, deaths, natural change and GRO(S) 3.1 migration), 1994-2004. 3.13 – 2004 based population projections for period 2004-2024. “ ” 3.15 3.16 Projection of dependency ratios for period 2004-2024. Dependency ratios “ ” definition (as above). Projections based on 2004 population projections. 3.17- 2002 based household projections for period 2002-2016. Projected trends in “ ” 3.20 overall households and mix of households (one adult; two or more adults; two or more adults and one or more children; one adult with children). 3.21 – Ethnic Minority: percentage of population from a minority ethnic group - NHSHS Community 3.22 includes Black Caribbean, Black African, Black Other, Indian, Pakistani, Profiles (from 2001 Bangladeshi, Chinese, Asian Other, “other” minority ethnic groups. Census data) 3.23 – Births: birth rates per 100 females aged 15-44 years. “ ” 3.24 3.25 Infant deaths: deaths within the first year of life shown as number (totalled “ ” over five-year period) and rate per 1,000 live births in the period. Data at community level exclude deaths that had been assigned the postcode of a hospital. 3.26 – Deaths: average annual all-cause deaths expressed as number and directly “ ” 3.27 age-standardised rate per 100,000 population. Deaths at all ages included. Excludes non-Scottish residents. Standardisation carried out using WHO standard world population. 3.28 – Deaths: age-standardised rates among men and women aged 15-74 years. GRO(S) 3.29 Standardisation carried out using European standard world population. Definitions (including ICD codes) and methodology match those specified in: Leon, D. Scotland’s health in an international context. Public Health Institute of Scotland, 2003 (http://www.phis.org.uk/projects/network.asp?p=ff). 3.30 Deaths: average annual all-cause deaths expressed as number and directly NHSHS Community age-standardised rate per 100,000 population. Deaths at all ages included. Profiles (from 2001 Excludes non-Scottish residents. Standardisation carried out using WHO Census data) standard world population. 3.31 – Male and female life expectancy at birth in years. Office for National 3.34 Statistics (ONS) 3.35 – Male life expectancy at birth in years. Calculated applying Chiang (II) NHSHS Community 3.36 methodology as devised at ONS 2003 Profiles (from 2001 (http://www.statistics.gov.uk/statbase/Product.asp?vlnk=10622), Census data) using GRO death registrations for 1998-2002 [excluding non-Scottish residents] and 2001 census populations [including those persons living in communal establishments]. 3.37 Proportion of 15 year olds boys surviving to 65 of age. Derived from the life “ ” table used for life expectancy calculation (see notes for ‘Life expectancy’ above). 3.38 – Female life expectancy at birth in years. Calculated applying Chiang (II) “ ” 3.39 methodology as devised at ONS 2003 (http://www.statistics.gov.uk/statbase/Product.asp?vlnk=10622), using GRO death registrations for 1998-2002 [excluding non-Scottish residents] and 2001 census populations [including those persons living in communal establishments].

ii Figure Description/Notes Source No. 3. 40 Proportion of 15 year olds girls surviving to 65 years of age. Derived from “ ” the life table used for life expectancy calculation (see notes for ‘Life expectancy’ above). 3.41 – Estimates of male and female life expectancy at birth by deprivation: least GRO(S); Census 3.42 and most deprived Carstairs quintiles compared between 1981/85 - (1981, 1991, 2001) 1998/2002 (areas fixed to their deprivation quintile in 1981). 3.43 – Estimated healthy life expectancy at birth (for males and females) and years ISD (from Census 3.44 of life with a limiting long-term illness. See ISD web-site (Healthy life and GROS data) expectancy in Scotland: http://www.isdscotland.org/isd/info3.jsp?pContentID=2860&p_applic=CCC &p_) for details of methodology.

4.1 Employees by industry. All figures rounded to nearest 100. ABI excludes NHSHS Constituency self-employed, the armed forces and diplomatic and domestic services. Profiles (from ABI Employees assigned to area in which business is based. Further information data) on ABI data available from NOMIS website: http://www.nomisweb.co.uk. Table Employment in Glasgow by occupation. SLIMS/RF 4.1 4.2 Unemployment ‘Claimant count’: expressed as a percentage of the working NOMIS age population. 4.3 – Unemployment ‘Claimant count’: an annual average expressed as a NHSHS Community 4.4 percentage of the working age population. Profiles (from NOMIS data) 4.5 – Economically inactive: as a percentage of people aged 16-74. Includes: NHSHS Community 4.6 Retired, Student (excludes those students who were working or in some other Profiles (from Census way were economically active), Looking after family/ home, Permanently data) sick/ disabled and Other. A person who is looking for work but is not available to start work within two weeks is counted as Economically Inactive. 4.7 Economically inactive: as a percentage of working age people (i.e. males 16- Annual Scottish 64 years and females 16-59 years). Labour Force Survey 4.8 – Employment deprivation: percentage of working age population who are Scottish 4.9 employment deprived. Defined as the percentage of the working age Neighbourhood population (16-64 for men and 16-59 for women) who are on the Statistics (SNS) unemployment claimant count, are in receipt of Incapacity Benefit or Severe (from SIMD) Disablement Allowance or are Compulsory New Deal participants (New Deal for the under 25s and New Deal for the 25+ not included in the unemployment claimant count). The benefits data are provided by the Department for Work and Pensions and the claimant count data are supplied by ONS. For more details please refer to the Scottish Index of Multiple Deprivation (SIMD): http://www.scotland.gov.uk/stats/simd2004/. 4.10 – Gross Weekly Pay: mean gross weekly pay for all employees. Figure 4.10 ONS 4.11 shows pay estimates by employees’ place of residence, while the pay (from Annual Survey comparison estimates in Figure 4.11 are based on pay by employees’ place of of Hours and work. The Annual Survey of Hours and Earnings (ASHE) is a new survey Earnings) developed to replace the New Earnings Survey (NES) from 2004. ONS have suggested that, although small discontinuities in trends may occur because of the change over between the surveys, overall trends are relatively robust.

More information available from Annual Survey of Hours and Earnings (ASHE): http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=13101&Pos=4&Col Rank=1&Rank=160.

iii Figure Description/Notes Source No. 4.12 – Average annual gross household income (£). Household income estimates Communities 4.13 provided to Communities Scotland taken from CACI PayCheck, a Scotland (from commercial dataset to which Communities Scotland subscribe. This is a CACI) point-based dataset that uses postcodes as the basis for estimating household incomes. This dataset is derived from a household income model, and provides an estimate of income for every postcode in the UK. PayCheck models gross income before tax and is intended to cover income from every source including income support and welfare. PayCheck is a result of a modelling process that uses lifestyle data (as the main input), 1991 Census data, CACI population estimates, ACORN, and market research data. Lifestyle data is based upon many sources, including questionnaires returned with guarantee cards for electrical goods and direct mailings. Data are collected about the individuals returning the form, about their households, as well as details about purchasing habits, attitudes and behaviour. A high proportion of these records contain a figure for annual household income, which provides the baseline for PayCheck. 4.14 – Income support claimants. NHSHS Community 4.15 Income Support is a non-contributory, means tested benefit. To be eligible Profiles (from to claim IS, claimants must satisfy several basic conditions of entitlement. Department for Work They must be age 16 or over and be resident in Great Britain but in some and Pensions (DWP) cases, they may be eligible for IS during a temporary stay abroad if: data) the absence is unlikely to last more than 12 months they were entitled to IS immediately before leaving GB they continue to satisfy the conditions of entitlement while they are abroad, and not be doing paid work of on average 16 hours a week or more, or have a partner who is doing paid work of on average 24 hours a week or more (but there are exceptions to this rule). For more details contact DWP. 4.16 – Income Deprivation: percentage of population who are income deprived. Scottish 4.17 Defined as adults and children living in households in receipt of Income Neighbourhood Support, Income Based Job Seekers Allowance, Working Families Tax Statistics (SNS) Credit below a low income threshold or Disability Tax Credit below a low (from SIMD) income threshold and is derived from data provided by the Department for Work and Pensions and the Inland Revenue. For more details please refer to the Scottish Index of Multiple Deprivation (SIMD): http://www.scotland.gov.uk/stats/simd2004/. 4.18 – Eligibility for free school meals: primary school pupils entitled to free school SE Education 4.19 meals as a percentage of all pupils. Department

Data presented at small area level (Figure 4.19) are school-based data, with the postcode sector of the primary school assigned a descriptive name from the list used in the community profiles (see Appendix 2 for full list).

4.20 – Annual average house sale prices. Derived from a point based SASINE Communities 4.22 dataset of all housing transactions in Scotland. SASINE information is Scotland (from supplied by both the General Register Office for Scotland and the Land SASINE data); Valuation Information Unit at Paisley University. The database contains Scottish information concerning house-sales in Scotland. Communities Scotland have Neighbourhood cleaned and geo-referenced the data for GIS use. Statistics 4.23 – Households without access to a car: percentage of all households who do not NHSHS Community 4.24 have access to a car or van. Profiles (from Census data) 4.25 Persons without access to a car: percentage of all persons in private ISD (from Census households who do not have access to a car or van. data)

iv Figure Description/Notes Source No. 4.26 – Social grade: AB - higher and intermediate, managerial/ administrative NHSHS Community 4.29 /professional; Social grade: E - on state benefit, unemployed, lowest grade Profiles (from Census workers. Social Grade is the socio-economic classification used by the data) Market Research and Marketing Industries. Although it is not possible to allocate Social Grade precisely from information collected in the Census, the Market Research Society has developed a method for using Census information to provide a good approximation of Social Grade. Most output by Social Grade will be for people aged 16 and over in households. They will be classified by the Social Grade of their Household Reference Person (HRP). For households where the HRP is aged less than 16 or over 74 the Social Grade of people in the household will be determined by the household tenure. Table Social Class I and II: percentage of population from Social Class I J Arnott (from 4.2 (Professional occupations) or II (Intermediate - most managerial and senior Census data) administrative occupations).

5.1 Primary and secondary school pupils. All pupil figures quoted relate to Scottish Executive, pupils in publicly funded schools in Scotland. Pupil figures by council relate Pupils in Scotland to pupils in schools within each council area rather than pupils’ council of 2004 residence. 5.2 School pupils from ethnic minority groups: percentage. All pupil figures Scottish Executive, quoted relate to pupils in publicly funded schools in Scotland. Pupil figures Pupils in Scotland by council relate to pupils in schools within each council area rather than 2004 pupils’ council of residence. 5.3 Educational Qualifications – adults of working age with three or more Scottish 'Highers'; a degree; no qualifications. Neighbourhood Statistics 5.4 -5.5 Adults with no qualifications: % of people aged 16-74 with no qualifications. NHSHS Community Profiles (from Census data) 5.6 Participation in Higher Education: % of young (under 21) first-time entrants HESA, Performance to full-time first degree courses from state schools or colleges. Indicators, 2003/03 5.7 Participation in Higher Education: % of young (under 21) first-time entrants HESA, Performance to full-time first degree courses from 'low participation' neighbourhoods. Indicators, 2003/03 Low-participation neighbourhoods are defined as areas for which the participation rate is less than two-thirds of the UK average rate. 5.8 – Participation in Higher Education: estimated new student participation rates Derived from HESA 5.10 in Higher Education. Calculated as young (under 21) first-time entrants to & Census data full-time first degree courses divided by 17 year olds in the population in 2001 (from the Census). This is acknowledged to be a relatively imprecise estimate, given that the denominator (numbers of 17 year olds) is not precisely matched with the numerator in terms of time period or age range. 5.11- Lone parent households: calculated as lone parent households with Census 5.12 dependent children taken as a percentage of all households with dependent children. 5.13- Lone pensioner households: as a percentage of all households. NHSHS Community 5.14 Profiles (from Census data) 5.15- Social Capital: various indicators of social capital measuring civic NHS Greater 5.24 engagement, reciprocity, trust, social networks, isolation, volunteering and Glasgow’s Health perception of local area derived from NHS Greater Glasgow’s Health & and Well-being Well-being Survey, 1999 & 2002. Survey, 1999 & 2002 5.25 Voter turnout: % turnout at 2003 Scottish Parliamentary Election. NHSHS Constituency Profiles (from Electoral Commission data)

v Figure Description/Notes Source No. 5.26 Voter turnout and perception of the importance of voting. SNS (from Scottish Household Survey & Electoral Commission) 5.27 Voter turnout: percentage turnout. Parliamentary Constituency boundaries changed several times over the period analysed, so Research Services; trends for Glasgow are approximate. BBC website; Political Guide to Modern Scotland Table Recorded crime levels for a range of crime types including non-sexual Scottish Executive 5.1-5.2 crimes of violence, crimes of indecency, crimes of dishonesty, ‘fire raising, vandalism, etc’, serious assaults, crimes involving offensive weapons and domestic housebreaking, vandalism. Original source: Recorded Crime in Scotland, 2004/05 (http://www.scotland.gov.uk/Publications/2005/10/19155942/59484). 5.28 Index of overall crime rate. Scottish Executive Original source: Recorded Crime in Scotland, 2004/05 (http://www.scotland.gov.uk/Publications/2005/10/1955942/59484). 5.29 – Trends in crime: crimes include serious violent crime, domestic SNS 5.32 housebreaking, ‘fire raising, vandalism, etc’ and drug related crime. 5.33 – Crime patterns within Glasgow The data used in this analysis were provided Strathclyde Police 5.36 from the Strathclyde Police Corporate Database for the fiscal year 2004/05 and only cover the Glasgow City area. The crime types included were disorder, vandalism, vehicle crime and housebreaking. 5.37 – Violent crime patterns within Glasgow: distribution of offenders and victims Strathclyde Police 5.43 by age, sex and small area shown; violent incidents by small area also.

Data supplied by Strathclyde Police’s Violence Reduction Unit on the location (by data zone) of incidents of violent crime and the (data zone of) residence of victims and perpetrators of violent crime covering a three-year period from July 2002-June 2005 for Glasgow City. Offences that are classified as ‘violent offences’ include: murder, attempted murder, serious assault, simple assault and possession of an offensive weapon. 5.44 Incidents of domestic abuse: recorded incidents per 100,000 Scottish Executive Original source: Domestic Abuse Recorded by the Police in Scotland, 1 January - 31 December 2004 (http://www.scotland.gov.uk/Publications/2005/09/16120959/10005). 5.45- Hospital discharges after an assault: expressed as a rate per 1,000 population. ISD Scotland 5.46 Assault defined by the ICD10 codes (X85-X99, Y00-Y09) in any position GRO(S) population estimates used for denominator. 5.47 Main assault diagnoses on hospital discharge records: four main assault ISD Scotland diagnoses as a percentage of all assault discharges. Assault defined by the ICD10 codes (X85-X99, Y00-Y09) in any position. Only the first assault diagnosis code on each record was counted. 5.48 Frequency of assault discharges per person. ISD Scotland Assault defined by the ICD10 codes (X85-X99, Y00-Y09) in any position. NB Some multiple admissions may be readmissions for treatment of injuries caused in one rather than many assault incidents. 5.49 Hospital discharges after an assault: expressed as a rate per 1,000 population ISD Scotland Assault defined by the ICD10 codes (X85-X99, Y00-Y09) in any position 2001 Census population used for denominator. 5.50 Imprisonment: numbers of prisoners per 100,000 on 30th June 2003 Social Exclusion and Original source: Social Exclusion and Imprisonment in Scotland: A report Imprisonment in (http://www.sps.gov.uk/Uploads/C1D3FBFB-E123-4643-8D83- Scotland AB0F622E7755.pdf).

vi Figure Description/Notes Source No. 5.51 Prisoners from type H housing: % imprisoned coming from type H Social Exclusion and housing on 30th June 2003. Imprisonment in ACORN is a housing classification produced by the market research Scotland company, CACI. The type H housing classification includes housing areas characterised by high unemployment, overcrowding, council ownership, high proportion of lone parents and poorer families. Original source: Social Exclusion and Imprisonment in Scotland: A report (http://www.sps.gov.uk/Uploads/C1D3FBFB-E123-4643-8D83- AB0F622E7755.pdf). 5.52 Fear of crime: responses to a Scottish Household Survey question on Scottish Household whether respondents felt safe walking in their neighbourhood alone after Survey dark. 5.53- Homelessness: homeless applications expressed as a rate per 100,000 adults Scottish Executive 5.54 Original source: Operation of the Homeless Persons Legislation in Scotland: National and Local Authority Analyses 2003-04 (http://www.scotland.gov.uk/stats/bulletins/00363-00.asp).

6.1 – House condition: estimates of numbers and proportions of properties (a) Scottish House 6.3 classed as ‘below tolerable standard’; (b) with any urgent disrepair; (c) with Condition Survey rising/penetrating damp; (d) with mould in any room. (SHCS); Newhaven Research (for Full details of all definitions are included within the report of the 2002 additional analysis of Scottish House Condition Survey available from Communities Scotland. the SHCS data for GHA properties) 6.4 Overcrowding: percentage of population living in overcrowded households. 1981, 1991 and 2001 The definition of overcrowding relates the actual number of rooms in a Censuses property to the number of rooms 'required' by the members of the household (based on the relationships between them and their ages). Note that to show a comparable trend between 1981, and 1991-2001 a correction factor was applied to the 1981 figure. Further details available on request. 6.5 – Overcrowding: percentages of all households termed overcrowded. See NHSHS Community 6.6 definition of overcrowding above. Profiles (from 2001 Census data) 6.7 – Owner-occupancy: percentage of all properties that are owned. This includes NHSHS Community 6.8 accommodation that is either owned outright, owned with a mortgage or Profiles (from 2001 loan, or shared ownership (paying part rent and part mortgage). Census data) 6.9 – Vacant dwellings: percentage of all household spaces which are unoccupied. NHSHS Community 6.10 Profiles (from 2001 Census data) 6.11 Cleanliness: % of all sites graded A (no litter or refuse), B (predominantly Keep Scotland free of litter and refuse – apart from small items), C (widespread distribution Beautiful of litter and refuse with minor accumulations) and D (heavily littered with significant accumulations). These are the four levels of cleanliness graded within the Keep Scotland Beautiful recording system. The system grades areas of study (transects) within each council according to the Code of Practice on Litter and Refuse (1999), which relates to Part IV of the Environmental Protection Act 1990 (EPA). The number of sites inspected in each council area varies slightly each year. It is a 2% random sample of streets but the actual number of sites varies slightly depending on length of street selected - the longer the street the more sites inspected. The results are collated annually. Under the grading system in use, sites graded ‘C’ or ‘D’ are unacceptable and must be cleaned. Grade A is the standard that a thorough conventional sweeping/litter-picking should achieve.

vii Figure Description/Notes Source No. 6.12 Cleanliness index: this is derived from the cleanliness data above, and is Keep Scotland calculated thus: points, or weightings, are awarded as follows to each Beautiful cleanliness grade: A=3; B=2; C=3; D=0. These ‘weightings are multiplied by the count of sites in each grade and summed to create an actual score and then divided by the maximum possible score (total count of sites surveyed multiplied by three). The resulting ratio is multiplied by a 100 to give a Cleanliness Index between 0 and 100. 6.13 – Different sources of litter; adverse environmental quality indicators. These Keep Scotland 6.14 data are also made available by the Keep Scotland Beautiful data system Beautiful outlined above. Further details are available from the Keep Scotland Beautiful LEAMS Benchmarking report referenced in Chapter 6: Physical environment. 6.15 Perceived problems in local area: % of respondents perceiving the following NHS Greater to be common or very common: young people hanging around, drug activity, Glasgow Health and excessive drinking, vandalism/graffiti, unemployment, car crime, burglaries, Well-being Survey assaults/muggings, domestic violence, bullying in schools. 2002 6.16 Perception of environmental problems: % of respondents perceiving the NHS Greater following to be common or very common: dog dirt, traffic, rubbish lying Glasgow Health and about, noise & disturbance, air pollution, contaminated drinking water, Well-being Survey vacant/derelict buildings, abandoned cars, poor street lighting. 2002 6.17 Noise complaints: total number of noise complaints per 10,000 population. Health Protection Data collected by Environmental Health departments within councils, passed Scotland (from onto Health Protection Scotland. It should be noted, however, that these council figures may be misleading in a number of ways. First, an individual could environmental health have complained on many occasions (thus inflating the population rate). departments). Second, the system only records complaints made to an Environmental Health department (thus underestimating the real scale of noise problems in a council area). Furthermore, the numbers are clearly dependent on how likely people are to make a complaint in each area. Finally it is more important to note that noise complaints can be subdivided by type (e.g. domestic, industrial, etc.) but this level of detail is not reported here, given these concerns regarding the reliability of the data. 6.18 Estimated traffic volume in all roads in Scotland by council area. Further Scottish Transport details on calculation, methodology, etc. are available from the Scottish Statistics 2004 Executive’s Scottish Transport Statistics 2004 publication. (Scottish Executive) 6.19 Projected traffic growth. Background traffic growth by local authority for all Scottish Executive traffic originating in that local authority. Full details of methodology used, (Review of Local etc. is available from the relevant part of the Scottish Executive website Transport Strategies (http://www.scotland.gov.uk/library3/transport/rlts-05.asp). and RTRA Reports Final Report (October 2001))

6.20 Air pollution: mean NO2 readings. Data collected by Environmental Health Health Protection departments within councils, passed onto Health Protection Scotland. Scotland (from However, there are a number of caveats about the data presented: the number council and location (kerbside/roadside; intermediate; background) of recording sites environmental health varies substantially between councils. There are also differences in departments). measurement recording relating to the laboratory used, which normally should be corrected for - bias correction. The figures presented have not been bias corrected. The means provided are an average of all results and do not differentiate between roadside or background monitors.

viii Figure Description/Notes Source No. 6.21 – Access to leisure services in Glasgow for non-car users. Geographical Fiona Marrison, MSc 6.26 Information System (GIS) based analysis of access to local authority in Geographical (Glasgow City Council) owned leisure facilities in terms of: walking (based Information Systems, around SE commissioned, and published, research stipulating maximum University of ‘acceptable’ walking distances for reaching services to be 1600m (distances Edinburgh Institute of 400m-800m are deemed as acceptable short to normal walking of Geosciences, 2004 distances)); cycling (relating to the similarly deemed acceptable cycling distances of 5km (maximum), and 1km and 2km (acceptable short to normal distances); public transport (% minutes walking time to a bus stop); car ownership.

Analysis carried out for MSc dissertation. Further details of analysis is available on request. 6.27 – Access to services: percentage of households within five minutes drive time NHSHS Community 6.28 of a dentist; and within five minutes drive-time of a secondary school. This Profiles (from SNS analysis of access to services was developed for the report, Availability of data); SNS Rural Services, published by the Scottish Executive in October 2002. Further information is available from: http://www.scotland.gov.uk/library5/rural/asrs-25.asp. 6.29 – Areas of, and proximity to, derelict land. Derelict land (and buildings) is SNS (from Scottish 6.30 defined as that ‘which has been so damaged by development or use that it is Vacant and Derelict incapable of being developed for beneficial use without rehabilitation, and Land Survey) which is not being used for either the purpose for which it is held, or for a use acceptable in a local plan’. Exceptions, caveats, and full definitions are available from the ‘area data guide’ of the Scottish Neighbourhood Statistics website (http://www.sns.gov.uk). 6.31 Areas of Urban Vacant Land. Urban Vacant Land (and buildings) is defined SNS (from Scottish as ‘land located in urban settlements (defined here as GRO(S) settlements Vacant and Derelict with a population of 2,000 or more) or within one kilometre of the edge of Land Survey) such settlements which is considered to display the characteristics of urban vacant land; that is, land which is unused or unsightly, or which would benefit from development or improvement’. Exceptions, caveats, and full definitions are available from the ‘area data guide’ of the Scottish Neighbourhood Statistics website (http://www.sns.gov.uk). 6.32 Proximity to landfill sites: % of population living within 2km of a landfill SNS (from SEPA site. Based on information supplied to SNS by SEPA on the location of data) licensed landfill sites. Full details of methodology employed are available from the ‘area data guide’ of the Scottish Neighbourhood Statistics website (http://www.sns.gov.uk). 6.33 Proximity to EPER sites (sites on the European Pollutant Emissions SNS (from SEPA Register): % of population living within 2km of a EPER site. Based on data) information supplied to SNS by SEPA on location of such sites. Full details of methodology employed are available from the ‘area data guide’ of the Scottish Neighbourhood Statistics website (http://www.sns.gov.uk). 6.34 ‘Greenspace’ map, categorising land usage across Glasgow. The Forestry Commission categorisation includes the following broad groupings (and sub groups of): Scotland; Glasgow roads, water courses, railways, paths, buildings, open space (e.g. public and Clyde Valley parks and gardens, amenity greenspace, sports areas, woodland, other Structure Plan Joint functional greenspace, etc.) and other open space (e.g. farmland, moor Committee; Scottish land).This is produced using GIS software. The ‘open space’ categories are Natural Heritage based on a modified version of the Scottish Executive’s PAN65 open space typology - further details are available from Planning Advice Note: PAN 65 Planning and Open Space (http://www.scotland.gov.uk/library5/planning/pan65-00.asp). Scottish Executive, January 2003.

ix Figure Description/Notes Source No. 7.1 Alcohol consumption: percentage of adults (aged 16-64) exceeding weekly Scottish Health recommended units of alcohol. Recommended units: 21 units per week for Survey males, 14 units per week for females. 7.2 Estimated prevalence of ‘problem alcohol use’: % of population aged 15-64 University of estimated to be ‘problem alcohol users’. Data taken from a report by Glasgow Centre for University of Glasgow Centre for Drug Misuse Research for Glasgow City Drugs Misuse Council Addiction Services (see references section of Chapter 7: Behaviour). Research Figures were derived from two sources: Glasgow City Council social enquiry reports and data from a national drugs misuse prevalence report (produced by the same authors): the former allowed calculation of the ratio of problem drug users to problem alcohol users, which was then applied to the latter. Please note, therefore, these are statistically modelled estimates and, given the lack of any accurate data on prevalence of problem alcohol use in Glasgow (as acknowledged by the authors of the report) it is extremely difficult to gauge the accuracy of these findings. 7.3 – Drunk-driving offences: total number, and rate per 1,000 population aged Scottish Executive 7.4 17+. Population data taken from GRO(S). Justice Department 7.5 – Alcohol attributable and related hospitalisations: average annual acute NHSHS Community 7.7 hospital inpatient stays in the period for directly alcohol related and alcohol Profiles (from ISD attributable conditions expressed as a directly age-standardised rate per Scotland SMR1 and 100,000 population. Admissions for all ages included. Diagnostic codes SMR4 data) included within alcohol-related category were defined by ISD and are available on request or from ISD Scotland (see www.alcoholinformation.isdscotland.org). List of conditions (and weights) included within the broader alcohol-attributable category is available on request. Relevant conditions were sought in all primary and secondary admission diagnosis positions. Standardisation carried out using WHO standard world population. 7.8 Alcohol related deaths. Total deaths, based on selection of ICD9/ICD10 GRO(S) codes used by ISD Scotland – see www.alcoholinformation.isdscotland.org for more details. Note this definition differs from that used historically by GRO(S) in two ways: first, it is slightly more comprehensive in terms of the number of ICD codes used, and second, it includes not only principal (or ‘underlying’) alcohol related causes of death, but also secondary (or ‘contributing’) causes as well. Note also, however, that despite this slightly more comprehensive definition, the results will unquestionably still underestimate the true number of alcohol related deaths, given (a) its reliance on the accuracy of cause of death recording by practitioners and (b) the fact that this definition excludes conditions such as alcohol attributable cancers. Note also that secondary causes of death have been limited to three in number: from 1996, up to nine secondary causes can be recorded on the GRO death record. At a national level, limiting the number of secondary causes to three results in a 2% reduction in total numbers compared with published ISD figures. 7.9 Liver cirrhosis mortality: age-standardised rates among men aged 15-74 WHOSIS years. Data for Scotland and Greater Glasgow presented in the context of maximum, minimum, and mean rates for 16 Western European countries (Austria, Denmark, Finland, France, Germany, Ireland, Italy, N. Ireland, Netherlands, Norway, Portugal, Scotland, Spain, Sweden, Switzerland, England & Wales). Standardisation carried out using European standard world population. Definitions (including ICD codes) and methodology match those specified in: Leon, D. Scotland’s health in an international context. Public Health Institute of Scotland, 2003 (http://www.phis.org.uk/projects/network.asp?p=ff).

x Figure Description/Notes Source No. 7.10 – Drugs misuse: number, location and proportion (% of population aged 15- University of 7.12 54) of problem drug users (individuals misusing opiates or benzodiazepines). Glasgow Centre for Figures are statistically modelled estimates. Full details of methodology, Drugs Misuse definitions etc. are available from the report by Glasgow University Centre Research; SCIEH for Drugs Misuse Research and the Scottish Centre for Infection & (now renamed Health Environmental Health – see references section of Chapter 7: Behaviour. Protection Scotland) 7.13 Drugs misuse: proportion (% of population aged 15-54) of problem drug University of users (individuals misusing opiates or benzodiazepines) by LHCC area. Data Glasgow Centre for taken from same report from which data in Figure 7.2 (see above) was taken. Drugs Misuse Figures are statistically modelled estimates and should be interpreted with Research; SCIEH caution. The report authors note that the prevalence estimate for Glasgow is (now renamed Health “more reliable and robust that the estimates for the smaller LHCC areas”. It Protection Scotland) should also be noted that the estimates at LHCC level were based on aggregations of data at the postcode district level (e.g. G31) - thus the definition of an LHCC area may differ considerably from recognised LHCC boundaries. 7.14 Drug related deaths: total number of drug related deaths over a five year NHSHS Community period. The precise definition used in determining drug related deaths is Profiles (from complex, combining information on causes – and underlying causes – of GRO(S) data) death in terms of ICD codes, with other, specific information on the type of drug known to be present in the body at the time of death. Further information is available on the GRO(S) website (http://www.gro- scotland.gov.uk). 7.15 Drug related deaths: total number of drug related deaths per year. See notes GRO(S) above (7.14) for more detail. 7.16 Percentage of adults (16+) who smoke. Scottish Household Survey 7.17 – Estimated smokers: estimated percentages of current smokers (aged 16-74). NHSHS Community 7.18 NHSHS commissioned Professor Graham Moon and colleagues at the Profiles (from data University of Portsmouth to develop estimates of smoking prevalence across from Portsmouth Scotland. Estimates of smoking prevalence were created using multi-level University) modelling techniques applied to data from the Scottish Health Survey (1995, 1998) and the 2001 census. Further details of the method used are available on request. 7.19 – Smoking attributable deaths: average annual deaths due to smoking related NHSHS Community 7.20 causes (aged 35 and over) expressed as a crude rate per 100,000 population. Profiles (from data Created using a formula (Callum, C. (1998). The UK Smoking Epidemic: from Portsmouth Deaths in 1995, Health Education Authority: London.) that links smoking University) status (current smokers and ex-smokers, obtained from the smoking estimates calculation described above) with attributable risks for specific causes of death known to be linked to smoking. These estimated proportions were themselves then applied to data on seven years’ (1995-2001) of actual deaths from the selected attributable causes. Further details of the method used are available on request. 7.21 % of overweight & obese adults (aged 16+). Based on calculation of Body Scottish Health Mass Index (BMI) (weight (in kg) divided by height (in metres) squared), Survey with ‘overweight’ classed as BMI greater than 25, and obese classed as BMI greater than 30. 7.22 % of obese adults (16-64). See note above for definition of obese. Scottish Health Survey 7.23 – Diet: % of respondents who on average eat no portions of fruit per day; % of NHS Greater 7.25 respondents who on average eat no portions of vegetables (excl. potatoes) or Glasgow Health and salad per day; % of respondents who on average eat five or more portions of Well-being Survey fruit and vegetables each day. 2002

xi Figure Description/Notes Source No. 7.26 – Oral health: % of respondents who had not been to the dentist in over 15 NHS Greater 7.27 months; % of respondents who brush their teeth less than twice a day. Glasgow Health and Well-being Survey 2002 7.28 Acute sexually transmitted infections (STIs): all acute STI diagnoses per ISD Scotland 100,000 population aged 15-64. Acute STIs include the following: infectious syphilis, gonorrhoea, chlamydia, genital herpes (first episode only), genital warts (first episode only), non-specific genital infections (non-chlamydial), trichomoniasis, HIV infection (newly diagnosed only), “other acute STI”. They do not include: other acquired syphilis, congenital syphilis, genital herpes recurrence, genital warts recurrence/reregistered. Note that these figures may be influenced by proximity to genito-urinary medicine services, and higher levels of screening particular areas. 7.29 – Exercise: survey respondents taking at least 20 minutes of vigorous exercise NHS Greater 7.30 3 or more times per week; survey respondents taking at least 20 minutes of Glasgow Health and vigorous exercise three or more times per week or 30 minutes moderate Well-being Survey exercise five or more times per week 2002 7.31 Travel: percentage of the population who travel to their place of work/study 2001 Census by bicycle, foot and car. Excludes people not working or studying, or who work or study mainly at or from home.

8.1 – Teenage pregnancies: teenage (13-19) pregnancies averaged over three years NHSHS Community 8.3 expressed as a crude rate per 100 females aged 13-19. Profiles (from ISD NB Rates are based on annual averages rather than three year totals, as Scotland data); ISD used in the NHSHS Community Profiles. Scotland 8.4 Teenage abortions: average annual teenage (13-19) abortions expressed as a NHSHS Constituency rate per 100 females. Profiles (from ISD Scotland data) 8.5 – Age of first-time mothers: average age in years of first time mothers. NHSHS Community 8.6 Profiles (from ISD Scotland data) 8.7 Older mothers: births to mothers aged 30 or older as a percentage of all ISD Scotland births. 8.8 Age of mother at birth of first child. Presented by Carstairs deprivation ISD Scotland quintile. Excludes home births and births at non-NHS hospitals. 8.9 – Smoking in pregnancy: maternal smoking recorded at booking expressed as a NHSHS Community 8.12 percentage of all admissions. Profiles (from ISD Scotland data) 8.13 Smoking in pregnancy: maternal smoking recorded at booking by ISD Scotland deprivation quintile. 8.14 – Low birthweight babies: live births of low birthweight (<2500g) (totalled NHSHS Community 8.17 over three years) expressed as a percentage of all live singleton births. Profiles (from ISD Scotland data);ISD Scotland 8.18 – Breastfeeding: average percentage of children born in 2000-2002 who were NHSHS Community 8.19 being breast-fed at 6-8 week review. Includes exclusively breast fed or fed Profiles (from ISD mixed breast and bottle. NB Scottish figure is based on data for ten NHS Scotland data) Boards. 8.20 Breastfeeding: breastfeeding rates recorded at the 6-8 week review for ISD Scotland children born in 2004. Includes exclusively breast fed or fed mixed breast and bottle. 8.21 Breastfeeding: breastfeeding rates recorded at the 6-8 week review for period ISD Scotland between 1998-2004. Includes exclusively breast fed or fed mixed breast and bottle. NB Scottish figure is based on data for ten NHS boards. 8.22 – Primary immunisation uptake rate at 24 months for: (1) all immunisations NHSHS Community 8.26 excluding MMR (mumps, measles, rubella) i.e. Diphtheria, Pertussis, Profiles (from ISD Tetanus, Polio, Hib; and (2) MMR only. Scotland data)

xii Figure Description/Notes Source No.

9.1 – Children of substance misusers: estimated numbers (and percentages) of University of 9.4 children (age 0-15) with (and living with) ‘problem drug use’ and/or Glasgow Centre for ‘problem alcohol use’ parents. Data taken from a report by University of Drugs Misuse Glasgow Centre for Drug Misuse Research for Glasgow City Council Research Addiction Services (see references section of Chapter 9: Children and adolescents). The figures are statistically modelled estimates derived from a number of different data sources. It is extremely difficult to gauge the accuracy of the findings and, as with any modelled estimates, the information should be interpreted with caution. Drugs misuse figures were calculated through combining data from a national drugs misuse prevalence report (published in 2005 and referenced in the ‘Behaviour’ chapter of this report), and the Drug Outcomes Research in Scotland (DORIS) study (see: www.gla.ac.uk/centres/drugmisuse/DORIS.html). The sample size for Glasgow in the latter study was only 240. Alcohol figures were derived from Glasgow City Council social enquiry reports and the same national drugs misuse report: the former allowed calculation of the ratio of problem drug users to problem alcohol users, which was then applied to the latter. Information on the numbers of children was again derived from the fairly small DORIS cohort. 9.5 – Number and proportion (rate per 1,000) of children (aged 0-17) ‘looked Care Scotland (from 9.7 after’ by a local authority. A child is defined as ‘looked after’ by a local Scottish Executive authority: for whom they are providing accommodation under section 25 of CLA Returns) the Children (Scotland) Act 1975; who is subject to a supervision requirement; who is subject to an order made, or authorisation or warrant granted, by virtue of Ch.2, 3 or 4 of the aforementioned act, being an order, authorisation or warrant in accordance with which they (the local authority) have responsibilities as respects the child; who is subject to an order in accordance with which, by virtue of regulations made under section 33(1) of the aforementioned act, they have such responsibilities (Norrie K, (1995) Children (Scotland) Act 1995. Edinburgh: W. Green/Sweet & Maxwell). 9.8 Children looked after: reason for children being looked after by Glasgow Glasgow City City Council, as recorded on the council’s CareFirst system. Due to Council Social Work recording issues, it is difficult to obtain an accurate breakdown of the most Department common reasons for children being looked after, as a significant percentage (CareFirst system) are recorded as being in care as a result of ‘child protection orders’ – and these may have been issued for a variety of different reasons which cannot be extracted from the system. 9.9 – Child protection register: number and proportion (rate per 1,000) of children Care Scotland (from 9.10 (0-15) placed on child protection register. Children are referred to the Scottish Executive register in response to allegations of child neglect or physical, sexual, or Children Statistics) emotional abuse. Not all referrals will result in the child's name being added to the register, an action which reflects suspected or actual risk to the child. Data presented here are for placements on the register, not referrals. 9.11 – Children in workless households: percentage of dependent children living in NHSHS Community 9.12 households where no-one is in employment. Profiles (from 2001 Census data) 9.13 Pre-school overweight and obese children: children born in 1998 whose BMI NHSHS Community (body mass index) – derived from height and weight measured at the 39-42 Profiles (from ISD month review - is greater than the 85th centile. Data for Scotland exclude Scotland data) Grampian, Highland, Orkney, Shetland and Western Isles NHS Board areas. 9.14 Dental health: percentage of five year old children with zero caries (no NDIP; SHBDEP decayed, missing or filled teeth). 9.15 Dental health: percentage of five year old children with ‘obvious or advanced NDIP decay’ (as defined by NDIP risk levels 2 or 3: risk level 2 – ‘obvious evidence of decay experience and/or poor oral hygiene’; risk level 3 – ‘obvious advanced and/or widespread current decay’).

xiii Figure Description/Notes Source No. 9.16 – Dental hospital admissions among children: total (over four years) hospital NHSHS Community 9.17 inpatient stays among children (0-15) for dental related conditions. Profiles (from ISD Expressed as crude rate per 100 children. Dental-related admissions defined Scotland data) by following ICD codes: ICD9 520-528 (except 520.3, .5, .7, 523.0, .3, 528.5-528.9), ICD10 K00-K12 (except K00.3, .5, .7, K05.0, .2, K100) (principal diagnosis only). For calculation of rates, 2001 populations were used for 1999-2002. 9.18 – Adolescent smoking, drinking and drug-taking: rates of smoking (pupils SALSUS 9.26 classifying themselves as ‘regular smokers’); alcohol consumption (whether pupils had ever had an alcoholic drink; whether pupils had drunk alcohol in the previous week); and drug-taking (whether pupils had taken drugs in the past month) among 13 and 15 year olds. 9.27 Teenage alcohol attributable/related hospitalisations: average annual acute NHSHS Community hospital inpatient stays for 13-19 year olds for directly alcohol related and Profiles (from ISD alcohol attributable conditions expressed as a crude rate per 100 population Scotland SMR1 and aged 13-19. Diagnostic codes included within alcohol-related category were SMR4 data) defined by ISD and are available on request or from ISD Scotland (see http://www.alcoholinformation.isdscotland.org). List of conditions (and weights) included within the broader alcohol-attributable category is available on request. Relevant conditions were sought in all primary and secondary admission diagnosis positions. 9.28 Child road accident casualties: total number of child (0-15) casualties Scottish Executive expressed as a crude rate per 10,000 population aged 0-15. Note that casualties data were obtained from the Scottish Executive with rates then calculated based on the resident population of each council area. It is worth noting that casualties are assigned to a council area in which an accident occurred. However, clearly not all casualties necessarily come from the area where the accident occurred and, where traffic volumes are high and the road systems are most developed, there is a likelihood of higher numbers of casualties occurring. These caveats should be borne in mind when interpreting the rates presented.

10.1 – Limiting long-term illness: percentage of individuals perceiving that they NHSHS Community 10.2 have a limiting long-term illness, health problem or disability which limits Profiles (from 2001 their daily activities or the work they can do, including problems that are due Census data) to old age. 10.3 – Self assessed health: percentage of individuals classifying their health as ‘not NHSHS Community 10.4 good’. This is derived from the census question on self-assessment of each Profiles (from 2001 person's general health over the last year. Three options are included on the Census data) census form: ‘Good’, ‘Fairly Good’, ‘Not Good’. 10.5 – Unable to work due to disability: percentage of working age population NHSHS Community 10.7 (women 16-59; men 16-64) claiming Incapacity Benefit (IB) or Severe Profiles (from DWP Disablement Allowance (SDA). Incapacity Benefit is a contributory, non- data); DWP means tested benefit. It is paid to people who are assessed as being incapable of work and who meet the appropriate contribution conditions. Severe Disablement Allowance is non-contributory, non-means tested benefit. People who are incapable of work and do not satisfy the contribution conditions for Incapacity Benefit (IB) may get SDA. 10.8 – Disability Living Allowance claimants: percentage of population aged 18-64 NHSHS Community 10.9 claiming Disability Living Allowance (Mobility Component). DLA is Profiles (from DWP payable to people who are disabled and who have personal care needs, data) mobility needs or both. The mobility component is for people who need help with getting around (it is not available for children under three).

xiv Figure Description/Notes Source No. 10.10 – Blue badge holders: total number (and rate per 100 population aged 17+) of Scottish Executive’s 10.12 blue (and orange (pre-April 2003)) badges issued. Includes badges issued on Scottish Transport automatic and discretionary basis. Badges issued in the automatic categories Statistics are to recipients of: mobility allowances; the higher rate of mobility component of Disability Living Allowance; Government issued cars or grants towards their own cars; War Pensioners' Mobility Supplement; or to registered blind people. Badges granted in the discretionary category to people with a permanent and substantial disability who are unable or nearly unable to walk.

Note, however, that it is unclear to what extent the variation in rates across the country is attributable to need, to different council practices or just to differences in age structure. 10.13 – Attendance Allowance claimants: percentage of population aged 65+ NHSHS Community 10.14 claiming Attendance Allowance benefit. Attendance Allowance is a benefit Profiles (from DWP for people over the age of 65 who are so severely disabled, physically or data) mentally, that they need a great deal of help with personal care or supervision.

11.1 – Estimates of disease prevalence at primary care level. The figures presented ISD Scotland 11.8 in this section are taken from the QOF (Quality and Outcomes Framework) (QMAS Database as data first published by ISD Scotland in summer 2005. The data – collated as at May 2005) part of the system to remunerate GPs within the agreed new General Medical Service (GMS) contract – include, for each practice, the total number of patients recorded on each of eleven separate disease registers. Participation in the scheme is, however, voluntary, and the data presented in Chapter 11: Illness and disease, for the NHS Greater Glasgow area, covers 210 out of the 215 Greater Glasgow practices. Two important points to note with regard to these data are highlighted in Chapter 11: (1) given the five missing GP practices, the figures will be an underestimate of the true disease prevalence of each disease category; (2) the data are currently not available by age or sex: thus, where crude rates are presented, they do not take into account the age/sex structures of the populations. Variations in rates could thus be a consequence of, for example, larger proportions of elderly patients within a practice population.

Data presented at small area level (Figures 11.2-11.8) are GP Practice level data, with postcode sector of the GP Practice assigned a descriptive name from the list used in the community profiles (see Appendix 2 for full list).

The total numbers of patients on disease registers (Figure 11.1) differ very slightly from figures published by ISD Scotland, due to differences in the total number of practices included in the analyses.

Prevalence rates for diabetes and epilepsy at GP Practice level differ slightly from figures published by ISD Scotland as rates have been calculated per 100 practice population aged 15+, whereas data published by ISD data used the total practice population as denominator.

Further information, data and definitions are available from: http://www.isdscotland.org/qof . 11.9 – Hospital admissions – diabetes: average annual numbers and directly age- NHSHS Community 11.12 standardised rates per 100,000 population of acute hospital continuous Profiles (from ISD inpatient stays for particular diagnoses (ICD9 250; ICD10 E10-E14 (all Scotland SMR1 data) diagnostic positions)). Standardisation carried out using WHO standard world population.

xv Figure Description/Notes Source No. 11.13 – Hospital admissions – external causes: average annual numbers and directly NHSHS Community 11.16 age-standardised rates per 100,000 population of acute hospital continuous Profiles (from ISD inpatient stays for particular diagnoses (ICD9 E800-E999; ICD10 V01-Y98 Scotland SMR1 data) (all secondary diagnoses)). Standardisation carried out using WHO standard world population. 11.17 Hospital admissions – deliberate self harm: average annual numbers and NHSHS Community directly age-standardised rates per 100,000 population of acute hospital Profiles (from ISD continuous inpatient stays for particular diagnoses (ICD9 E950-E959; ICD10 Scotland SMR1 data) X60-X84 (all secondary diagnoses)). Standardisation carried out using WHO standard world population. 11.18 – First hospital admissions – psychiatric: average annual numbers and directly NHSHS Community 11.19 age-standardised rates for all first psychiatric inpatient episodes (mental Profiles (from ISD health). Standardisation carried out using WHO standard world population. Scotland SMR4 data) 11.20 Road accident casualties: number and rate per 10,000 population of Transport Statistics, casualties (all adults and children (0-15 years)) injured in road accidents. Scottish Executive Road accidents and casualties are geographically referenced to the location of the accident. Thus, the rate of casualties presented is based on the number of road accident casualties in an area divided by the population in that area. Clearly not all casualties necessarily come from the area where the accident occurred and, where traffic volumes are high and the road systems are most developed, there is a likelihood of higher numbers of casualties occurring. These caveats should be borne in mind when interpreting the rates presented. 11.21 Ischaemic heart disease mortality: age standardised rates among men aged GRO(S) 15-74 years. Standardisation carried out using European standard world population. Definitions (including ICD codes) and methodology match those specified in: Leon, D. Scotland’s health in an international context. Public Health Institute of Scotland, 2003 (http://www.phis.org.uk/projects/network.asp?p=ff). 11.22 Deaths from heart disease (all forms): average annual deaths due to heart NHSHS Community disease (ICD9 390-429; ICD10 I00-I52 (principal cause only) expressed as Profiles (from number and directly age-standardised rate per 100,000 population. Includes GRO(S) data) deaths at all ages. Excludes non-Scottish residents. Standardisation carried out using WHO standard world population. 11.23 Cerebrovascular disease mortality: age standardised rates among men aged GRO(S) 15-74 years. Standardisation carried out using European standard world population. Definitions (including ICD codes) and methodology match those specified in: Leon, D. Scotland’s health in an international context. Public Health Institute of Scotland, 2003 (http://www.phis.org.uk/projects/network.asp?p=ff). 11.24 Suicide: age standardised rates among men aged 15-74 years. GRO(S) Standardisation carried out using European standard world population. Definitions (including ICD codes) and methodology match those specified in: Leon, D. Scotland’s health in an international context. Public Health Institute of Scotland, 2003 (http://www.phis.org.uk/projects/network.asp?p=ff). 11.25 – Deaths from cancer: average annual deaths due to all malignant neoplasms NHSHS Community 11.26 (ICD9 140-208; ICD10 C00-C97 (principal cause only)) expressed as Profiles (from number and directly age-standardised rate per 100,000 population. Includes GRO(S) data) deaths at all ages. Excludes non-Scottish residents. Standardisation carried out using WHO standard world population. 11.27 – Lung cancer mortality: age standardised rates among men and women aged GRO(S) 11.28 15-74 years. Standardisation carried out using European standard world population. Definitions (including ICD codes) and methodology match those specified in: Leon, D. Scotland’s health in an international context. Public Health Institute of Scotland, 2003 (http://www.phis.org.uk/projects/network.asp?p=ff).

xvi Figure Description/Notes Source No. 11.29 Premature mortality: male and female deaths under the age of 65 expressed GRO(S) as percentage of all deaths. Note that these proportions do not take account of the age structure of the population, and thus could be influenced by higher than average under 65 populations in any of the communities. 11.30 – Ten most frequently occurring principal causes of death under the age of 65 GRO(S) 11.33 (shown as percentage of all deaths under 65).

12.1 Projections of male life expectancy at birth in years. Applied to data from Projections created applying a simple linear regression to past life Office for National expectancy trends. Statistics (ONS) 12.2 Projections of alcohol related mortality. Projections created applying a Applied to GRO(S) simple linear regression to past alcohol related mortality trends. data See note for Figure 7.8 (above) for more details of the calculation of alcohol related mortality from death registrations.

xvii

Appendix 2: Postcode sectors

Appendix 2: Greater Glasgow and West of Scotland postcode sectors

The following postcode sectors are those contained within the West of Scotland ‘communities’ used in the analyses. With some minor adaptations, the descriptive names are those that were used in the Community Profiles. Although we believe that presenting the information in this way is more meaningful to the reader, it should be noted that these names are very approximate, and the boundaries of postcode sectors will seldom match natural communities.

Note that in the Community Profiles, particularly small postcode sectors (i.e. with populations of less than 1,000 people) were aggregated to produce areas with a larger population for which more robust statistics could be presented.

(Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) G1 1, G1 2, G1 3, G1 4, City Centre Bridgeton and G G1 5, G2 1, G2 2, G2 3, Dennistoun G2 4, G2 5, G2 6, G2 7, G2 8 G11 5 Partickhill Glasgow West End G G11 6 Meadowside Glasgow West End G G11 7 Broomhill Glasgow West End G G12 0 Kelvindale; Kelvinside Glasgow West End G G12 8 Hillhead Glasgow West End G G12 9 Hyndland; Dowanhill Glasgow West End G G13 1 Jordanhill; Temple Anniesland, G Bearsden and Milngavie G13 2 Knightswood N Glasgow West End G G13 3 Knightswood S Glasgow West End G G13 4 Yoker N Glasgow West End G G14 0 Yoker S Glasgow West End G G14 9 Scotstoun Glasgow West End G G15 6 Drumchapel SE Clydebank and G Drumchapel G15 7 Drumchapel NE Clydebank and G Drumchapel G15 8 Drumchapel W Clydebank and G Drumchapel G20 0 Maryhill N Maryhill, Woodside G and North Glasgow G20 6 Kelvin N Glasgow West End G G20 7 Woodside Maryhill, Woodside G and North Glasgow G20 8 Kelvinside N Maryhill, Woodside G and North Glasgow G20 9 Ruchill Maryhill, Woodside G and North Glasgow G21 1 Cowlairs Maryhill, Woodside G and North Glasgow G21 2 Garngad; Royston Bridgeton and G Dennistoun G21 3 Barmulloch; Robroyston Maryhill, Woodside G and North Glasgow G21 4 Balornock Maryhill, Woodside G and North Glasgow G22 5 Hamiltonhill Maryhill, Woodside G and North Glasgow

xviii (Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) G22 6 Parkhouse Maryhill, Woodside G and North Glasgow G22 7 High Possil Maryhill, Woodside G and North Glasgow G23 5 Summerston Maryhill, Woodside G and North Glasgow G3 6 Park Circus; Woodlands…. Glasgow West End G G3 7 Kelvingrove Glasgow West End G G3 8 Yorkhill Glasgow West End G G31 1 Camlachie Bridgeton and G Dennistoun G31 2 Dennistoun Bridgeton and G Dennistoun G31 3 Haghill Bridgeton and G Dennistoun G31 4 Parkhead S Eastern Glasgow G G31 5 Parkhead N Eastern Glasgow G G32 0 Springboig; Mount Vernon N Eastern Glasgow G G32 6 Carntyne Eastern Glasgow G G32 7 Shettleston; Tollcross Eastern Glasgow G G32 8 Carmyle Eastern Glasgow G G32 9 Sandyhills; MountVernon Eastern Glasgow G G33 1 Blackhill Eastern Glasgow G G33 2 Riddrie Eastern Glasgow G G33 3 Ruchazie Eastern Glasgow G G33 4 Barlanark Eastern Glasgow G G33 5 Garthamlock Eastern Glasgow G G33 6 Stepps Eastern Glasgow G G34 0 Easterhouse E Eastern Glasgow G G34 9 Easterhouse W Eastern Glasgow G G4 0 Townhead Bridgeton and G Dennistoun G4 9 Port Dundas; Woodlands Glasgow West End G G40 1 Bridgeton W Bridgeton and G Dennistoun G40 2 Calton Bridgeton and G Dennistoun G40 3 Bridgeton E Bridgeton and G Dennistoun G40 4 Dalmarnock Bridgeton and G Dennistoun G41 1 Kinning Park S South West Glasgow G G41 2 Strathbungo Greater Shawlands G G41 3 Shawlands Greater Shawlands G G41 4 Dumbreck Greater Shawlands G G41 5 Pollokshields; Bellahouston Greater Shawlands G G42 0 Polmadie; Toryglen South East Glasgow G G42 7 Govanhill N South East Glasgow G G42 8 Crosshill South East Glasgow G G42 9 Battlefield South East Glasgow G G43 1 Pollokshaws Greater Shawlands G G43 2 Newlands Eastwood G G44 3 Cathcart South East Glasgow G G44 4 Kingspark South East Glasgow G

xix (Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) G44 5 Croftfoot; Linn Park South East Glasgow G G45 0 Castlemilk E South East Glasgow G G45 9 Castlemilk W South East Glasgow G G46 6 Giffnock Eastwood G G46 7 Thornliebank Eastwood G G46 8 Carnwadric; Darnley E Greater Shawlands G G5 0 Hutchesontown; Gorbals; Oatlands South East Glasgow G G5 8, G5 9 Tradeston; Gorbals South East Glasgow G G51 1 Kinning Park N South West Glasgow G G51 2 Ibrox South West Glasgow G G51 3 Govan South West Glasgow G G51 4 Shieldhall South West Glasgow G G52 1 Craigton; Mosspark South West Glasgow G G52 2 Cardonald N; Hillington South West Glasgow G G52 3 Cardonald S South West Glasgow G G52 4 Penilee South West Glasgow G G53 5 Pollok South West Glasgow G G53 6 Nitshill South West Glasgow G G53 7 Hurlet; Nitshill; Darnley South West Glasgow G G60 5 Old Kilpatrick Clydebank and G Drumchapel G61 1 Bearsden - Westerton Anniesland, G Bearsden and Milngavie G61 2 Bearsden - Kessington Anniesland, G Bearsden and Milngavie G61 3 Bearsden - Kilmardinny Anniesland, G Bearsden and Milngavie G61 4 Bearsden - Castlehill; Thorn Anniesland, G Bearsden and Milngavie G62 6 Milngavie - Keystone; Dougalston Anniesland, G Bearsden and Milngavie G62 7 Milngavie - Clober; Mains Est. Anniesland, G Bearsden and Milngavie G62 8 Milngavie - Barloch Anniesland, G Bearsden and Milngavie G64 1 Bishopbriggs E; Auchinairn Strathkelvin G G64 2 Bishopbriggs W Strathkelvin G G64 3 Bishopbriggs N; Cadder Strathkelvin G G64 4 Torrance; Balmore Strathkelvin G G65 0 Kilsyth Cumbernauld W G65 9 Balmalloch; Queenzieburn Cumbernauld W G66 1 Kirkintilloch W Strathkelvin G G66 2 Kirkintilloch N; Hillhead Strathkelvin G G66 3 Kirkintilloch S; Waterside Strathkelvin G G66 4 Lenzie N Strathkelvin G G66 5 Lenzie S; Auchinloch Strathkelvin G G66 7 Lennoxtown Strathkelvin G

xx (Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) G66 8 Milton Of Campsie Strathkelvin G G67 1 Seafar Cumbernauld W G67 2 Lenziemill; Kildrum Cumbernauld W G67 3 Abronhill Cumbernauld W G67 4 Condorrat; Mollinsburn Cumbernauld W G68 0 Cumbernauld Village; Dullatur Cumbernauld W G68 9 Balloch; Westfield Cumbernauld W G69 0 Moodiesburn Eastern Glasgow G G69 6 Baillieston N Eastern Glasgow G G69 7 Baillieston S Eastern Glasgow G G69 8 Gartcosh Eastern Glasgow G G69 9 Chryston Eastern Glasgow G G71 5 Viewpark Motherwell W G71 6 Tannochside Motherwell W G71 7 Uddingston Hamilton W G71 8 Bothwell Hamilton W G72 0 Blantyre S; High Blantyre Hamilton W G72 7 Cambuslang N Cambuslang and G Rutherglen G72 8 Cambuslang S Cambuslang and G Rutherglen G72 9 Blantyre N Hamilton W G73 1 Rutherglen N Cambuslang and G Rutherglen G73 2 Rutherglen W Cambuslang and G Rutherglen G73 3 Rutherglen E Cambuslang and G Rutherglen G73 4 Rutherglen SW Cambuslang and G Rutherglen G73 5 Rutherglen SE Cambuslang and G Rutherglen G74 1 East Kilbride - Centre East Kilbride W G74 2 East Kilbride E - Saint Leonards East Kilbride W G74 3 East Kilbride NE - Calderwood East Kilbride W G74 4, G74 5 East Kilbride NW; Thorntonhall East Kilbride W G75 0 East Kilbirde SE - The Murray; East Kilbride W Whitehills G75 8 East Kilbride SW - Westwood; East Kilbride W Hairmyres G75 9 East Kilbride S - Greenhills East Kilbride W G76 0 Eaglesham Eastwood G G76 7 Clarkston Eastwood G G76 8 Busby Eastwood G G76 9 Carmunnock Cambuslang and G Rutherglen G77 5 Broom; Kirkhill; Mearns Eastwood G G77 6 Newton Mearns Eastwood G G78 1 Barrhead W Paisley and Levern W Valley G78 2 Barrhead E Paisley and Levern W Valley G78 3, G78 4 Neilston; Uplawmoor Paisley and Levern W Valley

xxi (Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) G81 1 Whitecrook Clydebank and G Drumchapel G81 2 Drumry; Linnvale Clydebank and G Drumchapel G81 3 Radnor Park Clydebank and G Drumchapel G81 4 Dalmuir Clydebank and G Drumchapel G81 5 Faifley Clydebank and G Drumchapel G81 6 Duntocher; W Hardgate Clydebank and G Drumchapel G82 1 Dumbarton E Lomond W G82 2 Milton Lomond W G82 3 Dumbarton N Lomond W G82 4 Renton; Kirktonhill Lomond W G82 5 Cardross Lomond W G83 0 Alexandria Lomond W G83 7, G83 8 Arrochar Lomond W G83 9 Bonhill; Jamestown Lomond W G84 0 Garelochhead Lomond W G84 7 Helensburgh E Lomond W G84 8 Helensburgh; Rhu Lomond W G84 9 Glen Fruin Lomond W KA1 1 Kilmarnock East Ayrshire W KA1 2 Kilmarnock; Bonnyton; Grange East Ayrshire W KA1 3 Kilmarnock Centre; Bellfield East Ayrshire W KA1 4 Riccarton; Shortlees East Ayrshire W KA1 5 Hurlford East Ayrshire W KA10 6 Troon-Town Centre; Barassie South Ayrshire W KA10 7 Troon-Muirhead; Loans; Barassie South Ayrshire W KA11 1 Girdle Toll; Stanecastle; Bourtreehill; North Ayrshire W Broomlands KA11 2 Perceton; Sourlie; Doura; Roddinghill North Ayrshire W KA11 3 Springside North Ayrshire W KA11 4, KA11 5 Irvine; Dreghorn North Ayrshire W KA12 0 Irvine North Ayrshire W KA12 8 Fullarton North Ayrshire W KA12 9 Irvine Centre; Stanecastle North Ayrshire W KA13 6 Kilwinning North Ayrshire W KA13 7 Kilwinning North Ayrshire W KA14 3, KA15 1 Glengarnock; Longbar North Ayrshire W KA15 2 Beith North North Ayrshire W KA16 9 Newmills; Greenholm East Ayrshire W KA17 0 Darvel East Ayrshire W KA18 1 Cumnock East Ayrshire W KA18 2 Ochiltree; Auchinleck East Ayrshire W KA18 3 Muirkirk; Smallburn; Lugar; Logan East Ayrshire W KA18 4 New Cumnock East Ayrshire W KA19 7 Maybole; Crosshill; Straiton South Ayrshire W KA19 8 Maybole South Ayrshire W KA2 0 Knockentiber; Crosshouse East Ayrshire W KA2 9 Dundonald South Ayrshire W KA20 3 Stevenston; Auchenharvie North Ayrshire W

xxii (Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) KA20 4 Stevenston North Ayrshire W KA21 5 Saltcoats South North Ayrshire W KA21 6 Saltcoats North North Ayrshire W KA22 7 Ardrossan; Whitlees; Chapelhill North Ayrshire W KA22 8 Ardrossan North Ayrshire W KA23 9 West Kilbride North Ayrshire W KA24 4 Dalry North Ayrshire W KA24 5 Dalry; Drakemyre North Ayrshire W KA25 6 Kilbirnie South North Ayrshire W KA25 7 Kilbirnie North North Ayrshire W KA26 0 Ballantrae; Colmonell; Barrhill South Ayrshire W KA26 9 Old Dally; Dally; Turnberry South Ayrshire W KA27 8 Holy Island; Isle of Arran North Ayrshire W KA28 0 Millport North Ayrshire W KA29 0 Glenside; Fairlie; Kelburn North Ayrshire W KA3 1 Altonhill; Knockinlaw.... East Ayrshire W KA3 2 Kilmaurs; Kirktoun; Onthank East Ayrshire W KA3 3 Stewarton East Ayrshire W KA3 4 Lugton; Dunlop East Ayrshire W KA3 5 Stewarton; Fulwood; Kingsford East Ayrshire W KA3 6 Southcraigs; Fenwick East Ayrshire W KA3 7 Whinpark; New Farm Loch; East Ayrshire W Beansburn KA30 8 Largs North Ayrshire W KA30 9 Largs East North Ayrshire W KA4 8 Galston East Ayrshire W KA5 5 Tarbolton East Ayrshire W KA5 6 Mauchline; Catrine; Sorn East Ayrshire W KA6 5 Mossblown; Annbank South Ayrshire W KA6 6 Coylton; Dalrymple; Hollybush South Ayrshire W KA6 7 Patna; Dalmellington…. East Ayrshire W KA7 1 Ayr - Harbour and W Town Centre South Ayrshire W KA7 2 Ayr; Belmont South Ayrshire W KA7 3 Holmston; Forehill; Belmont; South Ayrshire W Castlehill; Masonhill; Kincaidston KA7 4 Doonfoot; Alloway South Ayrshire W KA8 0 Dalmilling; Craigie South Ayrshire W KA8 8 Woodfield; Wallacetown South Ayrshire W KA8 9 Heathfield; Whitletts.. South Ayrshire W KA9 1 Prestwick South Ayrshire W KA9 2 Monkton South Ayrshire W ML1 1 Motherwell E Motherwell W ML1 2 Motherwell S - Knoweton; Muirhouse Motherwell W ML1 3 Motherwell N Motherwell W ML1 4 Holytown Motherwell W ML1 5 Newarthill; Cleland Wishaw W ML10 6 Strathaven East Kilbride W ML11 0 Lesmahagow; Coalburn; Douglas Clydesdale W ML11 7 Lanark Clydesdale W ML11 8 Carstairs; Forth; Carnwath Clydesdale W ML11 9 Blackwood; Kirkmuirhill; Rigside Clydesdale W ML12 6 Biggar; Leadhills; Abington Clydesdale W ML2 0 Netherton; Overton Wishaw W ML2 7 Wishaw W Wishaw W

xxiii (Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) ML2 8 Wishaw E- Coltness; Greenhead Wishaw W ML2 9 Newmains Wishaw W ML3 0 Hamilton N- Whitehill; Burnbank Hamilton W ML3 6 Hamilton NE Hamilton W ML3 7 Hamilton SE - Barncluith; Eddlewood Hamilton W ML3 8 Hamilton SW - Laighstonehall; Hamilton W Fairhill ML3 9 Hamilton W - Udston Hamilton W ML4 1 Bellshill N Motherwell W ML4 2 Orbiston; Milnwood Motherwell W ML4 3 Bellshill W Motherwell W ML5 1 Coatbridge West Airdrie and W Coatbridge ML5 2 Glenboig; Marnock Airdrie and W Coatbridge ML5 3 Cliftonville Airdrie and W Coatbridge ML5 4 Carnbroe; Shawhead Airdrie and W Coatbridge ML5 5 Old Monkland; Kirkwood Airdrie and W Coatbridge ML6 0 Burnfoot; Glenmavis Airdrie and W Coatbridge ML6 6 Airdrie North Airdrie and W Coatbridge ML6 7 Caldercruix; Longriggend Airdrie and W Coatbridge ML6 8 Chapelhall; Craigneuk Airdrie and W Coatbridge ML6 9 Coatdyke; Calderbank Airdrie and W Coatbridge ML7 4 Shotts; Salsburgh Wishaw W ML7 5 Allanton; Stane; Harthill Wishaw W ML8 4 Carluke Clydesdale W ML8 5 Rosebank; Crossford; W Carluke Clydesdale W ML9 1 Larkhall W Hamilton W ML9 2 Larkhall E Hamilton W ML9 3 Stonehouse Hamilton W PA1 1 Paisley Central Paisley and Levern W Valley PA1 2 Millarston Paisley and Levern W Valley PA1 3 Ralston Paisley and Levern W Valley PA10 2 Kilbarchan Renfrew and West W Renfrewshire PA11 3 Bridge of Weir Renfrew and West W Renfrewshire PA12 4 Lochwinnoch Renfrew and West W Renfrewshire PA13 4 Kilmacolm Inverclyde W PA14 5 Port Glasgow W Inverclyde W PA14 6 Port Glasgow E; Langbank Inverclyde W PA15 1 Greenock Central Inverclyde W PA15 2 Greenock E Inverclyde W

xxiv (Merged) postcode Descriptive name Community Greater Glasgow (G) sectors or other West of Scotland (W) PA15 3 Greenock SE Inverclyde W PA15 4 Greenock Rankin Inverclyde W PA16 0 Inverkip; Greenock SW Inverclyde W PA16 7 Greenock Esplanade Inverclyde W PA16 8 Greenock Finnart Inverclyde W PA16 9 Loch Thom Inverclyde W PA17 5 Skelmorlie; Meigle; Auchengarth North Ayrshire W PA18 6 Wemyss Bay Inverclyde W PA19 1 Gourock Inverclyde W PA2 0 Foxbar Paisley and Levern W Valley PA2 6 Espedair Paisley and Levern W Valley PA2 7 Hunterhill Paisley and Levern W Valley PA2 8 Glenburn Paisley and Levern W Valley PA2 9 Lounsdale Paisley and Levern W Valley PA3 1 Ferguslie Park Paisley and Levern W Valley PA3 2 Laigh Park Paisley and Levern W Valley PA3 3 Linwood Renfrew and West W Renfrewshire PA3 4 Gallowhill Paisley and Levern W Valley PA4 0 Renfrew S Renfrew and West W Renfrewshire PA4 8 Renfrew N Renfrew and West W Renfrewshire PA4 9 Inchinnan Renfrew and West W Renfrewshire PA5 0 Johnstone Castle Renfrew and West W Renfrewshire PA5 8 Johnstone Renfrew and West W Renfrewshire PA5 9 Elderslie Renfrew and West W Renfrewshire PA6 7 Houston Renfrew and West W Renfrewshire PA7 5 Bishopton Renfrew and West W Renfrewshire PA8 6 Erskine W Renfrew and West W Renfrewshire PA8 7 Erskine E Renfrew and West W Renfrewshire PA9 1 Howwood Renfrew and West W Renfrewshire

xxv Appendix 3: Table of abbreviations

Appendix 3: Table of abbreviations

ABI Annual Business Inquiry ASHE Annual Survey of Hours and Earnings BMI Body Mass Index BTS Below Tolerable Standard CHCP Community Health and Care Partnership CHD Coronary Heart Disease CHP Community Health Partnership CLA Children Looked After COPD Chronic Obstructive Pulmonary Disease Dep Quin Deprivation Quintile DLA Disability Living Allowance DORIS Drug Outcomes Research in Scotland DWP Department for Work and Pensions EHS3 Environmental Health Surveillance System for Scotland EPA Environmental Protection Act EPER European Pollutant Emissions Register FCS Forestry Commission Scotland FQA Four Quarter Average GCPH Glasgow Centre for Population Health GCVSPJC Glasgow and Clyde Valley Structure Plan Joint Committee GHA Glasgow Housing Association GIS Geographical Information System GMS General Medical Service GRO(S)/GROS The General Register Office for Scotland GVA Gross Value Added HESA Higher Education Statistics Agency Hib Haemophilus influenzae type b HLE Healthy Life Expectancy HRP Household Reference Person IB Incapacity Benefit ICD International Classification of Diseases IPPC Industrial Pollution Prevention and Control IS Income Support ISD Scotland Information Services Division of NHS National Services Scotland LE Life Expectancy LEAMS Local Environmental Audit and Management System LHCC Local Healthcare Cooperative LLI Limiting Long-term Illness MMR Measles, Mumps, Rubella MOH Medical Officer of Health (of the City of Glasgow) NES New Earnings Survey NDIP National Dental Inspection Programme NHSGG NHS Greater Glasgow NHSHS NHS Health Scotland NOMIS National Online Manpower Information System ONS Office for National Statistics OPEC Organisation of Petroleum Exporting Countries PAN Planning Advice Note QMAS Quality Management and Analysis System QOF Quality and Outcomes Framework RF Regional Forecasts RTRA Road Traffic Reduction Act

xxvi SALSUS Scottish Schools Adolescent Lifestyle & Substance Use Survey SCIEH Scottish Centre for Infection and Environmental Health SDA Severe Disablement Allowance SE Scottish Executive SEPA Scottish Environment Protection Agency SHBDEP Scottish Health Boards' Dental Epidemiological Programme SHCS Scottish House Condition Survey SHHS Scottish Household Survey SHS Scottish Health Survey SIMD Scottish Index of Multiple Deprivation SIP Social Inclusion Partnership SMR1/2/4 Scottish Morbidity Records SNH Scottish Natural Heritage SNS Scottish Neighbourhood Statistics STI Sexually Transmitted Infections SVDLS Scottish Vacant and Derelict Land Survey TIA Transient Ischaemic Attack WHO World Health Organisation WHOSIS World Health Organisation Statistical Information System

xxvii