Don’t over-simplify our health issues

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It may be something to do with her role as an arts commentator – as the arts encompass all the tragedies and comedies of human life – but Joyce McMillan unfailingly gets to the heart of the ­matter when she talks about the problems affecting contemporary society (Perspective, 14 December).

In her piece on the health problem of the “lost world” she powerfully challenges the tendency of some commentators to blame people for doing things which have been proven to damage their health: smoking, eating too much, drinking too much 
alcohol or taking recreational drugs.

We could add to that list: driving too fast, especially by young drivers. All of these health risks, as she suggests, have developed in the main because people’s daily lives lack interest, comradeship and meaning. This is not to excuse, for example, someone who drives at 70mph round a bend and kills another driver, but to point out that people who feel they have a significant stake in ­society tend to be less reckless with life.

Here in the North-east we are supposed to have a better health record than some areas of Scotland – this may be due in part to the cosmopolitan nature of the area, which offers a significant number of very highly paid professional jobs.

However, not all jobs in the energy sector are professional or well paid and some, especially offshore, are both dangerous and disruptive to family life.

I suspect people are ­resigned to doing them because we have a history in this area of people undertaking physically stressful and dangerous jobs – in farming or fishing, for example.

People doing these jobs traditionally relaxed by hard drinking, and smoking was a means of relieving stress. The physical labour was not of the kind which enhances health either, but at least most people felt they had something to contribute to wider society through their work.

Now we tend to value only those individuals who are high earners, usually those in the so-called “knowledge economy” rather than manual labour. And, as Joyce says, we blame those who cannot find work when all the evidence shows there are not enough meaningful jobs for all those who want them.

Joyce is quite right that there is no quick fix for this situation, but blaming people for the coping strategies they adopt, however damaging these strategies might be, is to miss the point of why they need them in the first place.

(Dr) Mary Brown

Dalvenie Road


It is all very well for Joyce McMillan to point to the link between unemployment, 
ill-health and substance abuse; the flaw in her argument is that when the traditional industries boomed, alcohol and cigarette use 
was greater (they are slowly declining).

While there is probably a link between unemployment and hopelessness, culture plays a part in poor health, ie the macho man image of smoking and drinking.

William Ballantine

Dean Road

Bo’ness, West Lothian

Your leader, “Is there a will to bridge the great health divide?” (14 December), asks a valid question, deserving of an honest answer.

Statistics obtained from a recent Audit Scotland report reveal, as you suggest, a shocking disparity between the health of Scots in different parts of the country.

It is likely that a large number of Scots would agree that something has to be done to address this societal problem.

However, your suggested solution of simply diverting resources from affluent areas to deprived areas seems simply to be a panacea, from which there is no guarantee of a successful outcome.

Quadrupling the availability of GPs to recognised areas of deprivation is unlikely to provide a long-standing 
solution. The two key words of your leader headline, I would suggest, are “will” and “bridge”.

However, the “will” surely has to be a responsibility shared between the different elements of society.

Poor diet, living conditions, alcohol abuse, smoking and obesity are all major contributors in the spiral of ill-health, described by the Auditor General as entrenched in areas of Scottish society.

These are mostly personal choices. Is it too much to expect of individuals to take some responsibility for their own health and to take life-altering decisions to improve both their lifestyles and their health.

The diversion of funding from more affluent areas in an attempt to begin to bridge the gap would certainly be necessary, and it is important that such increased funding should be directed at improved health education and early intervention programmes aimed at both young and old in identified areas of deprivation.

This first step can surely be an achievable aim which can be brought about by involving the collective will of Scottish society.

This is far too important an issue for party political point-scoring, as shadow health secretary Jackie Baillie should well recognise.

Previous Labour administrations in Holyrood were obviously unable to solve a problem which has existed in Scotland for decades.

If society can be persuaded to work together, then we might see at least the possibility of some success in dealing with the problem.

Ian Hendry



The often repeated mantra that poverty causes ill-health (in Britain) is piffle. True, poverty and ill-health often coincide, but coincidence, as the philosopher David Hume took great pains to point out, is not causality.

The nonsense mantra is disproved if even one case exists of a poor person being in good health; and there are plenty.

Progress cannot long be based upon lies. The guilty party is not poverty but incompetence.

Two families in otherwise identical circumstances other than health can also be distinguished by the wise/foolish management of their often scarce resources.

An extreme solution may be for the state to oblige people at risk to spend sensibly (vouchers for good food, clothing, heating and shelter instead of cash?) We should then see the health gap gradually diminish to almost ­vanishing point.

Tim Flinn


East Lothian