Bad hearts belong to Glasgow: It is the world's worst city for coronary deaths in women, second worst for men. Cal McCrystal asks why

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The Independent Online
MUNCHING a cheeseburger in Drumchapel community centre for the unemployed in north Glasgow, Anne Gallie ticked off items in life's grim menu. 'I'm a smoker. I make chips in roast-beef dripping. I brought up a family of eight, all of them with a sweet tooth. We go through four loaves of bread a day and whatever puddings are going, though we're not fond of custard. We eat all kinds of biscuits. But it's a hard life, and there's been a lot of stress.'

Stress, rather than diet, she said, was probably to blame for her angina. For the past 16 of her 65 years she has been taking pills for reducing blood pressure. If she is very careful, and very lucky, Mrs Gallie may avoid joining the ranks of those who have put Glasgow at the top of the international league for heart attacks in women.

Women in Glasgow are more likely to die from coronary heart disease than anywhere else, according to the latest World Health Organisation study. Glasgow men are the second most vulnerable group (after Finland). The WHO report, published last week, looked at selected areas of Australia, Belgium, Canada, China, the Czech Republic, Denmark, Finland, France, Germany, Iceland, Italy, Lithuania, New Zealand, Poland, Russia, Spain, Sweden, Switzerland, the USA, Yugoslavia and the UK (Glasgow and Belfast).

The cheeseburger was Mrs Gallie's lunch - 'First bite I've had today.' Coleslaw squelched from between meat and bun, a symbol of the community cafe's new 'health-consciousness'. She glanced at it without enthusiasm as she talked of her preferences: mince and potatoes, stews, a fry-up on Sunday mornings, sweets. Her children, she said, 'always got money for sweeties every day'.

In a small hall off the cafe, George Godfrey, 48, and John Lamont, 52, edged around a pool table. Like Mrs Gallie, they are unemployed (as are more than 80 per cent of Drumchapel citizens). They also share her coronary trouble. 'I had by-pass surgery about four years ago,' Mr Godfrey said. 'I've still got angina and I'm a bit breathless. I smoke a bit more than I did before the surgery. I eat anything - meat, mostly grilled chops. I'm not into salads. I sometimes go on (drinking) binges, with a litre of vodka at a time, though I think I'm actually allergic to it.'

Mr Lamont, a former coal deliveryman, said that after 'two-and-a-half heart attacks' he has stopped smoking. 'As long as I've a drink and a sandwich, I'm happy. I love cider - there's apples in it, so it must be good for you.'

Mr Lamont likes to joke about health risks. Leaning over the pool table, wearing a funny nose that flashed red every two seconds, he waxed lyrical about eggs, bacon, sausage rolls, black pudding, fried 'tatie-scones', Scotch pie, beans and chips - 'Oh, and pancakes, and trifle, and ice- cream'. But he quietened down after Mr Godfrey said that much of Glasgow's heart problem was brought on by the depression of high-rise life. 'There must be as much suicide as heart attacks,' Mr Godfrey said. 'Some of it's drugs but a good lot is depression. One Sunday morning last year, a lady of 72 jumped from the 17th floor of Linkwood Flats where I live. Quite a few jump from the flats.'

Why are Glasgow hearts failing in such numbers? Smoking and drinking are major causes, but bad diet has a lot to do with it. In some ways, the 19th-century poverty diet of porridge and buttermilk, herring, marrow-bone broth and potatoes was superior to today's poverty diet: tinned beans, Scotch pie (allegedly minced- mutton centre) crisped in the chip-fryer, pizza done likewise.

In A Century of Scottish People 1830-1950, T C Smout says early nutritionists put 'a considerable onus on the feckless urban poor, appearing cross and disappointed when they found them buying tinned beans instead of the porridge oats they medical pundits felt they needed'. Attempts by middle-class women to improve the cooking skills of their working-class sisters were rejected as 'patronage and interference'. Even in pre-Second World War Scotland, where calorie intake was as high as in England, Scots were deficient in vitamins A and C 'due to their aversion to fresh vegetables and fruit'. Scottish consumption per head of syrup, treacle, jam and marmalade was nearly three times the English - a situation that seems to continue.

On the concourse of Glasgow Central station, among the first things one sees is the Sweetie Express, a shop selling 100 vareties of jellybeans and other confections. Across the inner city, hamburger joints have proliferated. Pastry shops are more mouthwatering than those anywhere else in the UK (apart from Belfast, which has the second-worst rating for heart deaths among women).

Glasgow's overall death rate is 8 per cent higher than the Scottish average, but in younger groups (0-64 years) it is 20 per cent higher - an adverse difference that is increasing. The city's latest annual health report says it is likely 'that if just five factors (smoking, high cholesterol, obesity, lack of exercise and heavy alcohol consumption) could be eliminated, then death rates would fall by 25 per cent'.

The portents are not encouraging; 60 per cent of unemployed people smoke daily; lung cancer in men is 34 per cent higher than the Scottish average, and in women, 65 per cent higher. The premature- death rate in Glasgow women is 19 per cent higher than in Scotland as a whole; in men it is 27 per cent higher. In both, the leading cause is coronary heart disease. Women living in deprived areas such as Drumchapel are 3.5 times more likely to die of heart disease and lung cancer than women in affluent areas, such as adjacent Bearsden. Twice as many Glasgow women as men are admitted to psychiatric hospitals with depression and anxiety. One in seven women have been raped by their husbands.

According to Dr Graham Watt of Glasgow University, Glasgow's high proportion of deprived citizens contributes to the exceptional rate of coronary heart disease. 'It is no comfort that 40 per cent of households with children aged 0-15 years in Glasgow currently receive income support, nor that this proportion has doubled in the last decade. Over 50 per cent of families with children living in council housing are exposed to conditions of dampness.' Almost half of Glasgow's primary school children receive financial assistance to buy shoes and clothing.

Studies refer to 'a matrix of factors including poverty, housing and nutrition', particularly the lack of fruit and vegetables. Why Glaswegians should despise fresh fruit and vegetables is not clear, though there was talk last week about these items being 'too dear' for the unemployed, or 'unavailable' in deprived neighbourhoods.

Dr Caroline Morrison, who helps monitor Glaswegian hearts for the WHO, said: 'Heart disease used to be the disease of affluence and is now the disease of poverty. It's a disease of lifestyle. Smoking took off at the top and stopped at the top. The poor are still at it. The poor used to eat herring and oatmeal, but now the rich eat these things. Many people no longer know how to cook because of diminishing integrated, granny-type families.'

Dr Carol Tannahill, acting director of health promotion in the city, is combating a 'West of Scotland culture' of Scotch pies and Scotch-pie 'butties'. In an experiment, her department, the largest of its kind in Britain, has subsidised the sale of brown bread, low-fat sausages and other healthy foods in poor areas, run cooking classes for young Glaswegians and sent dietary teams to communties such as Drumchapel. Posters have gone up in Glasgow's Underground stations: 'Look after your heart] Take the stairs]'

At Drumchapel, there was one glimmer of optimism from Mr Godfrey. 'My two daughters are 19 and 17 and they smoke,' he said, adding with some pride: 'But my boy, who's 11 - he doesn't'

(Photograph omitted)