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The Story of Solutions

We Need Compassion, Not Judgments About Poor People


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by Peter Hetherington


As a young surgeon in Glasgow Royal Infirmary, Sir Harry Burns was so troubled by the challenges facing poorer people in the city that he embarked on a new career path. "I became very interested in the way society organised itself for the greater good," he recalls. "I eventually thought the time had come to stop cutting bits out (of people) and start thinking more creatively about doing something to stop the bits that needed to be cut out."

After 15 years at the hospital, five of them as a consultant, he took a master's degree in public health to pursue a theme that has since dominated his professional life: trying to make people healthier, in both body and in mind, by reinforcing the social and communitarian bonds of society.

So it is perhaps little surprise that Burns, 63, will retire as Scotland's chief medical officer next month to take up a senior professorship in global public health at Strathclyde University.

Doctors, he once recalled, are obsessed with the causes of disease rather than the causes of what he calls "wellness". In a lecture, he added: "As a doctor at the Royal, I never once wrote a death certificate saying the cause of death was living in a horrible house or unemployment. People die of molecular deaths, such as proteins coagulating in arteries and causing heart attacks and strokes. Yet we know that poor [social] conditions lead to poor health and premature deaths."

So began a professional life devoted to turning round the health of a Scottish nation that remains among the unhealthiest in Europe – although successive governments, since political devolution in 1999, have moved with speed to introduce a smoking ban in public places, outlaw the sale of cut-price alcohol, which Burns is in no doubt will have a "significant impact" on public health (albeit with the drinks industry challenging new legislation) and, more recently, devoting an extra £500m for "preventive measures".

Burns, thoughtful and engaging, chooses his words carefully, but is never afraid to make a powerful social comment – albeit couched in the diplomacy of the public servant keen to stress that, of course, he is not party political. He says forcefully that he has always been driven by science and by evidence and, implicitly, not by ideology. "Unless you have evidence all you have is opinion," he says. Evidence tells him that the most successful societies are those with strong social bonds, connection and cohesion. "I've worked with every health minister, in some capacity, since 1999 and they've all wanted to do the right thing … if you present them with the evidence they are convinced and want to move the agenda forward. We've made some great strides," he says. "It's harder to do that in a country 10 times the size."

Yet, for outsiders, the health of Scotland remains a puzzle. "What we've seen since 1990 is increased mortality rates among younger people – the 15-45 age group – and it's a relatively recent phenomenon," Burns explains.

In his new job, he will focus on health, "wellness" creation and social exclusion at home and abroad. He is clearly still troubled by the health of his own nation, and particularly that of the densely populated area of greater Glasgow – an area that will be crucial to the outcome of the independence referendum on 18 September (he declines to say how he will vote).

Burns points to research by the Glasgow Centre for Population Health (GCPH), which is studying the issue in the city. It stresses the well-chronicled links between poverty and ill-health and the area's long-established high levels of deprivation, while adding: "These explanations do not appear to be sufficient to explain the particularly … poor health of Scotland … mortality rates are particularly higher those of England and Wales"

Research in 2010 showed the deprivation profiles of Glasgow, Liverpool and Manchester to be virtually identical, yet premature mortality in Glasgow was 30% higher than in the English cities.

So is there something in the collective psyche of Glasgow setting it apart? On the one hand, Burns stresses there is nothing inherently different about Scotland. But turning to the GCPH's studies, he notes that Glaswegians are less likely to go to church, join clubs, take part in community activities or to volunteer.

The reasons may be many and varied, but he notes that 20 years ago life expectancy in Scotland was similar to the European average. Since then, other countries have leaped ahead because, Burns observes, mortality rates in younger people "down the social scale" in Scotland have not declined.

He puts part of the problem down to the de-industrialisation of west-central Scotland, allied to the breakup of well-established communities as old tenement blocks – social centres in their own right – were demolished and residents scattered to large housing schemes on Glasgow's outskirts. "There was something about 'connectedness' that was falling apart. Skilled work was going. Someone at the time said 'all these men got jobs', but what kind of jobs? If you were a welder in a shipyard you were somebody, but if you were working in a shop somewhere, well …"

He recalls talking to a priest from Los Angeles, who was devoted to working with the gangs of the Californian city. He had come to observe social issues in Glasgow, and told Burns that "connectedness" was the key to social cohesion. Burns quotes him enthusiastically. "What we need is a compassion that stands in awe at the burdens the poor have to carry, rather than stands in judgment at the way they carry it."

The Clydeside of Burns' formative years was a hive of industry – shipyards, engineering works, steel-making complexes employing tens of thousands. He recalls, with admiration, the late Jimmy Reid, one of the leaders of the Upper Clyde Shipbuilders eight-month work-in in 1971-72 – after a Conservative government initially refused to give the company, which had a full order book, a bridging loan to secure its future.

As a medical student, Burns voted for Reid – who was a SNP supporter in later life – to become rector of the University of Glasgow, and vividly recalls his rectorial address, which was printed in full in the New York Times.

"Jimmy Reid understood what was happening – the alienation, the cry of men who were victims of blind economic forces beyond their control, a feeling of despair and hopelessness," he observes thoughtfully. "People who do not feel in control over their lives struggle because the system does things to them – it doesn't work with them and help them create 'wellness' for themselves … when things happen that alienate people, they lose that sense of control and a whole range of biological, as well as psychological, things occur."

And on the referendum itself? Burns is non-committal. "Whatever happens, I would want to continue to make Scotland a better place for people to live, grow and develop," he says. Read into that what you will.


See additional sources at:

Harry Burns: 'We Need Compassion, not Judgments about Poor People'