Getting Glasgow better

Elaine Campbell has lived in Easterhouse, in the east end of Glasgow, for most of her life. Less than a year ago, she worked in a local bakery. Now she is a member of a unique team working to redress the massive health inequalities in Easterhouse, a vast area of decaying high-rise blocks and one of the most deprived parts of urban Britain.

Glasgow has a reputation as one of the unhealthiest cities in the UK. Last year, in an attempt to change this, the Glasgow Healthy City Project decided to borrow a trick from the Third World. They selected 12 people from various backgrounds to train at Strathclyde University, then return to their own communities in the sprawling estates. Three areas were chosen: Easterhouse, Possil and Milton.

The scheme may be new to Britain, but in the under-developed world trained local people, the so-called "barefoot doctors", have been effective in passing on health knowledge on basic issues when qualified doctors would be costly and ineffective.

"It's no good people coming into the area from just nine to five," Elaine explains. "They have no idea of what it's like to stay in a place like Easterhouse 24 hours a day. At five o'clock the problems do not miraculously disappear."

Glaswegians may not like their city being equated with the Third World, but its record on heart disease gives health planners major problems. Earlier this month the Imperial Cancer Research Fund found that Scottish women have the highest premature death rates from smoking-related illnesses in the world.

Death from lung cancer is 80 per cent more likely for women in Easterhouse and Possil, another deprived estate to the north-west of the city, than their counterparts elsewhere in Glasgow; men in these areas have 60 per cent more chance of dying from heart disease than those elsewhere in the city. For men in the Gorbals, another estate just south of the Clyde, the chances of death are 200 per cent higher than in the rest of Scotland. The disturbing truth is that for people in deprived areas of Glasgow, life expectancy is 10 years less than for Glaswegians in more affluent districts.

Ellen Hurcombe and Sadie Gordon, new health workers in Possil, describe themselves as community activists. There will be few people who have not come across the pair in their 50 or so years in the area. "We've reached so many people by world of mouth," Ms Gordon says. "People know who we are, which is better than some stranger coming in saying, `This is what you must do about your problems.' They'd be laughed off the street, or ignored."

Rod Macnamara, co-ordinator of the Healthy City Project, agrees. "To get involved in the community on a professional basis would take a year at least. The new health workers already have a great network in the areas, and that will be the success of the project." Their role is also to provide impetus and support for groups as diverse as post-natal depression classes and stopping smoking initiatives, and to liaise with schools.

Ms Gordon is adamant that the agenda for change comes from the communities themselves. "We can't decide what the people need," she says. "While outside organisations might feel they know best, we take the other approach. We may not think that t'ai chi or aromatherapy classes are top priority, but if the community groups feel these are necessary, for stress, for kids, for something to do, then we'll try and sort something out."

As for preaching to her neighbours, Linda Dolan, from Milton, to the north of the city, wouldn't be so bold. "We're not out to teach people what to eat. They know what's not healthy, that smoking isn't good for you. We are here to listen and maybe point them in the right direction. I certainly don't consider myself much like a teacher."

One of the biggest challenges the city's "barefoot doctors" face is tackling the Glaswegian's notoriously poor diet. But that will require far more than educating people. In these parts of Glasgow there are no supermarkets, and fresh fruit and vegetables are expensive and poor quality.

At the unemployed workers' community centre in Milton, a local resident, Betty Maple, gives a resigned laugh when asked about shopping facilities. "We've fought for years to get a supermarket. We've offered all the different companies premises, but they won't come here because it's only the people in the estate that will use them."

With almost 80 per cent unemployment, most families in Milton are on benefits, and getting to city-centre shops on the bus with children in tow is virtually impossible. That leaves freezer centres, takeaways and small stores, which charge more for "convenience shopping". According to Ms Dolan, "it's not convenience, it's necessity. People preach that it's as cheap to eat healthily as it is to eat junk. But that all depends if you've got decent shops nearby. It's hard to live healthily when you have to watch every penny."

For many Glaswegians, a healthy diet is the least of their worries. Most of the housing is substandard, and living in flats which are cold, draughty and damp means an unusually high proportion of children in housing estates suffer from asthma.

Stewart Macfarlane believes that the answer lies in alerting people to their rights, as well as providing authorities with facts, figures and action plans. "If enough pressure is put on the council - if we tell them that if they put decent windows into houses in the first place, they wouldn't have to treat them all for damp - we might get somewhere," he says.

The project will not stop at basic health issues such as diet and housing. All aspects of physical and mental well-being are considered. Ways to alleviate stress and depression, for example, are high on the agenda in all target areas. "If you can imagine a woman bringing up three kids on her own, on income support, her house cramped and damp - living like this is obviously stressful," Ms Campbell says. "Stress is an ailment you associate with high-flying businessmen, but for many people in Easterhouse, managing on very little money makes every day stressful. By giving people a chance to talk about their problems, we can make a lot of difference."

Two more areas in Glasgow are set to benefit from the initiative next year. Empowering the community brings benefits to housing, diet and other factors essential to a healthy life. "When people get together," Mr Macfarlane says, "there is little they can't do."