 Those are always uncomfortable. We can see so many former colleagues who might need out and say what on earth has emerged since the past associate letter Oil in Germany. What i will to do tonight is trying to explain to you what has been up to you. I will answer these two questions. What is wellbeing and causes it? First question, what is well-being to the medicine audience might sound daf fyddeidwyd yn ddansi'n gweld i'n dda gennym. Felly mae'r edrych i meddwl gyda gweld, mae'n ddedig ydyn nhw'n rywbeth o'r busa ac yrych i'r busa. Diolch yn ymdapol a llun yma. Mae hynny i'r dweud bydd yma yn yr oriyg peth, oherwydd mae'n ardal yn yr edrych i meddwl mewn nu. A oes, ydy yn 1940, bydwch cydnabol byddwch rhai effeithio llyriaethio o santhwyhaeth s sistemeth aisoes yma niferodol, felly mae rhai effeaith compileidais. So rhai effaith comentariadydau yma vo'n blynydeletd. Bydd hyn ymgarchydd cymaint o santhwyhaith phoôna bwysigol, felly mae'r llw Bethe毛br ei ressiggle hon y lle raddynt yn mwy rwyloedd iddyn nhw, i mynd i gyllsanthwyhaeth iefyd paysfeydd ystod. mae nhw ymb staminaethai t서 ac mae'n o wel refugees hi nhw neu rôl o rhai effaithpedig o santhwyhaeth i gael ei modd i'w meddwl i'r tyfnod, cyfwyrd yn gweithio i gyd mewn gwirionedd, a'r hyn yn ei gael i'r mynd i'r gweithio. 30 yw gweithio, rwyf wedi'n ddyn nhw'n ddweud o'r ysgol yw'r gwneud yma. Rwyf wedi'n gweithio i'r hefyd, dyna'r ddwylliannol, ac mae'r rai thwynt o'r eu gwirionedd yn y cyd yn y gweithio, mae'n gweithio'n gwirionedd yn hŷn i'r ddweud. mae'n cael ei hyffordd yma yn gynnal, dwi'n gynting ac rwy'n dweud na'r gyferon hyn ac yn cael ei lle le gan'n mynd i gwirion bethau i ni, gyda gwrthon a chynghuno, cael peidio'r cyffordd yn Lensï o ran i'r leidio yn y ysgol â'r arfuddwch sy'n rhaid. Rwyf wedi dweud y teimlo'r cyfrofiadau gweld ar ôl, wedi'u mynd i ei drafn o'r gofyn taeth, pandemic? Rydyn ni'n bwys monarch, ond yn anrhyf amser a gweld fishfad段 o'r cyfnod o'r newid. Rydyn ni'n nôl i chi, mae'r ysgol ddaeth oeddennig, a dw i'n ni'n byw'r ffordd mwrdd yr ysgol er enghraith, ac mae'r ysgol ym ysgol wedi'i cynnyddio'r cyfrifysgol maen nhw i gemnig field hyn. Felly mae'n gweithio i chi eu ddweud i'r cyfrifysgol a chyfodd mewn cyfrifysgol a'r golygu ni'n rwy'n being a Professor of Strategic Management for their side-trOOM심 The other point about that slide is the The other point about that slide is the mural on the gable end Someone in the City Council, obviously thought a good way of improving the quality of life in that place was to paint a mural of a corporation bus on the gable end i'n gwych Толькоf nhw'n fif having more appropriate solution. Anyway, a longer than this before. So, over the years I've worked with colleagues at Glasgow University, with colleagues in the Glasgow Centre for Populatiation Health, a lot of what I'm going to describe to you is what these organisations have generated. To put things in context, mwy o'r lightlyn oedd. Si'n cael ei ddon â'u clywed eich clywed ddull, a'u gwagodol, y gallun yn ddingsbeth yn ei ddysgu, ac rydyn ni'n gweithio â'r hand, ar y gyfer hyn o'r hyn o'r hyn o'r hyn o'r 같은데ll yw'r If you think about going out to the pub after this, be careful. So, is Scotland an unhealthy place? This slide shows life expectancy in 16 Western European countries going back to 1851. There is a 160 years worth of data on that slide and you can see that for most of that time Scottish life expectancy has been at the middle, the Western European average, no better, no worse than anyone else. It's only in the past five or six decades that we have drifted to the back of the pack and if you look at the rate of growth and life expectancy and the richest 20% of the population you can see that they have done significantly better than the European average. So, the rate of growth and life expectancy and the poorest 20% of the population, however, this machine ain't working, why is it not working? This is unhealthy this thing. No, you have to see it to believe it. Right. Don't speak too soon. So you can see here that the rate of growth and life expectancy and the poorest 20% of the population has that since the 1950s there's been a divergence in life expectancy between rich and poor and it's not the Uber rich, it's the top 20% versus the bottom 20% and that decline in rate of growth and life expectancy in the poorest 20% has been what has slowed down the Scottish average. So only some of the population is unhealthy and it's not due to smoking. This slide shows smoking rates in 15-year-old teenagers in the countries of the European region of the World Health Organization. Scottish teenagers are the fifth lowest smokers in Europe. All these countries with higher life expectancies than us, their teenagers smoke more. Scottish males in this study were the third lowest smokers in Europe, beacon only by the Finns and Swedes. Scottish females let us chaps down a bit by being closer to the European average but we're not where we are because we're the worst smokers in Europe. What about diet? So the classic population intervention to improve diet, to improve health was carried out in Finland, the North Korea layer project. In the 1960s they concluded, here this is the heart attack death rates in men under the age of 75 in Finland and in the 1960s they had a very high death rate and they decided it was all due to too much fat in the diet. So they decided to change the diet. And I once asked the director of the Finnish Institute of Public Health how did he change the diet and what he said to me and this is verbatim, what he said was, well the Finnish Institute of Public Health told the Finnish Government what to do, the Finnish government told the Finnish people what to do and the Finnish people did it. So my response was well that's Scotland's stuff then because we never do anything like that. What they did was they took subsidies away from dairy farmers to discourage them from producing milk, butter, cream, cheese etc. thereby making the things the most miserable people in Europe. And they gave them subsidies back if they'd switched to growing fruit and vegetables and made free salads, compulsory in all schools and workplaces and then they stood back and marveled at the results. Okay, significant reductions must be due to the change in diet. Well, that line is Scotland. So the Finns took radical action to change their diet. The Scots invented the deep fried mars bar and we've got the same results. Actually this is post-hoc, ergo, proctor, hot fallacy. We did something and something happened therefore what happened was due to what we did. Actually the main thing that led to that significant reduction was men gave up smoking in enormous numbers in the 1960s. That was the decade where the penny dropped with men and they gave up smoking and also we began to see the introduction of better therapies and every western country has seen a significant reduction in death rates from heart disease. The booze, what about the booze? This slide shows death rates in our 16 western European countries going back to 1950. The line at the top is the highest mortality any country reached and for the first couple of decades that was France. The line at the bottom is the lowest mortality any of our country reached and the line in the middle is the mean of our 16 western European countries. From 1950 to 1970 Scotland had one of the lowest alcoholic cirrhosis death rates in western Europe. This notion of the Scots as happy drunks is a myth. Apart from anything else we're never happy. From 1970 to 1990 it went up a bit but it was still below the European average. Then from 1990 that's what happened. For both men and women we went from being one of the lowest to being the highest in western Europe. When you think about the drinking culture in the 1950s well who drank, men drank, what did they drink, beer? Where did they drink it in the pub? When did they drink it after work on a Friday night? Now who drinks? Everyone. What did they drink? Everything they can get their hands on. Where did they drink it everywhere and when did they drink it? Seven days a week. The culture has changed and we have embraced that culture. But that's the main thing that we have embraced if you like. Alistair Lailand, who works at Glasgow University, began, like the rest of us, to question this. What is causing this inequality? Most people would assume that the inequality and death rate between rich and poor is due to the fact that poor people tend to die more of heart disease and cancer. That's what most folk die of. Therefore that's presumably what's driving the inequality. But Alistair went a stage further to probe in some detail what was causing it. He did a clever thing with the data. What he did was for each five year age group for men and women, he plotted death rates by deprivation category. So the death rate for the most affluent people here, and men in that upper 60 age band, about 1500 deaths a year per 100,000 population in that age group, all the way down to the poorest age group. By subtracting the best from the worst and dividing by the mean, you come up with a single number called the slope index of inequality that reflects how steep the difference is between rich and poor. By plotting the slope index of inequality for each five year age band, you can see that inequality and death rates in Scotland are largely driven by inequalities in deaths in teenagers, people in their 20s, 30s and it starts to come down in their 40s. Young working age people and teenagers, these are not the people dying of heart disease and cancer. So he went a stage further, he plotted death rates for individual causes of death, this is heart disease and he calculated the slope index of inequality, and you can plot that on the thing and you can see that heart disease barely contributes to inequalities in survival. It does a bit in people in their 50s and 60s, but it's not the main driver. So what's the main driver of this inequality, widening inequality in Scottish mortality and life expectancy? It's drugs, suicide, diseases due to alcohol, violence and accidents, drugs, alcohol, suicide and violence. We're not going to fix that by persuading people to reduce the saturated fat content of their diet. This is a complex, socially driven problem and we need to be thinking quite cleverly to make some difference occur. Now that gave people the excuse to start talking about the Glasgow effect and that was a term I hated because it didn't seem to me that there was anything special about Glasgow. Glasgow was a city where in the 50s and 60s you'd collapse of heavy industry, lots of men lost their jobs, you'd collapse of community as the traditional houses were knocked down and garbles and so on. And people were transplanted to Easter house, to Cumbernauld, to Irvine, the New Towns and so on. And what I used to say was Glasgow got austerity 50 years before anyone else. And then a couple of years ago, proof emerged. Angus Deaton, a Scott who's a Nobel Prize winning economist working in Princeton, published data on what he called deaths of despair. What he found was that men in their 50s, white blue collar workers, non African American, non Hispanic workers in America without a college education between the year 2000 and 2014 saw a 240% increase in deaths from drugs, alcohol and suicide. That's the Glasgow effect. But only this wasn't happening in Glasgow, this was happening all the way across America. The Brookings Institution in Washington recently published that graph which showed that the counties that voted for Trump were the counties that saw the highest incidence of deaths of despair. What we're seeing as a result of austerity is the rise of right wing fringe parties across Europe. People are turning away from conventional political discourse to folk that, well, you know, he may be mad, but maybe he'll do something different. Very worrying. So, with that kind of background that maybe challenges what your concept of wellness are, what causes it? And I mentioned the word pathogenesis at the start, the causes of disease, the origins of disease. Salutogenesis is a term that's been coined to describe the causes of wellbeing. Salus was the Roman goddess of wellbeing and safety. And colleagues in the Nordic School of Public Health have produced this slide, which clusters 25 different theories under the umbrella of solutogenesis. And obviously I'm going to take you through them all one by one. No, I'm not. Just to mention a couple, or even not to mention a couple. Well, mention one. If you take those 25 different theories and distill them down, the common features of them all are these. People tend to do well in difficult circumstances if they have acquired an optimistic outlook on life. If they feel that they are in control of their lives, not other people, they can take control. If they have a sense of purpose, they have a reason for staying well. If they feel confident in their ability to deal with the problems that their circumstances throw at them, and particularly if they have a supportive network of people. And as we will discuss if they come from an nurturing family. And I'll just mention two of those theories. One, Victor Frankel, an Austrian psychotherapist who spent four or five years of the war in Auschwitz and survived and he wrote about man's search for meaning. He and the men with him who survived the horrors of Auschwitz had to stay alive because they had a purpose and their purpose was usually family. Their wife had been taken away from them and they didn't know what their children were. They had to stay alive in order to go and find their family. They had an optimistic outlook that everything would be okay and they knew what to do to survive and they did it. And what he said was if you have a why to live, you can cope with almost any how. Aaron Antonowski, an American sociologist who also investigated Holocaust survivors, went to Israel to work to study the health of adults who his children had been in concentration camps. He concluded that children who acquired the correct view of the world when they were young had this property of feeling in control. What Antonowski said, he described it as a sense of coherence. It's a sense that you find the social and physical world around about you as being understandable, manageable and meaningful. And what he said that really made sense to me was unless you found the world around about you as understandable, manageable and meaningful, you would experience a state of chronic stress. Now, as soon as I read, I remember vividly reading those two words on a sat whole cup night, cos I'd been a surgeon and as Alan says, did a lot of work with the biochemists. A surgeon's job is to create acute stress in people, seriously. The stress response is the body's defence mechanism. When it's threatened, whether socially by horrible circumstances, or whether it's threatened by the surgeon's knife, the body has to repair itself. So it produces cortisol and adrenaline and so on to allow energy to flow through the body and it stimulates various proteins in order to start the healing process. What Antonowski was saying, well actually if you have a difficult childhood, you switch on the stress response and it stays on permanently. And I thought this is the missing link. This is what links the social circumstances to physical health. Now I was only partly right cos that was the start of a whole chain of evidence that I found that showed what the process was. We started to look for evidence that cortisol, one of the main stress hormones, was elevated and we found thousands of studies that showed that. This is Canadian data that looks at cortisol levels in children and orphanages. The longer a child is absent from a single significant adult to relate to the more stress it becomes. This is the Whitehall study, this is Michael Marmot's study of 30,000 civil servants laid out for many, many years. What this shows is that in an occupational hierarchy, the higher up you are in the hierarchy, the less stressed you are. This is daytime cortisol profiles. Cortisol is always highest in the morning, goes down before you go to sleep at night. Higher grade civil servants in the purple line are less stressed out the day than lower grade civil servants in the red line. The first person in any government department is the permanent secretary. They used to love it when I told them that. The reason is that if a minister asks a permanent secretary to do something he doesn't fancy doing, what does he do? Get somebody else to do it. If they don't fancy it, they get someone else to do it. It goes down the hierarchy till the person at the bottom gets all the crap nobody else wants to do. That's usually the chief medical officer I have to say. Control is the lesson from this. The more control you have over life, the less stressed you are. Of course, life expectancy of permanent secretaries is greater than life expectancy of people at the bottom of the civil service hierarchy. Control, this is another example. Control, Martin Bowback from University College London went round the countries of the former Soviet bloc ten years after the fall of the Berlin Wall and asked people how much control they felt they had of their lives and related that to annual death rate in the country. Russians reported the lowest level of control had the highest death rate, polls and checks, high levels of control, lowest death rate. You see they are hungry is a bit higher than the polls and checks, they have high levels of control too, but they have an interesting way with booze. They make their own in the bath. So I'm told that's my Hungarian friends tell me that accounts for this. And this business of optimistic outlook, again there's lots of evidence, I'll just show you this one. Susan Everson was an American lady who went to Finland to study the health of these adults, and these adults, these adult males rather, who were at high risk of death from heart disease. She measured every risk factor you could think of. She measured their smoking, their alcohol consumption, their weight, their educational attainment and so on. And one of the things she also measured was hopelessness. She had a scoring system that allowed her to split men into three groups. Those that were very, very hopeless, those that were moderately hopeless, and those that were just a little bit hopeless because she was a woman. And she knew that all men are hopeless today. But what she found was that men who were in the most negative mindset were four times more likely to die of heart disease and two and a half times more likely to die of cancer, and men who were optimistic. And she couldn't explain that by virtue of the fact that she smoked more or drank more. She was able to adjust for all these other risk factors in a statistical analysis. So positive outlook, I know that can be hard when you're a Scotland supporter, but positive outlook is very important to wellbeing. So the next bit of the jigsaw came when I'm trying to piece together this link between social circumstances and premature mortality. The next piece of the jigsaw came when I saw an experiment in the psychology department of a New York University, and the experiment they did was to make baby monkeys depressed. That's clearly not a happy baby monkey. And the way they made the baby monkeys depressed was all down to the way they let mum feed the baby. One half of the animal house, mum and baby are playing and they're swinging about and so on. And when baby indicated he was hungry, mum could bend down and pick up the food to baby. The other half of the animal house, they took the food away and hid it so that when baby indicated he needed food, mum had to go away and forage for it so she was away a long time. And she also was stressed because she'd fight with other mums to get access to it. So if I were to ask you, which group of babies do you think became depressed? Was it the ones where mum found it easy to feed them? Or the ones where mum was away a lot and stressed by being away? You'd probably think it was the second group, wouldn't you? And usually when I ask that question I can spot who the working mums are in a room. Well ladies, you needn't worry. It made no difference. These were the stress hormone levels where mum found it easy to feed the babies and those were the stress hormone levels where mum found it hard to feed the babies and they were the same. But those were the stress hormone levels in the babies where they randomly changed the feeding pattern from one day to the next. It wasn't mum being there or mum not being there. It was baby not knowing what was happening. It was inconsistency. And if you think about it, first thing a human baby feels, first stressor he feels, hunger. What's he do? He cries, mum picks him up, cuddles him, talks to him, feeds him, stress resolved. This is the start of a tennis match. You know, cry, resolve the stress. By the time that's happened a thousand times, baby knows the one that's structured, predictable and he's in control. Do the crying thing, this person comes along, fixes it, no problem. Develops that sense of coherence that Antonowski talked about. Contrast that to the experience of a baby who, when he cries, sometimes gets fed but sometimes doesn't because mum's drunk or under the influence of drugs and even worse, the boyfriend picks baby up and shakes him and slaps him because he doesn't know how to handle a crying baby. Baby learns the one that's not structured, is not predictable, he has no control and when he does the one thing he's programmed to do in response to a stress, it hurts. No sense of coherence there. The next stage was the people who were doing this study began to examine the brains of the stressed and unstressed babies and what they found was that chronic stress in early life led to significant changes in brain growth in three critical areas. The prefrontal cortex, which is a bit of the brain that allows you to make clever decisions, allows you to make any decision. So you take in new information, you process it in the prefrontal cortex and you respond. The amygdala, so the prefrontal cortex does not develop so well in stressed babies. The amygdala is a bit of the brain associated with emotional arousal and that becomes more active in these babies and the hippocampus is a bit of the brain associated with memory. So these babies are less well able to learn. So what you've got is a kid potentially in a human situation who goes to school less well able to learn, is more emotionally aroused, more anxious, aggressive, fearful and less well able to control himself. So when he gets bullied for being stupid, he's likely to lash out and he's likely to be excluded from school. Sound familiar to the teachers in the room? Now we took that, that was all experimental stuff and we didn't want to take experiment in animals as being applicable to your average Glaswegian. So we went out into the streets of Glasgow and we scanned brains and I was slightly worried about going down the East End. Amy, can we scan your brain? But I didn't have worried. What, you mean you're going to tell me I've got a brain? Can I get a certificate? Well, I mean these guys have spent their lives being told they're stupid. So, and we found it, we measured hippocampal volume, we measured cell density in the prefrontal cortex and we went a stage further and it was exactly as the animal studies suggested. We went a stage further, we measured the performance of these centres, the choice reaction time measures your prefrontal cortex activity, what choice reaction time showed here was that on average if you present some evidence to people and ask them to press a button on a computer quickly in response to it, people coming from the most deprived parts of Glasgow took on average about 200 milliseconds longer to hit the right button. Now that doesn't sound very much but if you think of two cars being driven side by side, one by some day with a cohesive upbringing, one by someone coming from a difficult upbringing, being driven 50 miles an hour and a child walks out in front of them, a car being driven by the guy with the difficult upbringing will take about two car lengths longer to stop. The disadvantage accrues in all sorts of ways that you can't quite understand at first. So why does the cortisol level become chronically elevated? This was the final piece of the jigsaw, the final chain in the evidence. It's epigenetic action, epigenetic. We inherit all these genes, it doesn't matter so much what genes we inherit, what really matters is when they're turned on and turned off. That's the study of epigenetics. What we find, this is the molecular biology of a cuddle. So what happens when you cuddle a baby? Probably what happens when you cuddle me, but that depends on who's doing the cuddly. Whenever you feel comforted and nurtured, you're happy. There's a chemical messenger called 5-hydroxy triptamine, also known as serotonin, is released in the brain and circulates in the bloodstream. When it's picked up by a transport mechanism and goes into the cell, chromosome number 5 has a gene on it called the glucocococcal receptor gene. When it binds on to serotonin, it's activated, and it produces a protein that allows the brain to recognise that cortisol is high, and it then sends signals down to the adenals to switch off cortisol production. Children who do not feel nurtured do not develop the glucocococcal receptor gene activity, and therefore they're chronically less able to switch off their stress response, and therefore they get the brain changes that make it difficult for them to succeed in life. It goes even further. Some of these genes are actually inherited. There's a thing called the warrior gene, a monoaminoxidase type A, which destroys serotonin. If you've got this gene, it means you're working with a chronically low level of serotonin, and therefore you get all the other problems. It was discovered, this guy, what's his name again? Who? What's his name? He's from Paisley, somebody tells me. In fact, my next-door neighbour tells me he's from Paisley, and he's class at school, and I think he quite fancied him. But the only film of his I've ever seen is this one, Olympus has fallen, in which he is a secret service agent in the White House, and 200 fanatical terrorists invade the White House, and they kill everybody except him, because he's away doing something in the basement or whatever, and they then get the president, and they try to get the launch codes off him, and I'm sitting there thinking, so there's 200 fanatical terrorists, and there's a boy in the basement from Paisley, with a gun, no contest, so sure enough he saves the world. So the warrior gene is a real thing, and they call it the warrior gene, when they discovered it, he said, where in the world are the most war-like people? So they went and studied the populations that do the hacker before rugby matches, went to Samoa, they went to New Zealand, the Maori and so on, and they have significantly higher levels of money than the Oxley's type, compared to anyone else. So this is real, this is what's happening out there. So let's look at what the consequences are for children who experience adversity in early life, who experience that kind of inconsistency, and even worse than inconsistency, actual physical abuse and neglect and domestic violence and so on. In the 1980s, Kaiser Permanente health system in California, which was an insurance system, and if you belong to Kaiser Permanente, you were middle class, you weren't working class, they started a weight reduction clinic, and they got everyone who was overweight, and they began to get their weight down and so on, and then they noticed that some people who could lose weight perfectly while they were putting weight back on again, and the guy who started it, Vincent Fomiti, started asking them, what's going on here? And what emerged was that a lot of the people who found it difficult to lose weight were experiencing, had experienced neglect, abuse, domestic violence, parental mental health problems, so the weight reduction clinic metamorphosed into a study of adverse childhood experiences. Basically, they looked at these, they asked the population that they have any of these. Middle class Californians, 60% of them reported one, 13% of them reported four or more. If you had four or more adverse events in your life, you were eight times more likely to become an alcoholic, 12 times more likely to become an narcotics abuser, boys who experienced physical violence at the hands of an older male, eight times more likely to engage in partner violence themselves, four times more likely to have been arrested for carrying weapons, drugs, alcohol, suicide, violence, criminal convictions, relating strongly to experiences in childhood. If you look at the pattern of adverse outcome in the adverse childhood experiences study, small increased risk of premature death from heart disease and cancer, and then these are all drugs, alcohol, suicide, mental health problems, that's the pattern of excess mortality seen in Glasgow compared to cities like Liverpool and Manchester. Could it be that the turmoil that afflicted Glasgow in the 1950s and 60s had created that breakdown in family structure that led to these outcomes that we're seeing now? Possibly. Dunedin, South Island of New Zealand, carried out a similar study to the ACEs study. They identified 1,000 children in the early 70s. They identified a subgroup at risk because of chaotic circumstances in which they were living. In their 40s now, they're more likely to be unemployed, have criminal convictions for violence, experience teenage pregnancy, have a substance misuse problem, and they are showing signs of the metabolic changes that will lead to diabetes and heart disease. This is what happens if you have a poor childhood. The economic cost of one year's worth of child neglect, that cohort of children born in 1960, by the time they die, they will have cost the American economy $124 billion in terms of increased costs of healthcare, increased costs of caring for them when their families break down, increased costs of caring for them when they go to jail. The fact that they do badly at school and never work, they never pay taxes, and they have increased risks of chronic disease later on in life. And indeed, some of the stuff I'm hearing from colleagues in the minute can now suggest that that $124 billion may be a very significant underestimate. So the costs to our society of poor childhood, disrupted families, are astronomical. This is what happens. It's not just the first few months of life that are the problem. This slide, which comes from the Benedyn study, they looked at children who scored at age two on the 90th centile for developmental progress, for cognitive function. So here you had affluent children on the 90th centile, who by the time you reached 10 were still pretty much, they were still about the 70th centile in terms of cognitive performance. If you came from a poor home by age two you were on the 90th centile, your performance degraded over the next eight years. If you came from an affluent home and you were on the 10th centile age two, you more or less recovered over the next few years, whereas if you were poor you never actually recovered. So it's not just the first few months of life, it's that grinding down of kids over the first 10 years. So when we think about policy to reduce things like heart disease and diabetes and lung cancer and so on, what we tend to think of is that it's the behaviours that we adopt. If only we would stop smoking and take exercise and change our diet, we would reduce those outcomes. But actually our ability to choose the right things to do and our ability to commit ourselves to the right things depends very much on having that sense of wellbeing, having that sense of purpose, sense of control and so on. And if you don't acquire that in your early life, you're up against it in later life. What I would argue we have seen in Scotland over the past 50 years is a cycle of alienation, kids living in chaotic circumstances, useless homes, significant increased risk of mental health problems, things like violent behaviour, inconsistent behaviour attributed to mental health problems. They go to school, they cause problems, they get excluded from school, they get into fights. They go to jail and I go to jail quite often. Usually they let me out. But you ask these 18-year-olds, what are you going to do when you get out? I'll never get a job, I've got a criminal record. So what are you going to do? I'll just sit at home. I'll watch telly and I'll drink. And what you never say is, by the way the girlfriend will probably have a couple of babies. So they have that low sense of self-esteem, low sense of control, and the baby is born into a worthless home and the cycle continues. And of course the man I first heard talk about alienation was this man, Jimmy Reid. In 1971 we elected him, Lord Rector of Glasgow University. His rectorial address was reprinted and told in the New York Times, which described it as the single most important public speech since the Gettysburg address. And to those of us in the room that day, that comparison of Jimmy Reid with Abraham Lincoln was very flattering to Abraham Lincoln. It was about alienation. The cry of men who feel themselves as the victims of blind economic forces beyond their control, the frustration of ordinary people excluded from the process of the decision-making, feeling of despair and hopelessness that pervades people to deal with justification of no say in shaping and determining their own destinies. He nailed it. That's the deaths of despair that we have seen in Glasgow and they're now seeing in America. And if we're going to fix it, we've got to tackle the circumstances that lead to those deaths of despair. And a whole load of things have been done over the years that produce change. Minimum income, universal basic income, trialled initially in Canada and the United States, reduced domestic violence, reduced hospitalisation significantly, increased high school graduations. However, Richard Nixon was about to take a bill to Congress to make universal basic income law in North America, would you believe. But it was torpedoed by the report that in the city of Seattle, universal basic income led to a 50% increase in the divorce rate. It appeared to them that this is what happens when you give women financial independence, they divorce their husbands. So the whole bill was scuppered and a few years later they found it was a lie. It was fake news, it was manufactured in order to torpedo the idea. Another experiment that began to show me what must we do to make this better. The Broadway experiment was carried out in the city of London. They had 13 rough sleepers who were perennial rough sleepers. Between them they had a fort, the shortest time anyone had been rough sleeping was four years, the longest time was 45 years which is pretty good going because 45 years is about the life expectancy of a rough sleeper. And these folk had cost them about a million pounds a year over the previous years in terms of different benefits and things that they tried to do. So they decided to do things differently. Instead of going to them and saying there's a voucher for that hostel or you know, instead of telling them what to do they decided to ask them what do you need, what matters to you in achieving a better lifestyle. And that process built a sense of trust between the individual and the social worker who was doing it. She wasn't telling them what to do, she was saying, what do you need? Let's work together, let's build that sense of control. When the results came in the economist concluded this, the most efficient way to spend money on the homeless might be to give it to them. What the city of London did was they gave each of the 13 rough sleepers a bank account with 3,000 pounds in it. The social worker asked them what did they need and she was surprised by the responses. One guy asked for a new hearing aid, one guy asked for a pair of spectacles, one guy said, the only time in my life I've ever been happy to go on holiday with my parents to this caravan park in Kent, could you see if there's a disused caravan that I might go and stay in? By the end of the year, 11 of the 13 were in permanent accommodation and the average spend from each of the bank accounts was 780 pounds. Here in Glasgow, the Wheatley Group, Martin Armstrong, the Wheatley Group is Scotland's largest housing association developed from Glasgow Housing Association. Martin Armstrong, the chief executive, started this programme, Think Yes, in which every single member of the staff in the Wheatley Group is told if a member of the public comes to you with a problem, you work with them to fix the problem. Don't hand them off, don't tell them to go to that office, don't give them a form to fill in. Work with them to fix the problem. It all came about because he was asked by a councillor to go and see a woman who was suicidal. He went into the house and he said, I diagnosed the problem in five minutes. She was suicidal because she had two autistic children who had to be kept in the house 24-7. She never got any respite from them. The reason they had to be kept in the house was because if they were allowed out, they would wander away and get lost. The reason they would wander away and get lost was because there was no fence around the garden. Martin got hold of the housing officer and said, I know about the fence, but I can't build it until I get a health and safety assessment. Build the fence. None of the rules say, buck are the rules, I'm the boss. Build the fence. The fence built problem solved. When you begin to ask people, when you begin to get under the surface and say once really is the problem here, you discover simple solutions that fixing them with the person transforms that individual's ability to tackle things. What must the children living in circumstances like that to be experiencing in terms of adverse events? We're stoking up huge problems for ourselves if we don't begin to tackle these kind of world problems differently. These kids are going to be alienated and that will not be good for the rest of the world. Whereas if we showed them some compassion and some support, then it might be different. The city of Stoke-on-Trent did a really interesting thing about this sort of stuff. They used their data to segment the population into those who were managing perfectly well, those that were struggling with it, and they identified 1,500 people who were chaotic. They then calculated how much they were spending on each of these 1,500 people, and it came out £100,000 each. Mainly in social work, local authority, having broken windows fixed and so on, health service spending a bit, criminal justice spending a bit, and then they started this what matters to your approach. Let us work with you to solve these problems. A year later that £100,000 had fallen to £2,000 per person. We weren't going to social work, housing authority, health service, lesdemann, criminal justice costs almost disappeared. The only bit of the public sector that was spending more money was education because the kids were going to school more often. So we need to be thinking about doing things differently. Joseph Townsend was a Church of England cleric who, where he alive today would probably be working for the Department of Work and Pensions. He was also a medical doctor. And as a graduate of Glasgow University I'm delighted to tell you he was a medical graduate of Edinburgh University. But that is still the attitude that is out there in many individuals minds. These people make this choice so we have to give them incentives. So we have fat children. Let's tax sugar. That'll fix the problem. Well actually when you look at the biochemistry the centres in the brain associated with feeling full are resistant to the effects of insulin. So they eat and the brain never gets the signals that says we're full. So they can't actually control their appetite. And the problem with policy is we jump to simplistic solutions without due attention being paid to the science and the complexity of the issue that underlies it. Just finish with a quote or two this guy is a Catholic priest who about 30 years ago was sent to work in the most violent parish on the west coast of America, south-central Los Angeles, where an LAPD told him he would be killed if he tried to interfere with the business of the Latino gangs. He went to the church house the day he was there he dumped his bag and he decided to go and work on the parish and he stopped and said this is what we do. And off he went. And he talked to them and he found out what they were thinking and just generally befriended them. And 30 years on you can see him here with the Latino gang members what he did was he realised he asked them what they needed a job. If we are going to give up the fighting and the drugs and so on we need a job. They got this guy who was a film producer to buy a disused bakery and he started Homeboy Bakeries and he told me once that he needed that within a few weeks he realised he needed to start a second business which was Homeboy Tattoo the Movable. He said that really came home and one of the Homeboys sat down and said Greg you really need to help me I keep trying to get a job but nobody will pay any attention to me he just you know go to interviews and he just shrug their shoulders and said he can't employ me and Greg said I looked at him and he had piercings and he's nose and he's ears and he's lips and so on but what really drew your attention was the tattoo across his forehead buck the world and Greg said I think I know what your problem is they got a plastic surgeon friend to come bring a laser and they started the moving tattoos and 30 years later Greg has literally by befriending people transformed thousands of lives he comes to Glasgow at the invitation of the Violent Reduction Unit that have adopted some of his approaches and I take him to schools occasionally and what he tells the school kids and I'm really proud to have got this it wasn't the Daily Mail which I tried for it was the Mail on Sunday that printed this it was about compassion not a word you see often in the Daily Mail I have to say here's what we seek a compassion that stands in awe at the burdens the poor have to carry and one that stands in judgment at how they carry them when we see people in difficulty yeah we should help them but more importantly we should try to help them help themselves because that's what transforms their lives that's what the science tells us and just another quote from a 9th century Confucianist we indicate to roles after us that rather than punish the country's deviance instead consider the poverty of the multitudes and relieve their misery then criminals will disappear reason why ordinary people like badly comes from an inability to survive there's no criminality in the country but waste of natural resources 9th century impressive the reason why younger classes are not honest is because they're rulers who should be honest are not I love that quote so what we are taught to do is to intervene and do things to people the paradigm of life as a river and what the health services is a rescue system I mean because I talk a lot about healthy places they made me an honorary fellow of the royal incorporation of architects of Scotland and asked them what did that mean and it said well it means you can draw pictures of houses and charge a lot of money for it so anyone want to buy this so the health service is the guy who lives at the top of the waterfall and what he does is he goes out and rescues drowning people and the public health system says why are all these people falling into the river will go upstream and will fix the hole in the fence that is the wrong paradigm to think about health and wellbeing the correct paradigm is this we're all in the river all the time and one side of the river is sunny and there's a guy handing out beer and mojitos and things and we can float along and it's very pleasant the other side of the river is where crocodiles and sharks and ox are and the challenge is to teach people to navigate the river teach them how to stay on the right site and we do that by thinking way way before they're born even so the question is how do we create wellbeing well it's complicated but it's much more important to support people in ways that allow them to be able to make the right choices so it's a bit deterministic it's the environment we find ourselves in that free will comes in because if we teach people in ways that allow them to analyse the problem and make the right decisions then we're all a lot better off so my final word to you is but just get out there and start doing stuff okay