Ann McKechin MP

Labour Member of Parliament for Glasgow North

Midspan - 29 November 2005

I am grateful for the opportunity to speak about the Midspan studies, which are centred in my constituency at the university of Glasgow's division of community based sciences, which has just celebrated 30 years of follow-up studies.

Since the creation of the Scottish Parliament, it is a bit unusual for a Scottish MP to speak here about health issues, but not every aspect of health is devolved. There is significant cross-border interest regulation in the medical professions, terms and pay rates for NHS staff and medical research.

The Midspan studies are as worthy of analysis by politicians in this place as they are in Holyrood, not least in the debates over the next few weeks as the Health Bill passes through its legislative programme. As I will explain today, I have more than a passing constituency interest in those studies.

The Midspan studies based in Renfrew, Paisley and workplaces in the west of Scotland are the largest long-term health studies ever carried out in predominantly working-class areas and they were, importantly, the first such studies to include women. It is amazing to think that major research into cardiac problems and lung cancer routinely did not include women until this study commenced in the 1970s. The driving force behind the studies was Dr. Victor Hawthorne, who entered medicine immediately after world war two and still takes an active role in the studies in his present position as emeritus Professor at the University of Ann Arbor in Michigan. He arrived in Glasgow in the 1950s and recalls that parts of the city reminded him of the deprivation he observed when serving as an artillery officer in India. His future career was to be marked by his work in tackling the persistent pockets of tuberculosis that remained in Glasgow in the late 1950s and taking part in the TB campaign from 1957 to 1959, which involved a large number of volunteers, one of whom was my mother.

By the late 1950s, the service had identified those populations at high risk and its success in effectively tackling the problem encouraged Professor Hawthorne and his colleagues to extend their gaze to a wider range of chronic diseases and examine a whole population. Based on a small study on the island of Tiree in the Western Isles, and in collaboration with the team behind the famous Whitehall study, Professor Hawthorne's team developed the methodology that would subsequently be used in Midspan, particularly the use of community involvement. Community involvement was key to the success of the studies and the team chose an ideal location in the towns of Paisley and Renfrew, which are a short distance from the university. I am pleased that my hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan) is here today.

A total of 23,000 local people have been involved over the history of the studies, which is a wonderful example of civic public spirit and community involvement in an age when it is often assumed to be dead and buried. Both those towns and the Midspan team deserve credit for their efforts. Paisley, my home town, is Scotland's fifth largest centre of population, but it is often said with justification that it is also Scotland's largest village. That is one reason why it wasn't difficult to get everyone in the town talking about this study. As a young child, I remember the launch of the Midspan project as a huge event in the town, where local people from all backgrounds—but particularly from the working-class areas—were keen to volunteer for a study that they believed would hold real benefit for future generations. The council, the local newspaper, community groups, Churches, as well as local doctors, were all engaged in promoting the scheme. My parents, who fell within the 45-64 age bracket being examined, were among the 15,400 men and women who participated at that time. They had their height, weight, respiratory function, blood pressure and cholesterol measured, had an ECT, chest x-ray and tuberculin tine test, and answered questions on smoking habits, social background and previous medical history.

Jim Sheridan (Paisley and Renfrewshire, North) (Lab): I congratulate the hon. Member for Glasgow, North (Ann McKechin) on securing this worthwhile debate. Currently, I am the Member of Parliament for Paisley and Renfrewshire, North, but at the time of the survey I was at primary school. On Saturday, I had the pleasure of visiting the Midspan reunion and it was heart-warming to watch the people who took part in the study some 30 years ago meeting again. I pay tribute to the people of Paisley and Renfrewshire, North for doing that, particularly my hon. Friend's family, who are well respected in Paisley. Can I ask a question about how the survey identified the dangers of passive smoking?

I thank my hon. Friend, and I will come to the issue of passive smoking later.

Of the original participants, more than 8,000 were women, and there were more than 4,000 married couples involved, making the study unique in providing a general UK population sample of women, and long-term follow up. Although coronary heart disease killed a quarter of the women in the study, women tended not to feature when people talked about their understanding of the disease.

All the participants were invited for a further visit between 1977 and 1979, in which the same round of tests was used. More than 50 per cent. of the original participants took part—again, a significant tribute to the dedication of the local community. Computer linkage was established for data on Scottish hospital discharge and cancer incidence, and follow-up on mortality figures was established with the General Register Office for Scotland.

In recent years, some survivors involved in the original survey have been re-contacted and asked to take part in studies on healthy ageing and cognitive functioning. We have become much more aware, as medical science has developed, of the generational links to health problems. The Midspan studies had the good sense to include women and, in particular, couples, and that allowed the Midspan team to enlarge its work by looking at the health of the children of the original participants. In 1996, the team, now led by Professor Graham Watt, conducted a similar round of tests involving 1,040 sons and 1,298 daughters aged between 30 and 59 from 1,477 families. I can disclose that I was one of those later participants. Although trying to get blood from me is a real struggle, and although—like most—I am not too keen on the idea of testing, I knew that many could benefit from the study.

I am impressed that, over such a long time, the Midspan team has been able to achieve such a high response rate. That, in turn, means that their findings are reasonably representative of populations living and working in areas characterised by high rates of socio-economic deprivation and early mortality. For many years, our policy makers lived under the delusion that there was no clear link between ill health and poverty; in fact, I remember well that the previous Tory Administration refused point blank to admit the correlation and the consequent need to prioritise health spending accordingly. The study conclusively proves that link, and it continues to assist us in our understanding of how to tackle the most entrenched health problems affecting our society.

Of the 150-plus research papers—in a wide variety of journals—that directly use the data, the majority have been produced in the last seven years. I shall give just one example of how the Midspan data shows up the failings of standard risk assessment criteria still in use. Research by Dr. Peter Brindle, working with the Wellcome foundation at Bristol university, published just this month in the British Journal of General Practice, shows that people from deprived areas are less likely to receive medical treatment to prevent heart disease. That is because the method used to assess an individual's risk of getting heart disease underestimates the true level of coronary heart disease risk associated with elevated risk factor levels in some social groups. The recommended way of preventing heart disease involves using the Framingham risk score to identify high-risk patients, but the relevance of the score to the British population is uncertain. That is partly because the US data on which it is based are over 20 years old, and partly because the original study did not include areas with high socio-economic deprivation. The original Midspan survey involved 12,304 men and women who were free from cardiovascular disease at the time of testing. During the next 10 years, 696 died from cardiovascular disease; the Framingham score predicted only 406 deaths.

Although cardiovascular disease mortality was underestimated across the study population as a whole, for people in manual occupations the risk was underestimated by a significant 48 per cent., compared to by 31 per cent. for people in non-manual work. The same effect was observed when people living in affluent areas were compared to those in deprived areas. Crucially, the Midspan data shows that in addition to scoring systems based on cholesterol, blood pressure and smoking, there is another measurement that predicts how long people will live, namely, how hard they can blow—that is, their lung function. That last test was shown by Midspan to be the strongest predictor of long life.

In the light of the report, can my hon. Friend confirm whether her Department will consider adjusting national agreed clinical guidelines to take account of those higher risks? If that is done, what additional resources will be provided to general practices to treat, monitor and review the additional patients to ensure that they receive the benefit of life-saving treatments?

My hon. Friend the Member for Paisley and Renfrewshire, North (Jim Sheridan) mentioned smoking. The Midspan results show that lung function was decreased by smoking, air pollution and poor childhood circumstances. I am sure that, in the light of current debate, the Minister will be interested to know that Midspan was one of the first studies to demonstrate the harmful effects of passive smoking by examining the health of non-smokers living with a smoker. Passive smoking cast a long shadow, not only in terms of increased coughing, chest pain, lung cancer and heart disease deaths in non-smokers, but also through reduced lung function of the non-smoking offspring of parents who smoked, which is a prediction of reduced lifespan spreading down generations.

Perhaps in her response my hon. Friend. can give some indication of how her Department intends to tackle the problem of the home environment in relation to passive smoking, which is likely to be the main indoor location for smokers after changes in legislation, both here and in Scotland. In particular, what efforts can her Department make to highlight the effect on children's health of passive smoking in the home?

As for generational changes in health, the good news is that the Midspan offspring had greater social mobility, smoked less and were taller, which is another predictor of longer life. The bad news is they had twice the rate of asthma and obesity, with the horrific statistic that obesity affected one in five adult sons and daughters.

I am delighted to highlight the excellent work of the Midspan study at Glasgow university and thank Professor Watt for his assistance in providing me with information about the research results. However, the history that I have outlined shows the importance of funding long-term research to ensure that our health priorities are made on the basis of reliable, relevant and up-to-date statistics. That data take time to bear fruit; most of the information coming out of this particular study has been of use only in recent years. Sustained investment and engagement with our communities is required. I urge the Government to commit themselves to tackle the deep-seated causes of socio-economic deprivation by continuing to fund such work and ensuring that its conclusions are put into action in as we deliver a health service fit for the 21st century.


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