The Glasgow Effect

For decades Glasgow has had some of the poorest health and lowest life expectancy in Western Europe. Part of the reason is obvious: poverty and deprivation are strongly linked to ill health, and Glasgow has had more than its share of both. But in the early twenty-first century researchers noticed something puzzling. Even when they compared Glasgow with English cities that had almost identical levels of deprivation, Glaswegians were still dying younger. The unexplained gap became known as the Glasgow effect.

Measuring the gap

The most influential research was led by David Walsh of the Glasgow Centre for Population Health, a body set up in 2004 by the NHS, Glasgow City Council and the University of Glasgow to study the city’s health. Comparing Glasgow with Liverpool and Manchester, cities with very similar profiles of deprivation, the researchers found that premature deaths in Glasgow, those before the age of 65, were more than 30 per cent higher, and deaths overall around 15 per cent higher. The excess affected almost every part of the population, rich as well as poor.

The excess deaths came from many causes: heart disease, strokes, cancer and respiratory illness, but also deaths related to alcohol and drugs, violence and suicide, which especially affected younger adults. In 2010 the researchers coined the term Glasgow effect to describe what they could not yet explain.

A recent problem

One of the most important findings was that the gap is not ancient. In the first half of the twentieth century Glasgow’s death rates were similar to those of comparable English industrial cities. The excess mortality appeared only after about 1950 and widened from the 1970s onwards. Whatever caused it, it was not simply the legacy of Victorian slums, but something that happened in the second half of the twentieth century.

Headlines and statistics

The issue attracted worldwide attention, sometimes in misleading ways. A World Health Organization report in 2008 stated that male life expectancy in the Calton, in the East End, had been just 54 years in the period 1998 to 2002, a figure widely quoted as evidence of a crisis. Later analysis pointed out that it was based on a very small area with a population of around 2,500, which included hostels for people with serious alcohol, drug and mental health problems. Figures for the wider Calton and Bridgeton area for 2008 to 2012 were 67.8 years for men and 76.6 for women: still well below the Scottish average, but far from the headline.

The explanations

Many explanations were proposed, from the climate and lack of sunlight to the city’s soft water, its religious divisions, its diet and a culture of pessimism. Researchers tested them carefully. Studies found, for example, that Glaswegians did not drink, smoke or eat very differently from people elsewhere in Scotland, apart from some differences in obesity and heavy smoking, so individual behaviour alone could not explain the gap.

In 2016 the Glasgow Centre for Population Health published a major report concluding that the explanation lay largely in history and policy. Glasgow had experienced worse overcrowding than comparable cities for longer, with effects that lasted for generations. From the 1950s to the 1970s official policy moved large numbers of younger, skilled workers and their families out of the city to the new towns and overspill areas, leaving behind, as a government document of 1971 put it, a population with a very high proportion of the old, the very poor and the almost unemployable. Glasgow then suffered faster and more severe deindustrialisation than other cities, left more of its land derelict and placed many of its poorest families in poorly planned peripheral housing estates. In the 1980s, the report argued, the city was particularly exposed to the effects of national economic policies.

Researchers also pointed to the long-term effects of stress, insecurity and a sense of powerlessness on health, especially in childhood. Scotland’s former chief medical officer, Sir Harry Burns, highlighted research showing how chronic stress in early life can affect health for a lifetime.

Retiring the term

Having identified the likely causes, the researchers who coined the phrase have since stopped using it. David Walsh argued in 2016 that the Glasgow effect had been a placeholder for something unexplained, and that it had become a lazy shorthand. They now prefer to speak simply of excess mortality, with explanations rooted in political and economic decisions rather than in anything peculiar to Glaswegians themselves.

The story has also been told in fiction, most powerfully in Douglas Stuart's Booker Prize-winning novel Shuggie Bain, set in the Glasgow of the 1980s. And it connects to other parts of the city’s history: to the slum clearances, the new estates and the loss of the industries that once sustained the city. Understanding why Glaswegians died younger has meant understanding how the modern city was made.

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