Glasgow effect

Last updated

Buchanan Street, one of the main shopping areas in Glasgow city centre (looking down) Buchanan Street, Glasgow.jpg
Buchanan Street, one of the main shopping areas in Glasgow city centre

The Glasgow effect is a contested term [1] which refers to the lower life expectancy of residents of Glasgow compared to the rest of the United Kingdom and Europe. [2] [3] The phenomenon is defined as an "[e]xcess mortality in the West of Scotland (Glasgow) after controlling for deprivation." [4] Although lower income levels are generally associated with poor health and a shorter lifespan, epidemiologists have argued that poverty alone does not appear to account for the disparity found in Glasgow. [3] [5] [6] [7] [8] [9] Equally deprived areas of the UK such as Liverpool and Manchester have higher life expectancies, and the wealthiest ten per cent of the Glasgow population have a lower life expectancy than the same group in other cities. [10] One in four men in Glasgow will die before his sixty-fifth birthday. [11]

Contents

Several hypotheses have been proposed to account for the ill health, including the practice in the 1960s and 1970s of offering young, skilled workers in Glasgow social housing in new towns, leaving behind a demographically "unbalanced population". [12] [13] Other suggested factors have included a high prevalence of premature and low birthweight births, land contaminated by toxins, a high level of derelict land, more deindustrialisation than in comparable cities, poor social housing, religious sectarianism, lack of social mobility, [14] vitamin D deficiency, cold winters, higher levels of poverty than the figures suggest, adverse childhood experiences and childhood stress, high levels of stress in general, and social alienation. [15]

Excess mortality and morbidity

The Red Road Flats in Springburn were demolished in October 2015. Red Road flats at Balornock - geograph.org.uk - 119968.jpg
The Red Road Flats in Springburn were demolished in October 2015.

The city's mortality gap was not apparent until 1950 and seems to have widened since the 1970s. [10] The Economist wrote in 2012: "It is as if a malign vapour rises from the Clyde at night and settles in the lungs of sleeping Glaswegians." [16]

The mortality rates are the highest in the UK and among the highest in Europe. As of 2016, life expectancy in Scotland was lower for both females and males than anywhere else in western Europe, and was not improving as quickly as in other western European countries. [17] With a population of 1.2 million in greater Glasgow, life expectancy at birth is 71.6 years for men, nearly seven years below the national average of 78.2 years, and 78 years for women, over four years below the national average of 82.3. [15] [18] [19]

Glasgow within Scotland; also see Greater Glasgow. Glasgow location.png
Glasgow within Scotland; also see Greater Glasgow.

According to the World Health Organization in 2008, the male life expectancy at birth in the Calton area of Glasgow between 1998–2002 was 54 years. [20] [a] A local doctor attributed this to alcohol and drug abuse, and to a violent gang culture. [23] According to Bruce Whyte of the Glasgow Centre for Population Health, writing in 2015, the estimate was based on deaths in 1998–2002 in an area comprising 2,500 people, and the figures may have been affected by the presence of hostels for adults with alcohol, drug and mental health problems. The 2008–2012 estimate for Calton and nearby Bridgeton together, by then more ethnically diverse and with fewer hostels, was 67.8 years for males and 76.6 years for females. [24]

Research led by David Walsh of the Glasgow Centre for Population Health in 2010 concluded that the deprivation profiles of Glasgow, Liverpool and Manchester are almost identical, but premature deaths in Glasgow are over 30 per cent higher, and all deaths around 15 per cent higher, across almost the entire population. [10] The higher mortality is fueled by stroke, respiratory disease, cardiovascular disease and cancer, along with deaths caused by alcohol, drugs, violence and suicide. [25] According to a 2016 study, 43 per cent of adults are classified as either disabled or chronically ill. Suicide rates are higher than they were in 1968, and the all-cause mortality rate in the 15–44 age group is 142.4 deaths per 100,000. [9] Drug-related deaths in Scotland more than doubled between 2006 and 2016. [26]

Hypotheses

Derelict tenement housing, Paisley Road West, 2008, later demolished Derelict tenement on Paisley Road West - geograph.org.uk - 1096321.jpg
Derelict tenement housing, Paisley Road West, 2008, later demolished

The Glasgow Centre for Population Health (GCPH) was established in 2004 to study the causes of Glasgow's ill health; the centre's partners are NHS Greater Glasgow and Clyde, Glasgow City Council and the University of Glasgow. [27] In a publication introducing the GCPH, the Chief Medical Officer for Scotland, Harry Burns, referred to research suggesting that chronically activated stress responses, especially in children, affect the structure of parts of the frontal lobes of the brain, and that these determine the physical reaction to stress, which could result in chronic ill health. The ability to attain good health, he suggested, depends in part on whether people feel in control of their lives, and whether they see their environments as threatening or supportive. [28]

A GCPH report in 2016 concluded that certain historical processes and policy decisions had left the city more vulnerable to deprivation. [29] [30] [31] [13] Factors include the "lagged effects" of overcrowding and the former practice, in the 1960s and 1970s, of offering young, skilled workers social housing in new towns outside Glasgow; this, according to a 1971 government document, threatened to leave behind an "unbalanced population with a very high proportion of the old, the very poor and the almost unemployable". [32]

Other hypotheses have included a higher prevalence of premature and low-birthweight births; [33] land contaminated by toxins such as chromium; [34] a high level of derelict land, leading to a "negative physical environment"; [35] more deindustrialisation than in comparable cities; [36] and low-quality housing estates. [37] [13] Social deficits and sources of social dysfunction have been suggested: religious sectarianism; [38] a low "sense of coherence"; [39] low social capital; [40] lack of social mobility; [41] and a culture of alienation and pessimism. [15] [16] Soft water (with lower levels of magnesium and calcium) has been mentioned as a possible factor, [42] as have cold winters; vitamin D deficiency; higher levels of poverty than the figures suggest; and adverse childhood experiences. [15] [16]

See also

Notes

  1. ↑ This was based on "pooled data 1998-2002 (Hanlon, Walsh & Whyte, 2006)". [21] [22] [3]

Related Research Articles

<span class="mw-page-title-main">Life expectancy</span> Measure of average lifespan in a given population

Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is life expectancy at birth. This can be defined in two ways. Cohort LEB is the mean length of life of a birth cohort and can be computed only for cohorts born so long ago that all their members have died. Period LEB is the mean length of life of a hypothetical cohort assumed to be exposed, from birth through death, to the mortality rates observed at a given year. National LEB figures reported by national agencies and international organizations for human populations are estimates of period LEB.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, arrhythmia, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

The Whitehall Studies investigated social determinants of health, specifically the cardiovascular disease prevalence and mortality rates among British civil servants. The initial prospective cohort study, the Whitehall I Study, examined over 17,500 male civil servants between the ages of 20 and 64, and was conducted over a period of ten years, beginning in 1967. A second cohort study, the Whitehall II Study, was conducted from 1985 to 1988 and examined the health of 10,308 civil servants aged 35 to 55, of whom two thirds were men and one third women. A long-term follow-up of study subjects from the first two phases is ongoing.

<span class="mw-page-title-main">Social determinants of health</span> Economic and social conditions that influence differences in health status

The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

<span class="mw-page-title-main">Men's health</span> Broad subject that encompasses all facets of mens health

Men's health is a state of complete physical, mental, and social well-being, as experienced by men, and not merely the absence of disease. Differences in men's health compared to women's can be attributed to biological factors, behavioural factors, and social factors.

The Hispanic paradox is an epidemiological finding that Hispanic Americans tend to have health outcomes that "paradoxically" are comparable to, or in some cases better than, those of their U.S. non-Hispanic White counterparts, even though Hispanics have lower average income and education, higher rates of disability, as well as a higher incidence of various cardiovascular risk factors and metabolic diseases.

<span class="mw-page-title-main">Health in Brazil</span> General vision of health of population in Brazil

The fundaments of the Brazilian Unified Health System (SUS) were established in the Brazilian Constitution of 1988, under the principles of universality, integrality and equity. It has a decentralized operational and management system, and social participation is present in all administrative levels. The Brazilian health system is a complex composition of public sector (SUS), private health institutions and private insurances. Since the creation of SUS, Brazil has significantly improved in many health indicators, but a lot needs to be done in order to achieve Universal Health Coverage (UHC).

<span class="mw-page-title-main">Deprivation index</span> Measure of poverty of small areas

A deprivation index or poverty index is a data set to measure relative deprivation of small areas. Such indices are used in spatial epidemiology to identify socio-economic confounding.

<span class="mw-page-title-main">Healthcare in Europe</span> European health care

Healthcare in Europe is provided through a wide range of different systems run at individual national levels. Most European countries have a system of tightly regulated, competing private health insurance companies, with government subsidies available for citizens who cannot afford coverage. Many European countries offer their citizens a European Health Insurance Card which, on a reciprocal basis, provides insurance for emergency medical treatment insurance when visiting other participating European countries.

<span class="mw-page-title-main">Human sex ratio</span> Ratio of males to females in a population

The human sex ratio is the ratio of males to females in a population in the context of anthropology and demography. In humans, the natural sex ratio at birth is slightly biased towards the male sex. It is estimated to be about 1.10 or 1.06 or within a narrow range from 1.03 to 1.06 males per female. The sex ratio for the entire world population is approximately 101 males to 100 females.

Research shows many health disparities among different racial and ethnic groups in the United States. Different outcomes in mental and physical health exist between all U.S. Census-recognized racial groups, but these differences stem from different historical and current factors, including genetics, socioeconomic factors, and racism. Research has demonstrated that numerous health care professionals show implicit bias in the way that they treat patients. Certain diseases have a higher prevalence among specific racial groups, and life expectancy also varies across groups.

The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.

<span class="mw-page-title-main">Indigenous health in Australia</span> Medical condition

Indigenous health in Australia examines health and wellbeing indicators of Indigenous Australians compared with the rest of the population. Statistics indicate that Aboriginal Australians and Torres Strait Islanders are much less healthy than other Australians. Various government strategies have been put into place to try to remediate the problem; there has been some improvement in several areas, but statistics between Indigenous Australians and the rest of the Australian population still show unacceptable levels of difference.

<span class="mw-page-title-main">Health survival paradox</span> Sociological medical phenomenon

The male-female health survival paradox, also known as the morbidity-mortality paradox or gender paradox, is the phenomenon in which female humans experience more medical conditions and disability during their lives, but live longer than males. The observation that females experience greater morbidity (diseases) but lower mortality (death) in comparison to males is paradoxical since it is expected that experiencing disease increases the likelihood of death. However, in this case, the part of the population that experiences more disease and disability is the one that lives longer.

A disease of despair is one of three classes of behavior-related medical conditions that increase in groups of people who experience despair due to a sense that their long-term social and economic prospects are bleak. The three disease types are drug overdose, suicide, and alcoholic liver disease.

White Americans, as the largest racial group in the United States, have historically had better health outcomes than oppressed racial groups in America. However, in recent years, the scholarly discourse has switched from recognition of the immense positive health outcomes of white Americans towards understanding the growing persistence of negative outcomes unique to this racial group. Scholars have discussed the effects of racial prejudice and its negative effect on health outcomes to not only those being oppressed but also those being given privileges. In addition to the effects of living in a racialized society, white Americans have the highest rate of suicide and lifetime psychiatric disorders of any other ethnicity or racial category. In conjunction with these psychiatric issues, the population presents higher rates of alcohol usage alongside lower levels of psychological flourishing. Given this information, the health status of white Americans has gained increasing importance due to the differences in health outcomes between white Americans and white people from other parts of the world.

Biological inequity, also known as biological inequality, refers to the “systematic, unfair, and avoidable stress-related biological differences which increase risk of disease, observed between social groups of a population”. The term developed by Centric Lab aims to unify societal factors with the biological underpinnings of health inequities – the unfair and avoidable differences in health status and risks between social groups of a population — such that these inequalities can be investigated in a holistic manner.

The North Karelia Project was worldwide the first public health project for the prevention of cardiovascular disease mortality. It was first conducted from 1972 to 1977 in North Karelia and due to the success from 1977 to 1997 in all of Finland. It addressed the three risk factors identified by the British Doctors Study, the Framingham Heart Study, and the Seven Countries Study.

References

  1. ↑ Walsh, David (2016). "The 'Glasgow Effect' and the 'Scottish Effect': unhelpful terms which have now lost their meaning". Glasgow Centre for Population Health.
  2. ↑ Lewis, Daniel; et al. (2017). "Capturing complexity". In Brown, Tim (ed.). Health Geographies: A Critical Introduction. Oxford: John Wiley & Sons. p. 158.
  3. 1 2 3 Reid, Michael (2011). "Behind the 'Glasgow effect'". Bulletin of the World Health Organization. 89 (10): 706–707. doi:10.2471/BLT.11.021011 (inactive 5 December 2024). PMC   3209974 . PMID   22084504. Archived from the original on 29 November 2013.{{cite journal}}: CS1 maint: DOI inactive as of December 2024 (link)
  4. ↑ Friis, Robert H.; Sellers, Thomas (2013). Epidemiology for Public Health Practice. London: Jones & Bartlett Publishers. p. 745.
  5. ↑ Donnelly, P. D. (2010). "Explaining the Glasgow effect: Could adverse childhood experiences play a role?". Public Health. 124 (9): 498–499. doi:10.1016/j.puhe.2010.05.013. PMID   20728908.
  6. ↑ Gavine, A. J.; Williams, D. J.; Shearer, M. C.; Donnelly, P. D. (2011). "The Glasgow effect: Useful construct or epidemiological dead end?". Public Health. 125 (8): 561–562. doi:10.1016/j.puhe.2011.04.006. PMID   21794886.
  7. ↑ Fraser, Simon; George, Steve (2015). "Perspectives on differing health outcomes by city: Accounting for Glasgow's excess mortality". Risk Management and Healthcare Policy. 8: 99–110. doi: 10.2147/RMHP.S68925 . PMC   4476473 . PMID   26124684.
  8. ↑ Hanlon, Phil (2015). "Unhealthy Glasgow: A case for ecological public health?" (PDF). Public Health. 129 (10): 1353–60. doi:10.1016/j.puhe.2015.08.006. PMID   26376607.
  9. 1 2 Cowley, Joe; Kiely, John; Collins, Dave (December 2016). "Unravelling the Glasgow effect: The relationship between accumulative bio-psychosocial stress, stress reactivity and Scotland's health problems". Preventive Medicine Reports. 4: 370–375. doi:10.1016/j.pmedr.2016.08.004. PMC   4979043 . PMID   27512652.
  10. 1 2 3 Walsh, David; Bendel, Neil; Jones, Richard; Hanlon, Phil (September 2010). It's not 'just deprivation': Why do equally deprived UK cities experience different health outcomes? (PDF) (Report). Glasgow Centre for Population Health. pp. 1–12. Archived from the original (PDF) on 28 April 2018. Retrieved 27 April 2018.
    Walsh, D.; Bendel, N; Jones, R.; Hanlon, P. (2010). "It's not 'just deprivation': Why do equally deprived UK cities experience different health outcomes?". Public Health. 124 (9): 487–495. doi:10.1016/j.puhe.2010.02.006. PMID   20223487.
  11. ↑ Ash, Lucy (5 June 2014). "Why is Glasgow the UK's sickest city?". BBC News.
  12. ↑ Walsh, David; McCartney, Gerry; Collins, Chik; Taulbut, Martin; Batty, G. David (May 2016). "History, politics and vulnerability: explaining excess mortality in Scotland and Glasgow" (PDF). Public Health. 151. Glasgow Centre for Population Health: 209–210. doi:10.1016/j.puhe.2017.05.016. PMID   28697372.
  13. 1 2 3 Mackay, Kirsty (26 February 2021). The Glasgow Effect: examining the city's life expectancy gap –a photo essay. The Guardian.
  14. ↑ Walsh et al. 2016, pp. 218–276.
  15. 1 2 3 4 Muriel, Ali (6 November 2012). "Mystery of Glasgow's health problems", The Guardian, 6 November 2012.
  16. 1 2 3 "Unhealthy Glaswegians: No city for old men", The Economist, 25 August 2012.
  17. ↑ Walsh et al. 2016, p. 24.
  18. ↑ "Glasgow has lowest life expectancy in UK", BBC News, 19 October 2011.
  19. ↑ Reid, James (September 2008). "Excess mortality in the Glasgow conurbation: exploring the existence of a Glasgow effect", PhD thesis, University of Glasgow Faculty of Medicine.
  20. ↑ for., Europe, WHO Regional Office (2008). Closing the Gap in a Generation : Health Equity through Action on the Social Determinants of Health. World Health Organization. ISBN   978-92-4-156370-3. OCLC   990409996.{{cite book}}: CS1 maint: multiple names: authors list (link)
  21. ↑ Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health (PDF). Geneva: World Health Organization. 2008. p. 32.
  22. ↑ Hanlon, Phil; Walsh, David; Whyte, Bruce (2006). Let Glasgow Flourish (PDF). Glasgow: Glasgow Centre for Population Health.
  23. ↑ "GP explains life expectancy gap". BBC News, 28 August 2008; "Male life expectancy at birth". BBC News, 28 August 2008.
  24. ↑ Whyte, Bruce (2 June 2015). "Life expectancy in Calton—no longer 54". Glasgow Centre for Population Health.
  25. ↑ Walsh et al. 2016, p. 25.
  26. ↑ Gayle, Damien (15 August 2017). "Drug-related deaths in Scotland more than double in 10 years". The Guardian.
  27. ↑ Tannahill, Carol (27 October 2004). "Introducing the Glasgow Centre for Population Health". Glasgow Centre for Population Health. p. 5.
  28. ↑ Burns, Harry (27 October 2004). "How Health is Created: An Hypothesis". Glasgow Centre for Population Health, p. 15.
  29. ↑ Walsh et al. 2016.
  30. ↑ Goodwin, Karin (10 June 2016). "The Glasgow effect: 'We die young here – but you just get on with it'". The Guardian.
  31. ↑ "Scottish 'excess' mortality: comparing Glasgow with Liverpool and Manchester". www.gcph.co.uk. Glasgow Centre for Population Health. Archived from the original on 26 April 2018. Retrieved 25 April 2018.
  32. ↑ Walsh et al. 2016, pp. 209–210.
  33. ↑ Walsh et al. 2016, pp. 218–223.
  34. ↑ Walsh et al. 2016, pp. 224–227.
  35. ↑ Walsh et al. 2016, pp. 228–231.
  36. ↑ Walsh et al. 2016, pp. 232–237.
  37. ↑ Walsh et al. 2016, pp. 238–243.
  38. ↑ Walsh et al. 2016, pp. 244–248.
  39. ↑ Walsh et al. 2016, pp. 250–252.
  40. ↑ Walsh et al. 2016, pp. 255–259.
  41. ↑ Walsh et al. 2016, pp. 262–265.
  42. ↑ Walsh et al. 2016, pp. 275–276.

Further reading

Commons-logo.svg Media related to Glasgow effect at Wikimedia Commons

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.