Understanding the "Glasgow Effect"

Whilst some aspects of health in the Glasgow area are improving, the gap in life expectancy between the most affluent and deprived areas has increased over the past decade. We are aiming to improve our understanding of health problems facing the population of Glasgow by making comparisons with other places, both within Scotland and elsewhere, as work being conducted in collaboration with the Glasgow Centre for Population Health.

A recently published report (Comparisons of Health-Related Behaviours and Health Measures between Glasgow and the Rest of Scotland) provides comprehensive comparisons of adult risk factors, morbidity and mortality in the Glasgow/West Central Scotland area compared with elsewhere in Scotland, and establishes the extent to which differences can be explained by the unique socio-economic profile of the area.

The report considers a number of health-related lifestyle factors, health measures and mortality from different causes. A variety of indicators of socio-economic status are employed. Analyses are largely based on data from over 25,000 individuals from the Scottish Health Surveys but also encompass mortality and population data.

Findings

While a number of dimensions of health are no different in the Glasgow area than elsewhere in Scotland – such as obesity, diabetes, certain causes of death, aspects of diet and alcohol consumption (women only) – many health indicators are elevated in the region. Although a substantial proportion of these differences – such as for cardiovascular disease, self-assessed health, most causes of death, smoking and physical activity – can be accounted for by the distinct socio-economic profile of the area, there are aspects of health which transcend the socio-economic explanation and seem to truly represent a “Glasgow effect”. The following is a summary of unfavourable mortality, morbidity and lifestyle findings on West Central Scotland, Greater Glasgow and Glasgow City which persisted even after adjustment by socio-economic factors

Men
Following adjustment for differences in socio-economic circumstances, there were higher levels of long standing illness, acute sickness and potential psychological morbidity among men in West Central Scotland compared with the rest of Scotland. Elevated rates of excessive alcohol consumption and binge drinking were found in the area, after adjustment for socio-economic factors, and may be associated with these higher levels of morbidity. Excess mortality from all cancers (and notably lung cancer), chronic liver disease and mental and behavioural disorders due to the use of drugs persisted in men in Greater Glasgow following adjustment for socio-economic circumstances. Acute sickness and potential psychological morbidity levels also remained high in Greater Glasgow and in Glasgow City, with high levels of daily and weekly alcohol consumption again seen in these areas even once socio-economic factors had been accounted for. Poor diet, in terms of low green vegetable consumption, also persisted after socio-economic adjustment in Greater Glasgow as well as in the broader West Central Scotland area.

Women
Among women in West Central Scotland and Greater Glasgow there were higher levels of potential psychological morbidity compared with the rest of Scotland and these could not be explained by socio-economic differences. Low intake of green vegetables among women in West Central Scotland was also found. Excesses in female mortality in Greater Glasgow – found for most causes – were accounted for by area deprivation. Women in Glasgow City were identified as having higher rates of poor self-reported general health and mental aspects of quality of life, as well as higher levels of potential psychological morbidity compared with the rest of the country. Unlike men, elevated alcohol consumption was not seen among women in the region.

Sub-groups
Higher levels of morbidity and negative health-related behaviours in Greater Glasgow relative to the rest of the country were found to be clustered within certain sub-groups of the population. This was most pronounced for men with no qualifications; men aged 45-64; women living in the most deprived areas; women in low social classes; retired or economically inactive women; and women with no qualifications or qualifications below degree level.

Most deprived areas compared with other areas within Greater Glasgow
Differences in health-related behaviours and health measures between adults living in the most deprived areas in Greater Glasgow compared to the rest of the areas in the health board region tend to be larger than differences between Greater Glasgow and rest of Scotland. With the exceptions of alcohol consumption (both excess and binge drinking) in adults generally, and obesity and CHD among women, results were significantly less favourable in the most deprived areas. All-cause mortality was higher in deprived areas, and this was also the case for the majority of the specific causes. Exceptions were mortality from mental and behavioural disorders due to the use of alcohol, mental and behavioural disorders due to the use of drugs, from breast cancer and chronic liver disease among women.

Conclusions

The excesses in binge drinking and more general alcohol consumption among men in the Glasgow area, beyond those expected given the socio-economic profile, are clearly linked to the excess mortality from chronic liver disease and should be seen as a matter of urgency by those charged with improving public health. The high levels of potential psychological morbidity among men and women in the area also raise concern. However, the strong social patterning of many of the negative health behaviours and other morbidity measures examined coupled with the poorer socio-economic position of Glasgow accounted for many of the City’s less favourable outcomes. Improving Glasgow’s health thus remains inextricably linked to tackling the problems associated with deprivation and poverty.

A briefing paper and the full report can be found at the Glasgow Centre for Population Health website.

Publications

2012

Gray L, Merlo J, Mindell J, Hallqvist J, Tafforeau J, O'Reilly D, Regidor E, Næss Ø, Kelleher C, Helakorpi S, Lange C, Leyland AH. International differences in self-reported health measures in 33 major metropolitan areas in Europe. European Journal of Public Health 2012;22:40-7

pubmed  open access  

2009

Gray L, Leyland AH. A multilevel analysis of diet and socio-economic status in Scotland: investigating the 'Glasgow effect'. Public Health Nutrition 2009;12:1351-8

pubmed  open access  

Gray L, Leyland AH. Is the 'Glasgow effect' of cigarette smoking explained by socio-economic status? A multilevel analysis. BMC Public Health 2009;9:245

pubmed  open access  

2008

Gray L. Comparisons of health-related behaviours and health measures between Greater Glasgow with other regional areas of Europe. Glasgow, 2008

open access  

2007

Gray L. Comparisons of health-related behaviours and health measures between Glasgow and the rest of Scotland. Glasgow, 2007

open access  

Glossary

  • Scottish Health Survey The Scottish Health Survey provides a detailed picture of the health of the Scottish population living in private households. The survey is used to monitor health in Scotland.
  • socioeconomic involving both economic and social factors
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