The ‘Glasgow Effect’ and the ‘Scottish Effect’: unhelpful terms which have now lost their meaning

The ‘Glasgow Effect’ and the ‘Scottish Effect’ are terms that were coined many years ago to describe the unexplained worse health (higher rates of mortality) in Glasgow and Scotland compared with elsewhere in Britain and the UK. By ‘unexplained’, this meant after taking into account differences in poverty and deprivation – because these are the main influences on poor health in all societies around the world, not just Scotland.

In Glasgow’s case, we had previously shown that the rate of deaths under the age of 65 years (‘premature mortality’) was around 30% higher in Glasgow than in Liverpool and Manchester, and also Belfast – all cities with similar histories, and comparable levels of poverty, to Glasgow. And that 30% higher mortality was calculated after (statistically) taking into account any remaining differences in levels of deprivation across the cities’ neighbourhoods.

In Scotland’s case, similar ‘unexplained’ levels of higher mortality have been shown in comparison with England & Wales. By 2011 this added up to an extra 5,000 deaths in Scotland every single year.

It was in the context of such high levels of ‘unexplained’ poorer health that the terms ‘Glasgow Effect’ and ‘Scottish Effect’ started to be used. We at the GCPH are partly to blame for this, as we used the term ‘Glasgow Effect’ in the title of a report in 2010 and in other things we were writing at the time.

Some journalists loved these expressions: the idea of an unexplained mystery was (and still is) lapped up by some in the media. The terms also arguably helped to generate lots of unlikely proposed explanations – that it was all caused by the weather, or by deep fried mars bars, for example.

The terms also began appearing in all sorts of different and irrelevant contexts: for example in projects and websites that were nothing to do with health (and which thereby further muddied their meaning). More worrying still, they started being used as explanations in their own right – as if they were a diagnosis of a problem (‘oh, people just die younger because of the Glasgow Effect’) rather than a description of a problem for which there was no explanation.

It’s important to remember that these expressions were not created to describe any kind of ‘intriguing’ or ‘exciting’ mystery. They were about seeking to understand why every year in Scotland literally thousands of people die much younger than is right – and about the truly awful consequences for so many families, friends and communities. And for Scottish society as a whole.

As a result we stopped using these terms in our work several years ago. We now use the more accurate – although, for journalists, much less exciting – description of ‘excess mortality’.

However, more importantly, there is another reason why people should stop using these terms: the higher mortality is no longer ‘unexplained’.

New research undertaken by the GCPH alongside NHS Health Scotland, the University of the West of Scotland and University College London was published in May 2016.

From an assessment of a huge amount of evidence, this showed that in Glasgow’s case, the city’s population has been made more vulnerable to the important influences on population health (poverty, deprivation, deindustrialisation, economic decisions taken at UK government level), consequently leading to poorer health than in other places like Liverpool and Manchester which had similar experiences. And this greater vulnerability has been created by a toxic combination of a whole series of historical factors, processes and political decisions. The findings of this new research, and a set of policy recommendations aimed at Scottish and local government, have been endorsed by a wide range of experts in public health, history and other areas of study. 

So now we have explained the most likely underlying causes of Glasgow’s and Scotland’s excess levels of mortality, there is no longer a place for, or a point to, expressions which were created to describe unexplained phenomena.

So let’s not talk about a ‘Glasgow Effect’ or a ‘Scottish Effect’. Let’s instead understand the political dimensions to Glasgow’s and Scotland’s poorer health, and urge our politicians to do something about it.